Nighttime Interventions and Their Effects on GERD

Acid Reflux can cause painful symptoms and even significant disease burden through gastroesophageal reflux disease (GERD) 

These symptoms can lead to precancerous or even cancerous changes to the lining of the esophagus. For many people who suffer from acid reflux symptoms these symptoms are worse at night. 

There are multiple reasons that symptoms may be worse at night, while trying to sleep. Research shows that stomach acid secretion is at its highest from eight PM until about midnight (Am. J. Gastroenterol., 2007). We also do not swallow while we are asleep, therefore losing the benefit of bicarbonate containing saliva, which neutralizes acidity down the esophagus to the stomach. It is also interesting to note that GERD can cause sleep deprivation because of these increased symptoms at night while research has also shown that sleep deprivation worsens GERD and worsens a person’s perception of the symptoms associated with GERD (Gastroenterology, 2007; Neurogastroenterol. Motil., 2019).  

Researchers are always looking for ways to improve symptoms and decrease the incidence of disease. 

Traditional medical treatment for GERD have included oral medicine such as: proton pump inhibitors or PPIs which work by decreasing the amount of stomach acid produced by proton pumps (e.g., Prilosec, Nexium, Prevacid, Protonix), histamine H2-receptor antagonists or H2 blockers, which also decrease the amount of stomach acid produced by blocking the action of histamine at H2 receptors in the parietal cells in the stomach (e.g., Pepcid AC, Zantac), and antacids which work by neutralizing the existing acid in the stomach (e.g., Rolaids or Tums).

Medication can be very effective in treating GERD symptoms, but these medications do have potential side effects and do not relieve all symptoms for all people.

One avenue of research that has been looked at recently to decrease GERD symptoms is using specific head of bed and sleeping positions.  

There are a few different areas of research regarding sleeping positioning and their effect on GERD and its symptoms, primarily looking at raising the head of the bed, achieved by either sleeping on a wedge pillow or raising the head of the bed using blocks under the legs, and lastly sleeping on the person’s left side.

Studies looking only at raising a person’s head of the bed show inconsistent results. 

This is likely because there are still too many variables that are affecting the outcome; for example, different sleeping positions and whether patients remained on medication or were taken off. Overall, there seemed to be improvement in GERD symptoms from baseline, but some individuals reported adverse events (Gastroenterol Hepatol, 2020; J. Gastroenterol. Hepatol., 2012; BMC Fam. Pract., 2021).

For example, if you are a stomach sleeper, then unless you are willing to sleep on your side or back, a wedge pillow is not for you as it will cause pain and discomfort due to the hyperextension of your back. Some individuals reported difficulty with sexual experiences with elevating the head of the bed.

Research looking at lying on the left side while also raising the head of the bed by far showed the most benefit.  

Individuals in various studies show decrease in esophageal exposure to acid, decrease in self-reported GERD symptoms, and improvement in sleep difficulties (Neurogastroenterol. Motil., 2022). Some studies evaluated a specific sleep positioning device to determine which sleeping position resulted in the least reflux episodes and esophageal acid exposure. This device provided an inclined base that elevated the head and torso and used a wraparound body pillow that helped the person maintain the left lying position while sleeping. 

This device decreased nighttime GERD symptoms and improved GERD health related quality of life questionnaire responses. Three months after the trial period 91% of the test subjects continued to use the positioning device every night, which indicates it was continuing to help them with their symptoms (J. Clin. Gastroenterol., 2015; Dis. Esophagus, 2017). The specific device studied can be seen here. 

The goal of positioning to decrease GERD symptoms is to elevate the head and torso about 7-10 inches and use something to keep yourself on your left side during sleep. 

I recommend pillow positioning and not blocks under the bed legs. There are many options available that can facilitate this and a search on the internet will show you lots of options. If you have back, neck, or shoulder pain it may take some trial and error to find the positioning system that works for you, but the benefit to your GERD symptoms can be worth it.