Managing Your Time Between Dinner and Bedtime

By Para Chandrasoma MD
Scientific Director, RefluxMD

People who have acid reflux disease know by experience that heartburn most commonly occurs after any heavy meal and at night during sleep. The reason why heartburn occurs after a heavy meal is because a full (and even more so, an over-distended) stomach puts pressure on the lower esophageal sphincter (LES) from below. This causes the sphincter to “give way” resulting in reflux and heartburn.

The reason why acid reflux occurs more commonly during sleep is more difficult to explain. But there is no question that for some people, reflux occurs more at night while they are sleeping than during their waking hours. Quite apart from the fact that more reflux episodes occurs during sleep, people who are being treated for GERD often have an increased secretion of acid at night that aggravates these nighttime symptoms.

It should not surprise anyone, therefore, to learn that when these two factors merge together, a heavy meal followed by sleep, most people are setting themselves up for the highest likelihood of reflux, and potentially its most painful symptoms.

If you are a person who is troubled by reflux symptoms during sleep, the following simple lifestyle modifications to your eating and sleeping habits can produce dramatic improvement:

1. Eat dinner at least three hours before you retire to bed. This allows your stomach to partially empty before you go to bed. It takes about 6-8 hours for a normal meal to empty completely, but at 3 hours it has emptied sufficiently to prevent undue pressure being put on your LES.
2. Decrease the fat content of your evening meal. Fatty meals empty more slowly than meals that are low in fat.
3. Decrease the size of your evening meal. Starting with a less full stomach will get you to a reasonably empty stomach sooner.
4. Sleep with a couple of pillows to elevate your head. Elevation of the upper part of your body lets gravity work for you while it works against reflux.

These things should help you decrease your nighttime reflux and heartburn. These simple lifestyle changes are highly recommended since some of worst reflux symptoms that people can have develop suddenly at night. Perhaps the most disruptive event is to be suddenly awakened from your sleep during an episode of reflux – feeling a severe pain in your chest and with an acid taste in your mouth. Making it worse, many people feel a sense of suffocation that leads to acute panic when this happens. Trust us when we say – this is worth avoiding.

Finally, if you have done all these things and you still have nighttime acid reflux symptoms, you should see a physician specializing in reflux disease. If you are on twice-daily PPIs, adding a H2 receptor antagonist like ranitidine in the evening may help. However, doctors experienced in GERD treatment can help you develop a treatment plan to find relief. Before your reflux becomes that serious, you can help yourself considerably with the lifestyle modifications we have suggested above.

For other home remedies, check out our acid reflux home remedy summary.

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