Much of the reason why heartburn can actually be worse at night comes down to the reason for the heartburn in the first place, gastroenterologist Ashkan Farhadi, MD. When you eat, food travels down your esophagus, which is a tube that connects your mouth and stomach, he says. The bottom of the esophagus has a valve called the esophageal sphincter, which opens to let food in and then closes to keep everything in your stomach inside. With heartburn, the esophageal sphincter doesn’t close properly and some of the acidic contents from your stomach go into the esophagus, causing reflux and the symptoms of heartburn.
So, where does sleep and sleeping position come into play where heartburn is concerned? “People usually sleep in a horizontal position, and gravity is not working to keep everything in the stomach like it does when you’re awake and upright,” Dr. Farhadi says.
Depending on how severe your heartburn is, this can cause symptoms that range from being mildly uncomfortable to downright painful, says gastroenterologist Lea Ann Chen, MD, a gastroenterologist at Rutgers Robert Wood Johnson Medical School. “For some folks who have significant reflux, it can wake them from sleep,” she says. In fact, according to a survey of 1,000 people who self-reported experiencing heartburn, more than 60 percent said it negatively affected their sleep.
But if you suffer from heartburn and also experience sleep issues, the doctors say you’re not doomed to struggle with poor sleep indefinitely. Rather, there are a few strategies you can try to improve your situation, including changing your sleep position.
What’s the worst sleep position when you have heartburn?
There are actually two positions that aren’t so great for heartburn. One of the worst sleep positions when you have heartburn is lying flat on your back, Dr. Chen says. This, she says, “leads to the most episodes of reflux.”
She adds, “when you’re lying down this way, positionally you’re more likely to have reflux occur” because it “predisposes gastric contents to go up into the esophagus.” But Dr. Chen also cites research that found lying on your right side is also a reflux trigger. “Right-sided is the worst in terms of acid exposure time in the esophagus,” she says.
What’s the best sleeping position for heartburn?
One of the best positions for sleeping with heartburn is doing so on your left side. “The hypothesis is that it’s related to the shape of your stomach and positioning,” Dr. Chen says. “If you’re sleeping on your left side, it’s harder for things in your stomach to flow into the esophagus.”
“If you’re sleeping on your left side, it’s harder for things in your stomach to flow into the esophagus.” —gastroenterologist Lea Ann Chen, MD
One small randomized controlled trial tested this theory and concluded that people with reflux who slept on their left side had “significantly less” heartburn issues than those who slept on their right side.
Another strategy that can help is sleeping with your head elevated, Dr. Farhadi says. Because heartburn is more severe when you’re lying flat, he recommends either propping yourself up on pillows or getting a wedge pillow to help keep your body upright. Another option, adds Dr. Chen, is to elevate the top of your bed with risers you can buy online to make a permanent incline. “They’re usually about six to eight inches tall and elevate the head of your bed,” she says.
If sleeping on your left side isn’t your go-to, you can actually train yourself to do this, says W. Chris Winter, MD, of Charlottesville Neurology and Sleep Medicine, and author of the book, The Sleep Solution: Why Your Sleep Is Broken and How to Fix It. “There are low-tech solutions to help,” he says. For instance, you can try wearing a pocketed T-shirt backwards and putting a tennis ball in the pocket to elevate you, sleep with a backpack on that’s stuffed with a basketball or something else bulky, or invest in devices that vibrate if they detect that you’ve rolled onto your back.
All of that being true, if you’re struggling with heartburn, it’s keeping you up at night, and you can’t get relief with different sleeping positions, doctors recommend talking to your doctor about treatment options.
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