A hiatal hernia occurs when the upper portion of the stomach protrudes through the hiatus, a small opening in the diaphragm, and into the chest cavity. This anatomical shift leads to nighttime discomfort, primarily acid reflux and heartburn. Symptoms are often worse when lying down, making restful sleep a challenge. This article provides strategies focusing on physical positioning and evening habits to mitigate these disruptive symptoms and improve sleep quality.
How Hiatal Hernia Affects Sleep
The diaphragm is the muscular sheet separating the chest and abdomen; the hiatus is the opening where the esophagus connects to the stomach. A hiatal hernia compromises the integrity of the gastroesophageal junction, where the lower esophageal sphincter (LES) is located. When the stomach bulges through the hiatus, it interferes with the LES’s ability to close tightly, preventing reflux.
Normally, gravity helps keep stomach contents and acid in the stomach. When the body is horizontal during sleep, the compromised LES and altered anatomy allow stomach acid to flow back up into the esophagus more easily. This backflow, known as nocturnal gastroesophageal reflux, causes the burning sensation of heartburn and regurgitation, which can abruptly wake a person.
Optimizing Sleep Position and Elevation
Using gravity to your advantage is the most effective physical change to manage nighttime reflux caused by a hiatal hernia. The goal is to ensure the stomach remains lower than the esophagus, even when you are lying down. Elevating the entire head of your bed is superior to simply stacking pillows under your head.
A proper incline of approximately six to eight inches is recommended to be effective against reflux. This elevation should lift the head, chest, and torso, not just the head, which can be achieved by placing sturdy risers or wood blocks underneath the bedposts at the head of the bed. Piling pillows only raises the head and neck, potentially causing an uncomfortable bend at the waist that can increase pressure on the abdomen and worsen reflux.
Alternatively, a wedge pillow can provide the necessary elevation and support for the upper body. Look for a wedge that is six to eight inches high and has a gradual incline, which extends from the hips to the shoulders. This design supports the torso’s full length, ensuring proper spinal alignment while keeping the esophagus elevated above the stomach.
The side you choose to sleep on also makes a difference due to the body’s internal anatomy. Sleeping on the left side is widely recommended for reducing nocturnal acid reflux symptoms. On the left side, the stomach is positioned in a way that keeps the contents below the entrance to the esophagus, making it physically harder for acid to flow backward.
Conversely, sleeping on the right side should be avoided because it can relax the lower esophageal sphincter and place the esophagus above the stomach, promoting reflux. Similarly, sleeping on the stomach puts direct pressure on the abdomen, which can force stomach contents past the weakened LES. Maintaining a left-side-elevated position throughout the night is the optimal physical strategy for comfort.
Dietary and Behavioral Changes Before Bed
What you consume and when you consume it before sleep impacts nocturnal hiatal hernia symptoms. Adhering to the “three-hour rule” means avoiding all food and drink, except small amounts of water, for at least three hours before lying down. This waiting period allows the stomach sufficient time to empty most of its contents.
The evening meal should be lighter to minimize the amount of stomach acid produced for digestion. Controlling portion sizes is important because a distended stomach increases pressure and promotes acid backflow. Eating slowly and chewing food thoroughly also aids the digestive process.
Certain foods and beverages relax the LES or increase acid production, making them problematic in the evening. Common trigger items to avoid before bed include:
- Caffeine
- Alcohol
- Chocolate
- Mint
- High-fat meals
- Acidic foods like citrus fruits and tomatoes
- Spicy foods
Beyond diet, ensure your clothing does not constrict your abdomen. Tight clothing, belts, or waistlines exert pressure on the stomach, encouraging the upward movement of acid into the esophagus. Opting for loose-fitting pajamas eliminates this external pressure.