Gastroesophageal Reflux Disease (GERD) is a chronic condition where stomach acid frequently flows back into the esophagus, the tube connecting the throat to the stomach. This backward flow, known as acid reflux, irritates the esophageal lining and commonly causes the burning sensation called heartburn. While occasional heartburn is common, GERD involves frequent symptoms, typically occurring two or more times per week. Many individuals with this condition find their discomfort often flares up at specific, predictable times.
Yes, Morning Symptoms Are Common
It is a frequent experience for people with GERD to wake up with significant symptoms like heartburn, a sour taste in the mouth, or a sensation of food sticking in the throat. This phenomenon is so common that a 2009 study coined the term “riser’s reflux” after finding that nearly half of GERD sufferers experienced a reflux event within the first 20 minutes of waking. Symptoms upon waking can also include hoarseness, a chronic sore throat, or a persistent dry cough, which are consequences of acid exposure overnight. The severity of the symptoms experienced in the morning is a direct result of the physiological changes that occur while the body is at rest.
Nighttime Factors That Increase Acidity
The primary reason for increased acid exposure overnight is the loss of gravity’s assistance when a person is lying flat. In an upright position, gravity helps keep stomach contents down and rapidly clears any acid that does reflux into the esophagus. When the body is horizontal, acid that flows back into the esophagus is allowed to linger for a longer duration, significantly increasing the time the sensitive lining is exposed to stomach contents.
During sleep, the production of saliva, which acts as a natural buffer to neutralize stomach acid, is dramatically reduced. Furthermore, the frequency of the swallowing reflex decreases substantially when a person is asleep. Swallowing is a natural mechanism that pushes any refluxate back down into the stomach, meaning this protective clearance is less active at night.
The muscle that acts as a barrier between the stomach and the esophagus, the Lower Esophageal Sphincter (LES), may also experience more frequent and longer periods of relaxation during the night. The combination of a relaxed LES, reduced acid clearance, and the absence of gravity means that nocturnal reflux is common and associated with more aggressive forms of GERD and a higher risk of complications. The stomach itself also has a circadian rhythm that promotes a surge of acid production overnight.
Adjusting Sleep and Morning Habits
To mitigate the severity of morning symptoms, simple behavioral changes focusing on the period before and during sleep can be highly effective. The first adjustment is to allow a minimum of three hours between the last meal or snack and lying down for bed. This “three-hour rule” ensures the stomach has enough time to empty its contents, reducing the amount of material available to reflux.
Elevating the head of the bed is another highly recommended strategy that uses gravity to your advantage. This should be achieved by raising the entire head of the bed frame by six to eight inches using blocks or a specialized wedge pillow. Using extra pillows under the head is counterproductive because it can bend the body at the waist, increasing abdominal pressure and potentially worsening reflux.
Avoiding common trigger items close to bedtime can also reduce nighttime acid production and LES relaxation. These triggers often include alcohol, caffeine, chocolate, spicy foods, and high-fat meals. Finally, sleeping on the left side is anatomically favored for reducing acid exposure, as the stomach is positioned below the esophagus, making it more difficult for acid to flow upward.