Key Pointers
- Acid reflux can worsen at night because gravity no longer helps keep stomach acid down.
- A weakened lower oesophageal sphincter allows acid to flow back more easily when lying flat.
- Late-night meals, caffeine, and alcohol are common triggers.
- Simple changes in eating and sleeping habits can help reduce nighttime reflux.
- Persistent symptoms may require medical assessment and treatment.
When Reflux Disrupts Your Sleep
Few sensations are as distressing as suddenly waking up choking, coughing, or with a burning sensation in the throat. This often happens when stomach acid travels upward into the oesophagus and even reaches the airways, a condition known as nocturnal reflux.
While occasional reflux may not seem alarming, frequent nighttime episodes can disturb sleep, irritate the throat, and signal an underlying condition such as gastroesophageal reflux disease (GERD).
Why Acid Reflux Worsens When You Lie Down
During the day, gravity helps keep stomach acid where it belongs. But when you lie flat, that natural advantage disappears. If the lower oesophageal sphincter (LES), the ring of muscle that closes off the stomach, is weak or relaxed, acid can flow backward into the oesophagus more easily.
Other factors that make reflux worse at night include:
- Late or heavy dinners that leave the stomach full at bedtime
- Alcohol or caffeine, which relax the LES
- Lying down too soon after eating
- Certain medications or underlying conditions that slow digestion
What to Do When You Wake Up Choking from Reflux
If reflux wakes you suddenly, here are steps you can take right away:
- Sit upright immediately. Gravity helps acid move back down into the stomach.
- Drink a few sips of water. This can help wash acid away from the oesophagus.
Avoid lying flat again. Prop yourself up with extra pillows or rest in a reclined position for at least 30–60 minutes. - Stay calm and breathe slowly. The episode may feel frightening, but symptoms usually settle within minutes.
If such episodes happen repeatedly, it’s important to discuss them with a doctor. Persistent nighttime reflux can lead to complications like inflammation of the oesophagus (oesophagitis) or breathing difficulties.
Long-Term Prevention Strategies
Preventing nighttime reflux often involves changing habits that affect digestion. Try these practical approaches:
- Finish meals early. Allow at least 2–3 hours between dinner and bedtime.
- Eat lighter dinners. Avoid large, fatty, or spicy meals late in the evening.
- Elevate the head of your bed. Raising the upper body by about 15–20 cm helps gravity keep acid down.
- Limit alcohol and caffeine. Both can relax the LES and worsen reflux symptoms.
- Maintain a healthy weight. Excess abdominal pressure can push stomach contents upward.
- Quit smoking. Nicotine weakens the LES and increases acid production.
Making these small, consistent changes can significantly reduce symptoms and improve sleep quality.
When to See a Doctor About Nighttime Reflux
Occasional reflux can usually be managed with lifestyle changes, but recurring nighttime symptoms should not be ignored, especially if they are accompanied by:
- Difficulty swallowing
- Chest pain unrelated to heart issues
- Hoarseness or persistent sore throat
- Chronic cough or asthma-like symptoms
Your doctor may recommend further evaluation to understand the underlying cause and rule out complications.
How Doctors Evaluate Reflux Symptoms
For persistent or severe cases, your doctor may suggest tests such as:
- Gastroscopy (upper endoscopy) to inspect the oesophagus and stomach for irritation or damage.
- pH monitoring to measure acid levels and confirm reflux episodes.
- Imaging or blood tests if other conditions are suspected.
Based on findings, treatment may include medications to reduce acid production, repair inflammation, or in some cases, surgical intervention for severe reflux.
FAQs About Nighttime Acid Reflux
1. Why do I get acid reflux only at night?
When lying flat, gravity no longer prevents stomach acid from rising. A weakened lower oesophageal sphincter allows acid to flow back more easily during sleep.
2. What should I avoid eating before bedtime?
Avoid heavy, fatty, spicy, or acidic foods such as fried dishes, chocolate, citrus fruits, and tomato-based meals.
3. Can sleeping positions help with reflux?
Yes. Sleeping on your left side or with your upper body elevated can reduce reflux episodes.
4. Are over-the-counter antacids safe for nighttime reflux?
They may provide temporary relief, but frequent reliance on them without medical evaluation is not advised.
5. When should I see a doctor?
If reflux occurs several times a week, interrupts sleep, or causes chest pain or throat irritation, seek medical advice.
Next Steps with Clinic for Digestive Surgery
At the Clinic for Digestive Surgery, patients can receive evaluation and management for GERD and related digestive conditions. Tests such as gastroscopy may be recommended to identify the cause and guide treatment.
Locations:
- Mount Elizabeth Novena Specialist Centre
- Mount Alvernia Hospital
Contact: +65 6570 2702 | [email protected]
Book a Consultation to learn more about managing reflux and improving your digestive health.
