Waking up suddenly with the sensation of choking on stomach acid can be a frightening and disorienting experience. This event, often a symptom of acid reflux, can disrupt sleep and cause significant distress. Understanding the immediate actions to take during such an episode, as well as the underlying causes and preventive measures, can provide a sense of control and help manage this uncomfortable condition.
Immediate Steps During an Episode
When a choking episode due to stomach acid occurs, remaining calm is important. Panicking can worsen the situation and make it harder to clear the airway. Sit upright immediately, as gravity can help prevent further acid from entering the esophagus and airway.
Taking small sips of water can help wash down any acid that has come up into the esophagus or throat. This can also help to soothe the irritation caused by the acidic contents. Avoid lying back down too soon after an episode, as this can facilitate more reflux. Instead, try to remain in an upright position for at least an hour to allow the esophagus to clear. Gentle breathing techniques, focusing on slow, controlled breaths, can also assist in reducing anxiety.
Why Stomach Acid Comes Up
Acid reflux occurs when the lower esophageal sphincter (LES) does not function correctly. This muscular ring acts as a valve between the esophagus and the stomach, typically opening to allow food to pass and closing to prevent stomach contents from returning. When the LES relaxes inappropriately or becomes weakened, acid can escape into the esophagus, leading to symptoms like heartburn and, in severe cases, regurgitation that can cause choking.
Several factors can contribute to the relaxation or weakening of the LES and increase the likelihood of acid reflux. Certain foods, such as fatty or spicy dishes, chocolate, peppermint, citrus fruits, and tomato-based products, can trigger episodes. Large meals, especially those consumed close to bedtime, also place greater pressure on the LES. Additionally, conditions like obesity can increase abdominal pressure, pushing stomach contents upwards, and a hiatal hernia, where part of the stomach protrudes through the diaphragm, can compromise LES function.
Preventing Future Episodes
Lifestyle adjustments can significantly reduce the frequency and intensity of acid reflux episodes. Elevating the head of the bed by 6 to 9 inches, perhaps using a wedge pillow or blocks under the bedposts, utilizes gravity to keep stomach acid down during sleep. Wearing loose-fitting clothing, particularly around the waist, also helps by reducing pressure on the abdomen and the lower esophageal sphincter. Maintaining a healthy body weight can alleviate excess pressure on the abdomen, which is a common contributor to reflux.
Identifying and avoiding specific trigger foods, which often include fatty foods, spicy foods, caffeine, alcohol, carbonated drinks, acidic foods (like citrus and tomatoes), chocolate, and peppermint, can minimize symptoms. Eating smaller, more frequent meals throughout the day instead of two or three large ones can prevent the stomach from becoming overly full and putting pressure on the LES. Allowing at least two to three hours between the last meal and bedtime also gives the stomach time to empty before lying down.
Antacids, such as those containing calcium carbonate, neutralize stomach acid to offer quick relief. H2 blockers, like famotidine, reduce acid production by blocking histamine receptors in the stomach lining. Proton pump inhibitors (PPIs), such as omeprazole, work by inhibiting the proton pumps in the stomach that produce acid, offering more potent and longer-lasting acid reduction. These medications are generally intended for short-term use without medical supervision.
When to Seek Medical Advice
If acid reflux symptoms persist or worsen despite lifestyle changes and over-the-counter remedies, seek medical evaluation. Frequent choking episodes, especially at night, warrant professional attention. Other alarming symptoms that necessitate medical consultation include difficulty swallowing, painful swallowing, unexplained weight loss, black or bloody stools, or recurring chest pain that is not related to cardiac issues.
Chronic, untreated acid reflux can lead to serious esophageal complications. These can include esophagitis, which is inflammation of the esophageal lining, and Barrett’s esophagus, a condition where the normal lining of the esophagus is replaced by tissue similar to that found in the intestine. This change can increase the risk of esophageal cancer. A healthcare professional can provide a proper diagnosis and develop a personalized treatment plan to manage symptoms and prevent long-term issues.