Vomiting during sleep is possible. While the body possesses protective reflexes, certain circumstances can suppress these vital responses, leading to potentially serious complications.
The Reality of Nocturnal Vomiting
The body’s vomiting process is a complex, coordinated reflex. Normally, protective mechanisms like closing the epiglottis and elevating the soft palate prevent stomach contents from entering the airways. A deep breath is also typically taken before vomiting as a protective measure.
However, during sleep, especially deep sleep, these protective reflexes can be significantly suppressed. Sedatives, including alcohol, opiates, and barbiturates, further impair these natural defenses, increasing the risk of aspiration. The airway tissues can also relax and partially collapse during sleep, which can inadvertently obstruct the passage of vomit. Individuals may enter a semi-conscious state, unable to fully react or clear their airway, potentially waking up choking on vomit.
Potential Dangers and Complications
The primary danger of vomiting during sleep is aspiration, which involves inhaling stomach contents into the lungs. This can lead to a severe lung infection known as aspiration pneumonia, a bacterial infection causing inflammation in the lung sacs that fill with fluid or pus. Symptoms often include a persistent cough, fever, shortness of breath, chest pain, and extreme tiredness.
Complete airway obstruction by vomit can result in asphyxia, cutting off oxygen supply to the body and potentially leading to death within minutes if not addressed. Individuals with pre-existing respiratory issues or compromised immune systems face a heightened risk of developing serious infections from aspiration. The risk of choking is particularly increased when a person is lying on their back while vomiting.
Common Causes and Contributing Factors
Acute illnesses like viral gastritis (stomach flu), food poisoning, and specific food allergies can trigger nocturnal vomiting. Chronic conditions also play a role in recurrent nocturnal vomiting. Gastroesophageal Reflux Disease (GERD) is a common condition where stomach acid and contents flow back into the esophagus, potentially leading to vomiting during sleep.
Gastroparesis, a disorder where the stomach empties slowly, can result in food building up and causing nausea and vomiting at night. Cyclic Vomiting Syndrome (CVS), characterized by recurrent, often severe, episodes of vomiting, can also manifest during sleep, with fatigue and stress being common triggers.
Additionally, some medications, including certain antibiotics, anti-inflammatory drugs, and blood pressure medications, can have nausea and vomiting as a side effect. Excessive alcohol consumption is a significant risk factor because it depresses the central nervous system, impairing natural reflexes and increasing aspiration likelihood.
Pregnancy-related nausea, such as morning sickness or hyperemesis gravidarum, can extend into the night. Neurological conditions that affect the gag reflex or swallowing ability, such as certain brain injuries or dysphagia, also increase the risk.
Prevention and When to Seek Medical Attention
To reduce the risk of vomiting in your sleep, adjust your sleeping position. Elevating the head of the bed by six to eight inches uses gravity to help keep stomach contents down, particularly for those with GERD. Sleeping on the left side can also help prevent stomach acid from refluxing into the esophagus.
Avoid large meals, especially those high in fat, close to bedtime. Managing underlying health conditions like GERD or gastroparesis with appropriate medical treatment is also important. For individuals who consume alcohol, moderation and avoiding excessive intake before sleep can lower the risk of impaired reflexes and aspiration.
If someone vomits in their sleep, immediately turn them onto their side to help clear the airway and prevent choking. Consult a healthcare professional for frequent nocturnal vomiting or if you notice signs of aspiration pneumonia, such as a persistent cough, fever, shortness of breath, or chest pain. Other symptoms that warrant medical evaluation include difficulty breathing, a persistent fever of 102°F (39°C) or higher, a cough producing pus, extreme tiredness, or confusion, particularly in older adults. If vomiting continues for more than 24 hours, seek medical attention.