What causes acid reflux at night? Plus, how to calm your symptoms

Heartburn (acid reflux) is always uncomfortable, but it’s especially troublesome when it happens at night and affects your sleep.

Acid reflux occurs when acid leaves the stomach and rises in the esophagus (food pipe). This can happen when the band of muscle at the end of the esophagus (the sphincter) isn’t functioning as it should. Symptoms of acid reflux include a burning sensation, chest pain, and trouble swallowing.

Many people have heartburn occasionally, but if you experience it regularly, you may have gastroesophageal reflux disease (GERD).

According to the American College of Gastroenterology (ACG), lying down is a major factor contributing to heartburn. If you experience acid reflux at night, the ACG recommends sitting up or keeping your head elevated in bed. They also suggest waiting 2 to 3 hours after eating before lying down.

Certain foods

Some foods are more likely to cause acid reflux than others. Avoiding these foods near bedtime can reduce your chances of heartburn at night.

The ACG lists the following foods as “trigger foods” for acid reflux:

• chocolate
• greasy or spicy foods
• coffee
• peppermint
• tomato products
• alcohol

Medication side effects

Certain medications may cause acid reflux or make your symptoms worse. This is usually due to how they affect pressure or inflammation in your esophagus.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the following medications may increase your risk of acid influx:

• nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
• benzodiazepines, which are sedatives that relieve anxiety
• calcium channel blockers, used to treat high blood pressure
• some asthma medications
• tricyclic antidepressants

A 2017 review notes that other medications linked with acid reflux include:

• long-term aspirin use
• birth control pills
• hormone replacement therapy (HRT)
• anticholinergic medicines used to treat can treat obstructive pulmonary disease (COPD), gut disorders, and Parkinson’s disease, among other uses

Asthma

There is a strong link between asthma and acid reflux. A 2022 review reports that many people with asthma experience acid reflux.

The Asthma and Allergy Foundation of America (AAFA) reports that GERD is more common in people with asthma — and that GERD can activate asthma symptoms.

Experts believe that reflux may activate asthma symptoms, like wheezing or trouble breathing, when your stomach acid irritates the nerve endings in your esophagus. Conversely, asthma may activate acid reflux when breathing difficulties affect your esophageal sphincter.

People who take medication for GERD sometimes notice improvements in their asthma symptoms too. The researchers report that proton pump inhibitors are considered the primary treatment for GERD in people with asthma.

Research also suggests that asthma medications may lead to acid reflux.

According to the AAFA, asthma medications like prednisone and albuterol can impair how well the lower esophagus sphincter contracts, allowing stomach acid to escape and causing heartburn. Beta-agonists may also reduce the strength of this sphincter, leading to reflux.

Hernia

A hiatal hernia is when a small section of your stomach protrudes through a gap in your diaphragm toward your chest. Hiatal hernias typically have no symptoms except for GERD.

The diaphragm helps to create space between your esophagus from your stomach. When this structure is not intact, it can reduce the pressure your esophagus sphincter can withstand. This can cause acid reflux.

Treatment usually aims to relieve GERD symptoms through medication and lifestyle factors. A doctor may recommend surgery if other treatments haven’t had the desired effect.

Smoking

According to 2016 research, smoking can increase your risk of acid reflux.

This may happen through the following mechanisms:

• Reduced esophagus sphincter pressure: When this band of muscle gets weaker, stomach acid can more easily leak back up and cause heartburn.
• Reduced bicarbonate in your saliva: Bicarbonate neutralizes acidic substances and helps prevent heartburn. People who smoke have reduced amounts of this substance in their saliva.
• Physical stress: Research has shown that increased oxidative stress, which results from smoking, can increase your risk of Barrett’s esophagus, a condition that causes heartburn and is a precursor to esophageal cancer.

While E-cigarettes still contain nicotine, 2018 research notes that e-cigarette smoking increases the risk of nausea and vomiting — but not GERD.

Obesity

According to the ACG, people who have obesity or overweight are significantly more likely to experience GERD. Excess weight on the abdomen is a risk factor for acid reflux because higher abdominal pressure increases the risk of stomach acid leaking into the esophagus.

Likewise, people often experience acid reflux in the later stages of pregnancy when pressure in the abdomen is higher.

What to do during an acid reflux attack

Heartburn medication can relieve the symptoms of heartburn quickly. Research from 2009 notes that esomeprazole may be most effective at quickly reducing symptoms of heartburn and acid reflux.

Medications for acid reflux include:

• esomeprazole (Nexium)
• lansoprazole (Prevacid)
• omeprazole (Losec)
• rabeprazole (Aciphex)

A healthcare professional may recommend other treatments based on what’s causing your acid reflux, such as treatments for asthma or a hernia.

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How to prevent acid reflux

You may find that avoiding certain foods near bedtime (such as acidic and greasy foods) can prevent acid reflux from happening at night.

The National Health Service in the UK suggests the following lifestyle factors to treat and prevent acid reflux:

• avoiding eating 3 to 4 hours before bed
• raising the head of your bed so that your chest is above your waist, which can prevent stomach acid from traveling up
• avoiding tight clothing around your waist
• avoiding excessive alcohol intake
• avoiding smoking
• managing your weight
• reducing stress

When to talk with a doctor

The ACG recommends talking with a healthcare professional if your acid reflux symptoms aren’t resolved with lifestyle strategies, or if you use over-the-counter medications more than twice a week.

In addition, if you experience any of the following signs, talk with a healthcare professional:

• persistent difficulty swallowing (dysphagia), which can indicate esophagus damage
• blood in your stool that may look black and tarry
• persistent difficulty breathing
• dizziness

Summary

Acid reflux at night can be frustrating and disrupt your sleep. It happens when the contents of your stomach enter your esophagus.

You can treat some causes of acid reflux at home with lifestyle factors, such as avoiding certain foods before bed, raising the head of your bed, and taking acid reflux medication.

If at-home treatments don’t work or you need to take medication for acid reflux more than twice a week, it’s best to talk with a doctor.