Nighttime Heartburn May Be Dangerous

GERD at Night Can Cause More Damage

Extreme heartburn
Heartburn at night is dangerous. Jonathan Patterson / Getty Images

Why is heartburn more dangerous at night? There are several reasons this may be the case, and why you should take precautions if you have heartburn.

When symptoms of gastroesophageal reflux disease (GERD) occur at night, they can be more damaging than those same symptoms during the day. If you have GERD, you know how your symptoms can cause problems, such as the pain and the irritation. When you sleep at night, your body is less prepared to deal with these symptoms and less able to prevent possible lasting damage.

Factors Making Nighttime Heartburn More Damaging

You may know from experience that acid reflux at night can disrupt your sleep. You also need to understand the other potentially harmful factors that can make nighttime heartburn more likely to cause damage. These factors include:

  • Sleeping in a supine position. Lying flat in bed allows stomach acid to flow more easily into the esophagus, and stay there for longer periods of time than when a person is in an upright position. Even elevating the head and shoulders 6 to 8 inches will help keep stomach acid where it belongs, in the stomach.
  • You can't drink or swallow every time an acid reflux episode occurs when sleeping. When you have GERD and you are awake during an episode of acid reflux, you often will rinse your mouth or swallow some liquid. Even swallowing saliva helps. When asleep, once the refluxed acid is in the esophagus or throat, you aren't always aware of it and thus you don't take steps to rinse the acid away.
  • There's an increased risk of choking on refluxed stomach contents. If refluxed acid is in the throat and mouth, a person with GERD can inhale this into the lungs. Once in the lungs, it can cause coughing and choking on this aspirated material. The acid can also cause the same damage to the lungs as it can cause when refluxed into the esophagus.

    Clinical Complications of Nocturnal GERD

    With the increased risks of damage to the esophagus, there can be a greater risk of esophageal lesions and respiratory conditions with nighttime heartburn. One study, however, didn't find increased incidence of Barrett's esophagus (which increases the risk of esophageal cancer) between patients with and without nocturnal GERD. Nighttime GERD can impact your health in other ways through disrupting your sleep, which contributes to many health and quality of life issues.

    Help for Nighttime Heartburn

    If you have nighttime heartburn or other GERD symptoms, discuss them with your doctor. The good news is that it can be managed effectively. There are medications that can help control the acid reflux, including proton pump inhibitors such as Prevacid and Prilosec, and H-2-receptor blockers such as Pepcid, Tagamet, and Zantac.

    The doctor can also discuss nighttime heartburn prevention measures a person with GERD can use to help prevent damage, such as elevating the head of your bed. If required, there are also surgical options such as Nissen fundoplication, a laparoscopic procedure.


    Gaddam S, Maddur H, Wani S, et al. Risk Factors for Nocturnal Reflux in a Large GERD Cohort. Journal of Clinical Gastroenterology. 2011;45(9):764-768. doi:10.1097/mcg.0b013e318205e164.

    Gerson LB, Fass R. A Systematic Review of the Definitions, Prevalence, and Response to Treatment of Nocturnal Gastroesophageal Reflux Disease. Clinical Gastroenterology and Hepatology. 2009;7(4):372-378. doi:10.1016/j.cgh.2008.11.021.