Prevent Heartburn - Position and Sleep Apnea Therapy

Symptoms May Indicate Serious Disease or Represent Untreated Sleep Apnea

Tips to prevent heartburn or reflux at night may involve avoiding triggers, sleep position, and sleep apnea therapy
Tips to prevent heartburn or reflux at night may involve avoiding triggers, sleep position, and sleep apnea therapy. Getty Images

While some people may experience heartburn or reflux while they sleep, it is possible to prevent these uncomfortable symptoms. Heartburn may occur infrequently or nightly, and it is important to seek treatment to prevent significant consequences. Fortunately, there are many effective treatment options, including the use of over-the-counter and prescription medications. Avoiding triggers, altered sleep position and the use of a wedge pillow, and the treatment of obstructive sleep apnea with CPAP therapy all may have a role in reducing heartburn and reflux at night.

What Is Heartburn or Reflux (GERD)?

Heartburn is a very common condition that causes a sensation of burning in the middle of the upper stomach or behind the breastbone. It is sometimes called gastroesophageal reflux disease (GERD).

People who have GERD may also experience vomiting or pain with swallowing. They may have a hoarse voice or be prone to developing pneumonia. They may also have an acidic taste in their throat or mouth. It is even possible for food to move from the stomach back into the esophagus. There may be associated choking or coughing.

What Causes Heartburn to Occur at Night?

Heartburn is commonly associated with eating too much, or with eating spicy, acidic, or caffeinated foods. Some problem foods may include:

  • Tomato products
  • Citrus
  • Alcohol
  • Coffee
  • Chocolate
  • Peppermint
  • Fatty foods

It is possible to have worsened heartburn when large meals are eaten too close to bedtime, especially if meals occur fewer than 2 hours before going to bed.

Why Can Heartburn Happen While You Sleep?

Food travels from the mouth to the stomach through the esophagus, which is a muscular tube. Between the esophagus and the stomach is a muscular ring called the lower esophageal sphincter (LES). The LES stops food and stomach acid from traveling back up the esophagus, which can lead to symptoms of heartburn.

While lying in bed, gravity is not keeping the contents of the stomach away from the LES. If the LES is weak, it may open a little and allow some of the stomach acid into the esophagus, causing a burning sensation. Certain foods, such as those described above, may also cause this sphincter to relax.

Some people experience a sensation of choking at night. It may be the result of GERD, but another possibility for recurrent choking spells at night is sleep apnea. Sleep apnea may cause a collapse of the airway. To open it back up, the muscles are contracted and this may draw the contents of the stomach back into the airway. If sleep apnea is present, treatment with continuous positive airway pressure (CPAP) may be an effective option.

How Should Heartburn Be Treated?

There are many highly effective treatment options for heartburn. If you are experiencing symptoms at night, you need to seek treatment as this is not a normal phenomenon. Commonly used over-the-counter and prescription medications include:

Surgical treatment may rarely be necessary in some cases.

This is most often reserved for those cases where medications are ineffective. The most common surgery, called Nissen fundoplication, involves surgically wrapping the stomach around the lower esophagus to create reinforcement that prevents reflux.

You may also consider some simple lifestyle modifications. These include avoiding large meals late at night, especially those that include troublesome foods. Losing weight is another excellent option. Also, raising the head of the bed 6 to 8 inches with the use of blocks of wood, a foam wedge, or commercial products called sleeping wedge pillows can be very effective.

However, it is not recommended to use extra pillows as this may create a bend and unnatural pressure on the stomach, causing worsened reflux.

If your symptoms persist, reach out for help from your doctor and don't forget to consider the unexpected role of sleep apnea as a potential contributor to the symptoms.


DeVault, KR et al. “Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.” Am J Gastroenterol. 2005; 100:190.

Kaltenbach, T. et al. “Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach.” Arch Intern Med. 2006; 166:965.