Nocturnal Acid Reflux

At night, acid reflux can cause distress to patients resulting from symptoms such as heartburn. It may also affect the sleep quality of patients or trigger insomnia. Besides prescription medicine, clinical studies have shown that sleeping on the left side with the upper body raised can also improve acid reflux.

The prevalence of GERD is 3.8%. It is estimated 200,000 adults in Hong Kong have weekly GERD symptoms

79% GERD patients reported experiencing heartburn at night

About 30% GERD patients remain symptomatic while receiving daily medication

GERD

Risk Assessment Quiz

Nocturnal Acid Reflux

Acid reflux, also known as gastroesophageal reflux. When acid reflux becomes a long-term condition and happens more frequently, it may become Gastroesophageal Reflux Disease (GERD). GERD is a chronic digestive system disorder.

Causes of Acid Reflux

People often misunderstand that acid reflux is caused by excess stomach acid. In fact, acid reflux is mainly caused by our poor eating habits, such as eating irregularly, eating too fast, eating before bed, etc., and cause the relaxation of the lower esophageal sphincter (LES), which is a valve (a ring of muscle) between our esophagus and stomach. Under normal and healthy conditions, the LES only opens briefly during eating to allow food to enter the stomach, or from time to time after meals to allow stomach gas to escape; at other times, the LES closes to prevent the food and gastric acid in the stomach flow back up into the esophageal.
Other causes of acid reflux include stress, obesity, smoking, wearing tight clothes around your stomach, etc. In addition, hormonal changes during pregnancy are also one of the causes of acid reflux in pregnant women. If you want to learn more about the causes of acid reflux, please keep reading:

(A) Bad Eating Habits

People living in cities often eating irregularly, and the fast pace of life makes everyone eat in a hurry. Therefore, the stomach fails to adjust the level of gastric acid secretion in time, and it is more likely to have acid reflux. In addition, eating and drinking too much (even not frequently, only occasionally), it will also increase the burden on the stomach, increase gastric pressure, strain our LES, also make it easy for the food and gastric acid in the stomach leak out. Besides, eating before bed can also increase the risk of night-time acid reflux. This is because the stomach will secrete gastric acid during the digestion process, the LES will open again when the stomach gas needs to be released after eating; moreover, due to the influence of gravity when we sleeping on the back, the gastric acid will more easily flow back up to the esophageal. Therefore, it is best not to sit or lie on the sofa immediately after eating, you can stand up for 15-30 minutes to allow the stomach have time and space to digest, which will also help reduce belly fat.

(B) Food Choices

If you often eat greasy, high-salt, heavy spices, spicy and other indigestible or irritating foods, the stomach not only needs to secrete more gastric acid, but also need longer gastric acid secretion time to complete the whole digestion process, and it is more likely to produce stomach gas, which would prolong the opening and relaxation time of the LES, and even weaken the function of the LES, so that the risk of acid reflux will naturally increase.

(C) Beverage Choices

In addition to paying attention to the choice of food, the choice of beverages should not be ignored, because coffee, strong tea, alcohol, carbonated beverages, acidic beverages, etc., all of the above may increase the production of gastric acid and stomach gas, causing the problem of acid reflux.

(D) Obesity

Obesity is also one of the common causes of acid reflux, especially central obesity. Due to the influence of gravity, the belly will be pressed against the stomach when we sleeping on the back. When the abdominal pressure increases and the stomach is compressed, the force of gastric acid reflux into the esophagus will increase, and the LES will need more strength to prevent the occurrence of acid reflux. In the long run, the LES may damage and becomes loose, and the frequency of acid reflux will increase.

(E) Age

As we grow older, many functions of our body will weaken, and our digestive system is no exception. The LES may become unbalanced, and resulting in the problem of acid reflux.

(F) Smoking and Drinking

As mentioned earlier, the mucosa of the esophagus is not the same as the mucosa of the stomach. The mucosa of the esophagus cannot withstand gastric acid stimulation, and we swallow saliva from time to time is to neutralize the acidity of the esophagus. However, smoking will decrease our saliva secretion, also increase our gastric acid secretion and cause the relaxation of our LES. In such a situation, it’s not only worsened the problem of acid reflux, but it also increases the risk of acid damage to the esophagus. In addition, alcohol can also produce gastric acids and stomach gas. Therefore, if you have the habit of smoking and drinking at the same time, they are very likely to be one of the main reasons why you are suffering acid reflux.

(G) Pregnancy

In fact, many pregnant women have acid reflux problem. This is due to the hormonal changes during pregnancy. The increase in progesterone secretion slows down gastrointestinal motility and makes food stay in the stomach longer. In addition, the increase in estrogen concentration will also cause the LES to relax, allowing gastric acid to easily flow back up into the esophagus, and causing acid reflux. Furthermore, the increasing size of the fetus in the later stages of pregnancy will also increase the risk of acid reflux, because the enlarged uterus has the opportunity to squeeze upward to the stomach, which may be more serious when sleep on the back. Therefore, many pregnant women choose side sleeping pillows to help them sleep on their left side, in order to reduce the burden on the stomach and improve the problem of acid reflux during sleep.

Acid Reflux Solution

For the treatment of acid reflux (GERD), taking prescription drugs is the current first-line treatment. Patients also need to improve their poor eating and daily habits to help improve the problem of acid reflux. In addition, according to clinical studies, 60% of patients with obstructive sleep apnea have night-time acid reflux, and the use of CPAP can help reduce the occurrence of night-time acid reflux by nearly half. For more acid reflux solutions, please keep reading:

(A) Medication Therapy

The most familiar solution to acid reflux must be medication therapy. Drugs prescribed by doctors, such as Proton Pump Inhibitors (PPI), Antacid (neutralizes stomach acidity), etc., are used to control gastric acid secretion, reduce the occurrence of acid reflux, and relieve the symptoms of acid reflux. Patients need regular follow-up visits to check whether the dosage of the drug needs to be adjusted. If the acid reflux persists after taking the drugs, it may also be necessary to take the drugs for a long time. As you know, medication therapy for acid reflux just cures the symptoms but not the root cause. Therefore, the most ideal solution to acid reflux still needs to be combined with good eating and daily habits.

(B) Eating Habits

No matter how busy your daily life is, you should try to eat regularly to keep the gastric acid secretion stable; don’t eat too fast or too full, eating mall frequent meals, each meal should be about 70% full, so as not to increase the burden on the stomach or cause excessive pressure in the stomach, resulting in damage to the LES. In addition, you should avoid eating 2-3 hours before going to bed, especially high fiber foods. You should also avoid sitting or lying down to rest immediately after meals. It is recommended to take a walk after meals to help digestion and provide enough time for the stomach to complete the whole digestion process, reducing the risk that the grastric acid (which secreted during the digestion process) will flow back up into the esophagus by lying down. Then, you should also reduce the consumption of greasy and irritating foods, as well as the consumption of carbonated beverages, caffeinated and alcoholic beverages, etc., can also help improve the problem of acid reflux.

(C) Daily Habits

If you have the habit of smoking, of course, it is best to quit smoking. Quit smoking will help to control gastric acid, improve saliva secretion, and strengthen the LES. In addition, frequent wearing tight clothes should also be avoided, in order to improve acid reflux caused by stomach pressure. Furthermore, changed the sleeping posture is also one of the night-time acid reflux solutions recommended by medical professionals. Sleeping on the left side or/and slightly tilting the upper body to raise the LES higher than the stomach will help prevent the gastric acid flow back up into the esophagus.

(D) Weight Management

If you are overweight and have central obesity problem, it is recommended to lose belly fat through dietary management and regular exercise, in order to reduce the pressure on the stomach caused by the big belly, as well as reducing the occurrence of acid reflux caused by the stomach pressure. If you want to improve the problem of night-time acid reflux during weight loss, you can sleep on the left side. This can not only improve the problem of stomach pressure caused by big belly when you sleeping on the back, it can also make the LES higher than the stomach, which is recommended by medical professionals as a solution to night-time acid reflux.

(E) Surgery

Surgery is an invasive solution to acid reflux, unless your condition is severe and cannot be controlled with prescribed drugs, or you do not want to take long-term medication to control your acid reflux problem, or your acid reflux problem cannot be solved even you changed your eating and daily habits, then you should consider surgery such as fundoplication, in order to tighten the LES, increase the resistance between the stomach and the esophagus, so as to reduce acid reflux.

Learn more about the solutions for nighttime acid reflux: Reflux Relief Pillow, Therapeutic Body Pillow.

The information above is for reference only, you should consult your doctor if you have any health concern.

References: [1] Person E, Rife C, Freeman J, Clark A, Castell DO. A Novel Sleep Positioning Device Reduces Gastroesophageal Reflux: A Randomized Controlled Trial. J Clin Gastroenterol. 2015;49(8):655-659. [2] Tan VP, Wong BC, Wong WM, et al. Gastroesophageal Reflux Disease: Cross-Sectional Study Demonstrating Rising Prevalence in a Chinese Population. J Clin Gastroenterol. 2016;50(1):e1-e7. [3] Shaker R, Castell DO, Schoenfeld PS, Spechler SJ. Nighttimeheartburn is an under-appreciated clinical problem that impacts sleep and daytime function: the results of a Gallup survey conducted on behalf ofthe American Gastroenterological Association. Am J Gastroenterol. 2003;98(7):1487-1493. [4] Vaezi MF, Fass R, Vakil N, et al. IW-3718 Reduces HeartburnSeverity in Patients With Refractory Gastroesophageal Reflux Disease in a Randomized Trial. Gastroenterology. 2020;158(8):2093-2103. [5] Green BT, Broughton WA, O'Connor JB. Marked improvement in nocturnal gastroesophageal reflux in a large cohort of patients with obstructive sleep apnea treated with continuous positive airwaypressure. Arch Intern Med. 2003;163(1):41-45.

Acid Reflux - FAQs

1）Is Acid Reflux common in Hong Kong?

According to a research report published by The Hong Kong Society of Gastrointestinal Motility in 2020, the percentage of physical discomfort caused by acid reflux at least once a week has increased significantly by 39% between 2011 and 2017. It is estimated that every 17 people in Hong Kong have 1 person suffers from acid reflux, and the total number may be as high as 428,000. As for GERD, with a prevalence rate of 3.8%, it is estimated that it also affects more than 200,000 adults in Hong Kong, which deserves our attention.

2）How is Acid Reflux diagnosed?

Doctors usually perform gastroscopy on patients to check whether the patient has esophagitis caused by gastric acid reflux into the esophagus, and evaluate the severity of esophagitis; in addition, gastroscopy can also rule out other digestive system diseases, such as: peptic ulcer, gastric cancer and esophagus cancer, etc. Secondly, the use of Proton Pump Inhibitor (PPI) for examination is also a common diagnostic method. This method can achieve the therapeutic effect at the same time, because when the patient takes the prescribed PPI for about 2-4 weeks, and the symptoms such as heartburn are resolved, which means the patient had acid reflux. On the contrary, if the symptoms persist, other health problems may be involved, and further medical examinations may need to be arranged.

3）How does acid reflux affect your daily life?

Acid reflux can affect social life, mental health, daily sleeping and eating. The discomfort caused by acid reflux includes chest pain, heartburn, nausea, cough or painful swallowing. The acid reflux process can be very torturous, so patients may be afraid of eating, worry that acid reflux may occur again after each meal, or even feel embarrassed about the possibility of nausea and vomiting after eating , so they are unwilling to attend social gatherings, affecting their social life, and will also have a certain impact on personal emotions and psychology in the long run. In addition, long-term gastric acid reflux, the teeth may also be damaged by stomach acid, leading to problems such as tooth decay and bad breath, which will also affect the appearance. Lastly, because acid reflux has a higher chance to happen during sleep, because when we sleep on our backs and on the right side, the stomach is higher than the LES, with weakened function of the LES, stomach acid is easier flow back up into the esophagus, causing discomfort such as heartburn, unable to enjoy a good sleep, and then affecting the performance of school, work or daily life during the daytime. Therefore, if you have been suffering from acid reflux for a long time, do not take the problem lightly and seek professional medical advices for acid reflux as soon as possible.

4）Why acid reflux has a higher chance to happen during sleep?

This may be due to the fact that you often eat big meal before going to bed, and often drink carbonated beverages or drinks containing stimulants such as caffeine and alcohol. These poor eating and living habits will increase the secretion of gastric acid and the production of stomach gas. In addition, if there is not enough time for the stomach to complete the digestion process after meal, and lie down to rest directly during the digestion process, based on the fact that LES will open from time to time after meal to release the stomach gas, while the body is lying down, especially when sleeping on your back or sleeping on the right side, the stomach will be higher than the LES, causing gastric acid to easily flow back up from the LES to the esophagus. That’s why acid reflux is always occur when you lie down and sleep. If your sleep quality is often affected by acid reflux, it is recommended that you consult a doctor as soon as possible to alleviate the symptoms of acid reflux through prescription drugs or positional therapy (sleeping on left side).

5）What should I do if acid reflux often occurs while sleeping?

If acid reflux often occurs during sleep, you need to review your diet and living habits first, avoid eating 2-3 hours before going to bed, and avoid drinking carbonated beverages or stimulant drinks containing caffeine and alcohol before going to bed , to reduce gastric acid secretion and stomach gas production. Then, you may take a doctor-prescribed medication before bed to suppress the amount of gastric acid secretion and reduce the chance of gastric acid flow back up to the esophagus. If the power of drug does not last all night and the problem of acid reflux still occurs during sleep, you can use a side sleeping pillow to help you sleep on the left side, or use an acid reflux relief pillow (or wedge pillow) at the same time, tilt and lift the upper body slightly, to keep the LES above the stomach to reduce the chance of gastric acid flow back up into the esophagus during sleep.