Gastroesophageal Reflux Disease (GERD) is a disease in which acidic contents from the stomach reflux into the esophagus, causing a feeling of "heartburn". These feelings normally worsen after eating or drinking certain contents, and can be relieved with antacids like Pepto Bismol. GERD can be extremely discomforting and can also lead to issues sleeping. However, this relationship is bidirectional and sleep can actually impact GERD as well. Continue reading to find out more about this relationship and what you can do to make sure you're getting optimal sleep. 

GERD Overview 

GERD is a chronic disorder and is the most common disease that affects the esophagus. The stomach is a very acidic environment that helps with the chemical breakdown of food. Normally, the esophagus closes and prevents this acid from refluxing back into the esophagus. However, when this fails, then acid goes back into the esophagus which is not equipped with the protective factors that the stomach has against such an acidic environment. As a result, there is a "burning" sensation and the cells in the esophagus slowly begin to change as they are continuously damaged by the acidity. 

About 1 in 5 US adults have experienced GERD-related symptoms at least once a week. Studies have also showed that up to 4 in 5 of GERD patients have nighttime symptoms. Of these patients with nighttime heartburn, 75% report that the symptoms impact their sleep, and nearly half of patients state that symptoms impact their ability to function the following day. 

GERD and Sleep 

GERD and sleep have a bidirectional relationship with GERD being shown to adversely affect sleep by waking people up from the night. People with GERD experience multiple, short arousals that they are unable to remember which results in sleep fragmentation. However, sleep deprivation can adversely affect GERD by enhancing the perception of acid in the esophagus and potentially increasing the esophageal acid exposure time. 

Nighttime reflux is associated with more aggressive symptoms of GERD like erosive esophagitis (Inflammation of the esophagus), complications of GERD, Barrett's esophagus, and cancer of the esophagus, etc. This is why it's so important that if you have GERD at night that you find a solution so you don't experience one of those more devastating complications. Also, people with nighttime GERD have a higher prevalence of symptoms in the oral cavities and airways. 

Poor sleep quality and sleep disturbances have been added to the list of extraesophageal symptoms that also include hoarseness, throat-clearing, sore throat, wheezing and chronic cough. Most importantly, the quality of life in those with nighttime heartburn seems to be significantly worse than the quality of life of those with daytime heartburn only. 

How the two interact with each other 

Several studies were conducted to find out how GERD and sleep deprivation are related to one another. One study found that time spent in bed prior to falling asleep is a vulnerable period for GERD to occur. The longer the time spent awake in bed, the greater the esophageal acid exposure experienced. This may be due to the fact that when lying down, but still awake, certain hormones haven't been released that change the opening and closing of these various valves, but gravity can impact the flow of acid from the stomach into the esophagus. 

Deep sleep has been shown to suppress gastroesophageal reflux. Most reflux events during sleep occur after the person woke from sleep. Waking up in the morning is also associated with a significant reflux. So transitioning from sleep to awake in the morning is associated with significant reflux in those with GERD. 

The major conclusion from these studies was the importance of minimizing the time people with GERD spend in bed awake. In order to evaluate this approach, researchers assessed the prescription drug ramelteon, which is a melatonin receptor agonist. Melatonin is a hormone naturally released by the body when it's time to go to sleep. Those who received ramelteon at night had significantly less GERD related symptoms during nighttime. 

Naps also are associated with GERD because of their association with more shallow sleep. Shallow sleep is the perfect environment for GERD to occur, so the combination of taking a nap after a meal may result in more severe GERD. 

Healthy Sleep and Sleep Stages

Getting good sleep is important for everyone, but especially those with chronic disorders, like GERD. Lack of quality sleep can impact your digestive symptoms. Conversely, symptoms of GI disorders can impact the quality of your sleep. To understand why sleep is important. The first thing to understand are the various stages of sleep. 

There are four stages of Non-rapid eye movement (NREM) sleep and one stage of REM sleep. 

• Stage 1: Brief stage between being awake and fully asleep. This stage is characterized by slowed muscle activity. 
• Stage 2: The second stage is when the body temperature drops, brain waves becomes slower and then breathing and heart rate stay regular. 
• Stage 3/4: This is the more restorative stage of sleep. The breathing slows down and the blood pressure drops. Energy is restored and repair to tissue occurs. Hormones for growth and development are also released in this stage. 
• Stage 5/REM sleep: This stage of sleep is as close to being awake as sleep gets because of the movement of the eyes during dreaming. This stage gives energy to the body and stimulates the brain regions responsible for learning and memory. 

Improving Your Sleep Habits 

If you struggle with getting a good night's rest, it's important that you find a way to overcome those struggles in order to improve your GERD symptoms. Some tips include: 

• sticking to a sleep schedule and waking up and going to bed at a regular time 
• exercise and include it in your regular schedule
• avoid caffeine and nicotine 
• avoid alcohol before bed 
• avoid large meals and beverages late at night 
• avoid naps after eating 
• don't take naps after 3 pm 
• relax before bed 
• don't lie awake in bed

For more assistance on getting a good night's sleep, please click the orange button below to take a free online sleep test and talk to a sleep professional today. 

https://aboutgerd.org/signs-and-symptoms/sleep-gerd/