Heartburn - Night Pains: Is Heartburn Keeping You Up?

Night Pains: Is Heartburn Keeping You Up?

Author:

University of Connecticut Health Center, Farmington, Connecticut

Boston Medical Center and Boston University School of Medicine

Medically Reviewed On: January 09, 2002

Heartburn can create tremendous discomfort during daytime hours, but nighttime heartburn can positively torment. Freed from the burdens of gravity and regular daytime swallowing, acids creep up into the esophagus and do their terrible work.

Below, two gastroenterologists discuss nighttime heartburn, and how to stop those sleepless nights.

How prevalent is nighttime heartburn?
MICHAEL WOLFE, MD: It's actually a more significant problem than previously thought. We used to think of heartburn as occurring only after meals. But a recent Gallup poll concluded that nighttime heartburn is quite common. And, actually, in many situations, it is more bothersome at night than during the daytime.

What happens in the body that creates heartburn pain?
JAMES FRESTON, MD, PhD: Well, acid comes up into the esophagus, where it doesn't belong, and causes the pain. When a person is lying down at night, he doesn't have gravity to pull the acid back down into the stomach, like if he were upright. Also, when a person is asleep, there is less swallowing. Swallowing clears the esophagus of acid, and saliva helps neutralize the acid.

MICHAEL WOLFE, MD: Saliva is a natural antacid. It has bicarbonate inside it. And, of course, saliva is free.

For some people who are medicated for heartburn, there is a breakthrough at night. How often does this happen?
MICHAEL WOLFE, MD: The classic example are the proton pump inhibitors which block the final step of acid production in the stomach. They're a wonderful medication. And most people actually successfully relieve their heartburn by taking one pill a day in the morning. But there are a significant number of people who actually will breakthrough at night. It's called "nocturnal acid breakthrough." And it will occur right in the middle of the night, when someone is sound asleep. Not a good way to start the next day.

But if these medications are turning off acid production, why is there acid there to get through?
JAMES FRESTON, MD, PhD: Well, proton pump inhibitors are used in the morning. And their effect gradually wears off. As their effect is wearing off, the person is lying down. The wearing off of the medication, the loss of gravity, and reduction of saliva and swallowing combine to drive the heartburn in.

What can people do?
MICHAEL WOLFE, MD: Well, staying up all night is one method. Another is to elevate the entire head of the bed. That's great for the patient, but for the person sleeping with the patient, it's not too cool sometimes.

There are certain wedges one can use to raise the entire thorax -- not just the head of the bed with pillows, but rather from the waist up.

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