If you’ve ever experienced heartburn, chest pain, or a burning sensation in your throat while trying to sleep, you’re not alone. According to the American College of Gastroenterology, as much as 20% of the US population suffers from gastroesophageal reflux disease (GERD), a disorder characterized by frequent bouts of acid reflux. This occurs when the natural acid in your stomach leaks into your esophagus and aggravates the tissue in your throat.
Most Americans will experience acid reflux at some point during their lives. When reflux occurs at night, the burning, choking, and chest pain can prevent a good night’s sleep. Fortunately, there are ways to get some relief from nighttime reflux–without even leaving your bedroom!
While none of the following tips should replace medical advice, we’ve assembled some strategies for how to manage reflux at night, including how to stack pillows for acid reflux. But, if you have serious concerns, we recommend speaking with your doctor before making any lifestyle changes.
What Causes Acid Reflux at Night?
Several factors can cause or increase episodes of acid reflux at night. Let’s start with the main culprit: gravity. When standing or sitting upright, gravity helps keep your stomach’s natural acids from moving up into your esophagus. When lying down, the benefit of gravity goes away, making it easier for gastric acid to creep into the throat.
Anatomy also plays a big role in nighttime acid reflux. Weak or relaxed esophageal muscles allow acid to move more easily into the throat and increase the likelihood of nighttime reflux. Saliva production and swallowing are also naturally reduced during sleep. During the day, these mechanisms clear the throat and prevent the regurgitation of stomach acid, and the reduction of these functions at night can invite episodes of reflux.
Many of us have probably been told how eating sugar influences sleep, but when you eat can have as much influence on your sleep quality as what you eat. Eating within three hours of bedtime can trigger reflux as you finish digesting from a prone position. Big or heavy meals can also put pressure on your stomach, forcing acid up your throat when you lie down. If you suffer from acid reflux, try to eat less before bed.
Between gravity, anatomy, and diet, there are a lot of things that can trigger acid reflux at night. What can you do to reduce symptoms and get a better night’s sleep? Let’s explore.
Using Pillows to Reduce Acid Reflux
Without the help of gravity keeping gastric acid in the stomach, sufferers of acid reflux and GERD often report an increase in symptoms at night. Elevating your head and upper torso with pillows can get gravity back on your side and keep gastric acid where it belongs.
Stacking pillows is a practical and easy way to reduce nighttime reflux. The goal is to get the head, neck, and shoulders above your stomach so gravity can keep the gastric acid out of your throat. There are a couple things to keep in mind when stacking pillows for acid reflux:
- Stack pillows not only under your head but also under your shoulders and back. Your esophagus runs all the way from your throat to your stomach, so only elevating the head will still allow acid to leak into your lower esophagus. Raising only your head may also cause undue stress on your neck and add neck pain to your nightly discomfort. Aim for a slope of pillows that gets your torso off the mattress as well.
- Raise your head 6 to 8 inches off the bed, or around a 35-45º angle. Just elevating your head an inch or two off the mattress won’t be enough to keep the gastric acid out of your throat. Aim for at least 6 inches of consistent incline to get the most relief.
There are several benefits to using traditional pillows to elevate your head. Not only is stacking pillows quick, easy to do, and non-expensive, you also have the benefit of adjustability and trial and error when it comes to finding the perfect stack for you. Keep in mind, however, that your DIY stack of pillow can be prone to shifting and unevenness, which may become uncomfortable as the night wears on.
If a stack of traditional pillows isn’t providing the relief you need, try a wedge pillow. Wedge pillows are specifically designed to elevate the entire upper body, not just the head.
Wedge pillows like the MedCline Wedge Pillow have a built-in incline that can raise the head and torso enough to reduce the flow of acid into your throat. Mid-loft wedge pillows tend to be around 8” to 10” tall–enough height to, according to a review published with the National Library of Medicine, relieve symptoms of reflux. Unlike stacked pillows, wedge pillows won’t shift out of place when you move during the night, providing more consistent comfort.
While wedge pillows can provide more consistent support for your head and torso, most do not have the same adjustability as stacking traditional pillows. Finding the right angle, loft, and position for you may take some time.
Sleeping Positions and Acid Reflux
What position you sleep in can also affect nighttime acid reflux. As with stacking pillows, the goal is to limit the exposure of acid to your esophagus, throat, and sinuses by taking advantage of gravity and your own anatomy. Depending on your sleeping position, you may be more or less prone to bouts of acid reflux. Let’s take a look:
If you suffer from acid reflux, sleeping on your side may reduce the frequency of reflux. Specifically, sleeping on your left side positions your stomach below your esophagus and allows gravity to work in your favor. You won’t get the same benefits sleeping on your right side, so if you are a side sleeper with GERD or frequent acid reflux, try to sleep on your left side as much as possible.
When sleeping flat on your back, your esophagus and stomach are on the same plane. This makes it easier for acid to move up from your stomach and into your throat, causing discomfort. Try sleeping on your left side to limit symptoms, or, if you are a dedicated back sleeper, use pillows to sleep on an incline.
Stomach sleeping is the least common sleeping position and the position with the most potential to cause health problems. With regards to acid reflux, stomach sleeping not only puts your stomach and throat on the same level but also puts pressure on your belly, encouraging acid to leave the stomach and travel up the esophagus. Episodes of acid reflux may even last longer for stomach sleepers, as the acid cannot easily return to the stomach while you sleep in this position.
What can you do if you are a stomach sleeper who frequently suffers from acid reflux? While stacking pillows may help reflux, stomach sleepers may find the necessary loft causes neck and back pain. Stomach sleepers should instead pay close attention to their diet and lifestyle habits in the hours leading up to bed and avoid reflux triggers.
If reflux still prevents you from getting a good night’s sleep, consider training yourself to sleep on your back.
RELATED: Sleeping Positions Guide
Pillows aren’t the only way to get the elevation you need to keep acid reflux at bay. Your bed itself can be set at an incline, either through an adjustable base or other techniques. Let’s explore:
Adjustable bases are another way to create an incline and keep acid in the stomach where it belongs. These beds can independently raise or lower the head or foot of the bed to customize support and comfort. For those who suffer from acid reflux, the important part here is the ability to raise the entire head of the bed at a consistent slope. An adjustable base elevates the head, neck, and torso from the stomach without sacrificing spinal alignment.
There are some things to keep in mind when looking for an adjustable base. First, these high-tech bed frames can be a big investment, so durability is an important factor to consider when comparing adjustable bases.
Compatibility with your existing mattress, headboard, and bedroom layout is also important. Can your current mattress fit on the adjustable base, and can your adjustable base maintain its position relative to your wall and bedroom furniture when raised or lowered? Finally, adjustable bases may require more assembly and maintenance than traditional bed frames; think about your own needs and expectations when shopping for an adjustable base.
RELATED: Best Adjustable Bed Positions
While adjustable bases can be great for reducing acid reflux, these types of mechanized frames can be expensive. If you’re looking to achieve some bed elevation on a budget, there are a couple of steps you can take, including:
- Shimming the bed frame. According to the Mayo Clinic News Network, a possible home remedy to nighttime acid reflux or heartburn is to angle your bed with shims. To do this, put blocks of wood or concrete underneath the bedposts at the head of your bed frame. Aim for 6 to 9 inches of elevation, and be sure the blocks are big and solid enough the frame won’t slide off the blocks when weight is applied. Unlike an adjustable base, this will put the entire mattress at an incline.
- Using a mattress riser. Think of these as a wedge pillow for your whole bed. Mattress risers go underneath the mattress and create a gentle incline. These lack the customizability of an adjustable base, but they are a much more budget-friendly option. Bed risers, or risers that go under the frame rather than the mattress, are another option.
How to Sleep with Acid Reflux: The Bottom Line
If reflux is affecting your sleep habits, there are steps you can take to limit episodes of reflux and improve your quality of sleep. Stacking your pillows or using a wedge pillow takes advantage of gravity to limit the exposure of acid to your esophagus, as does using an adjustable base. You can also reduce nighttime acid reflux by sleeping on your left side.
While these strategies can help reduce nighttime bouts of acid reflux, none of them replace proper medical care. If GERD or acid reflux continues to affect your daily life, seek medical attention.
Still have questions? Let’s answer a few of the most frequently asked questions regarding acid reflux and sleep.
Can acid reflux cause lack of sleep?
Research shows GERD and acid reflux have an adverse effect on sleep quality. The burning and choking symptoms of reflux can prevent you from falling asleep or wake you up during the night. In turn, sleep deprivation can aggravate symptoms of acid reflux. If reflux is preventing you from getting a good night’s sleep, it’s time to take steps to reduce reflux at night.
How high should I elevate my bed for acid reflux?
In general, the higher the incline, the more effective the elevation is in reducing reflux. How high you should elevate your bed, however, depends on how well and how comfortably you can sleep at an incline. Most recommend between 6-8 inches of elevation, although this can be adjusted lower or higher depending on your sleep position and tolerance for the incline.
Can I drink water before bed with acid reflux?
Sips of water can help reduce acid reflux by clearing and calming the throat. However, drinking a lot of water before bed can put pressure on the stomach and push gastric acid into the esophagus. Drink water moderately before bed, and be sure to avoid fatty, acidic, or alcoholic foods before bedtime, as these will increase the likelihood of reflux.