Nocturnal acid reflux, where stomach contents travel back up the esophagus during sleep, can cause a terrifying sensation of choking. This is often due to two related issues: laryngospasm and aspiration. Laryngospasm is a sudden, involuntary reflex where the vocal cords slam shut when stomach acid touches the larynx, causing a momentary inability to breathe. Aspiration occurs when stomach material physically enters the windpipe and lungs, which the body attempts to clear through violent coughing. These episodes are a severe symptom of gastroesophageal reflux disease (GERD) and require immediate management.
Actions During an Acute Choking Episode
If you wake up choking or gasping due to reflux, the immediate response is to sit up instantly. Lying flat removes the benefit of gravity, making it easier for stomach contents to reach the throat and prolonging the episode. Remaining upright, ideally in a chair or sitting straight up in bed, helps gravity pull the acid back down into the stomach, allowing the vocal cords to relax.
Once upright, focus on clearing the airway by coughing forcefully, which is the body’s natural defense mechanism against aspiration. The laryngospasm causing the choking sensation usually lasts only a few seconds to a minute, but the experience can feel much longer. Do not panic, as hyperventilating can worsen the feeling of suffocation; instead, try to take slow, controlled breaths through your nose.
After the initial choking and coughing subside and breathing returns to a regulated rhythm, slowly take small sips of room-temperature water. This action helps wash any lingering acid from the esophagus and throat. Avoid the urge to lie back down right away, as this increases the chance of a second episode. Remain upright for at least 20 to 30 minutes to allow the esophagus to fully clear.
Preventing Nocturnal Reflux Through Lifestyle Changes
The primary defense against nighttime reflux is modifying daily habits, particularly those related to eating and sleeping position. Allowing the stomach sufficient time to empty before lying down is effective because it reduces the amount of acid available to reflux. Health professionals advise finishing all food and beverages at least two to three hours before bedtime.
Dietary choices play a significant role, as certain foods can relax the lower esophageal sphincter (LES), the muscle that acts as a barrier between the stomach and esophagus. Common trigger items include:
- High-fat or fried foods
- Spicy dishes
- Chocolate and mint
- Acidic items like citrus and tomatoes
Alcohol and caffeinated drinks are also known to weaken the LES and increase stomach acid production, making it advisable to limit or avoid them, especially in the evening.
Positional adjustments during sleep can use gravity to your advantage, significantly reducing the likelihood of a reflux event. Instead of simply piling up pillows, which only bends the neck, the entire head of the bed should be elevated by six to nine inches. This can be achieved by placing risers or blocks under the bedposts at the head of the bed, or by using a wedge pillow designed to raise the torso.
Sleeping on the left side is also recommended, as this position keeps the stomach below the esophagus, promoting acid clearance and reducing reflux episodes. Maintaining a healthy weight helps alleviate pressure on the abdomen, which can otherwise force stomach contents upward. Wearing loose-fitting clothing to bed also contributes to reducing this abdominal pressure.
Medical Options and When to Consult a Doctor
While lifestyle modifications can resolve nocturnal reflux for many people, persistent or severe symptoms require professional medical evaluation. You should consult a doctor if you experience:
- Frequent choking episodes
- Persistent hoarseness or chronic cough
- Chest pain
- Difficulty swallowing
These symptoms may indicate damage to the lining of the esophagus or vocal cords, requiring specific medical treatment.
The initial medical approach often involves over-the-counter medications to manage acid levels. Antacids provide quick, temporary relief by neutralizing stomach acid, but they do not address the underlying issue of acid production. For more consistent management, histamine (H2) blockers like famotidine reduce the amount of acid the stomach produces.
If symptoms continue despite these measures, a doctor may prescribe stronger medication called proton pump inhibitors (PPIs), such as omeprazole, which block the acid-producing pumps in the stomach cells. PPIs are taken daily before a meal to ensure peak effectiveness during the night, when reflux is more likely. If the condition is resistant to medication, a doctor may recommend diagnostic tests, such as an endoscopy or pH monitoring to measure acid reflux over a 24-hour period.