How to prevent aspiration while sleeping

Acid reflux is the upward flow of stomach acid into the esophagus (the tube that connects your throat to your stomach). Gastroesophageal reflux disease (GERD) is a chronic medical condition with frequent acid reflux. It’s estimated that up to 20% of the U.S. population has GERD.

Acid reflux and GERD are common problems that interfere with everyday life and may also interrupt sleep. Continue reading to learn how to manage GERD symptoms to prevent heartburn, improve sleep, and avoid choking on acid reflux at night.

There are several theories as to why acid reflux occurs at night. 

During the day, gravity helps send rising digestive acid in your esophagus back down into your stomach. When you're horizontal while lying in bed, you don't have the assistance of gravity to help send refluxed stomach acid back into the stomach, so it stays longer in the esophagus.

Another reason for nighttime acid reflux is decreased swallowing at night. This can make it more difficult for your body to push acid reflux back into your stomach. You also produce less saliva during deep sleep, and saliva usually helps neutralize stomach acid. Saliva contains bicarbonate, which is a buffer that can neutralize stomach acid.

The longer acid reflux stays in the esophagus, the more heartburn and other symptoms occur. This can lead to aspiration (the accidental breathing in of food or fluid into the lungs) of the acid reflux, or choking (getting food or other objects stuck in the throat).

Waking up to the sensation of choking on acid reflux can be scary. However, there are several things you can do to help prevent or decrease acid reflux at night and, in turn, reduce the chances of choking on acid reflux while sleeping.

Oftentimes people with GERD find that their symptoms occur or get worse after eating certain foods or having certain drinks. Your healthcare provider or dietitian might recommend reducing or avoiding certain foods or beverages to see if this helps decrease your GERD symptoms.

Some common dietary triggers for GERD are:

• Acidic foods (common culprits are citrus fruits, tomatoes, and tomato products)
• High-fat or greasy foods
• Spicy foods
• Chocolate
• Mint
• Salt and salted foods
• Caffeinated beverages, such as coffee and tea
• Alcoholic beverages
• Carbonated beverages

You may find that there are other foods not on this list that trigger GERD symptoms in you. Discuss them with your healthcare provider or dietitian.

Allowing more time for your food to digest and empty from your stomach can help decrease the likelihood of acid backing up into your esophagus at night.

If you experience GERD symptoms at night or when lying down, try eating meals at least three hours before you lie down or go to bed to help improve symptoms of GERD and the risk of choking on reflux at night.

Clothes that are tight-fitting, especially around your waist and abdominal area, put increased pressure on your stomach. This can push the contents of your stomach back up into the esophagus, causing heartburn or other symptoms of GERD.

To help reduce symptoms of GERD, wear clothing that is loose-fitting and comfortable around your waist.

Instead of lying flat, try using gravity to your advantage at night to help improve your GERD symptoms. Elevating your head with a wedge pillow or keeping the head of your bed elevated at an angle can be helpful for reducing nighttime GERD symptoms, including choking on reflux while sleeping.

Smoking is considered to be a risk factor for the development of GERD. Additionally, smoking causes more severe symptoms in patients with GERD. If you smoke, quitting may help alleviate your GERD symptoms.

Excess weight, especially in the abdomen, and increased adipose (fat) tissue are both considered risk factors for the development of GERD.

Some researchers have noted that excess weight, especially in the abdominal area, might trigger GERD symptoms due to an increase in abdominal pressure, slower emptying of the stomach, decreased lower esophageal sphincter pressure, and increased temporary lower esophageal sphincter relaxations.

Maintaining a healthy weight may help decrease these effects and, in turn, improve GERD symptoms.

In addition to the above, some of the tips below might help manage your symptoms of acid reflux during the day.

Medications that are available over the counter or by prescription can help decrease your GERD symptoms. Common GERD medications include antacids, H2 blockers, and proton pump inhibitors (PPIs). Talk with your healthcare provider about what medication (if any) might be appropriate for you.

Regular mild to moderate exercise has been shown to reduce the symptoms of reflux. Regular physical activity can also help maintain a healthy weight. However, excessive physical activity may be a risk factor for the development of GERD.

Eating large volumes of food at a time may increase your chances of reflux and GERD symptoms due to increased stomach pressure. Eating smaller amounts of food at a time may help decrease the likelihood of food backing up into the esophagus, and thus improving symptoms of GERD.

High stress levels can make symptoms of GERD worse. According to a 2013 study, stress doesn’t necessarily "cause" GERD, though it may enhance the perception of symptoms.

Finding a way that helps you relax and destress can go a long way in helping improve your GERD symptoms. This might be through meditation, breathing exercises, talking with a friend or therapist, reading a good book, or getting seven to nine hours of quality sleep each night.

Gastroesophageal reflux disease (GERD) is a chronic medical condition with frequent acid reflux. Sometimes if GERD occurs at night it can cause choking while sleeping. Steps you can take to help reduce the risk of choking on acid reflux while sleeping include avoiding trigger foods, not eating right before bedtime, changing your sleep position, wearing loose-fitting clothing, quitting smoking, and maintaining a healthy weight.

Choking on acid reflux can be a scary occurrence to wake up to. However, there are several steps you can take to help prevent or decrease acid reflux at night, which can reduce the chances of choking on acid reflux while sleeping.

Along with talking to your healthcare provider about your concerns and symptoms, try some of the home remedies listed here. Together, you can develop a treatment plan to ease your GERD symptoms and allow you to sleep peacefully without interruption from acid reflux.

Frequently Asked Questions

• Why is GERD worse after going to bed?

  GERD can be worse after going to bed because your body is no longer in an upright position, with gravity helping to keep the contents of your stomach down. When you lie down, it is easier for acid reflux to go back up the esophagus and stay there for longer.

  In addition, due to decreased swallowing at night, there is less pushing of acid reflux back into your stomach from swallowing actions. During deep sleep, you also make less saliva (which helps neutralize stomach acid).

• Does drinking water help acid reflux?

  Water is a great beverage to drink for hydration and is especially helpful for people who experience acid reflux. Most water has a neutral pH, which can raise the pH of an acidic meal.

  However, be careful not to drink large volumes of water at a time, as this may fill the stomach and put pressure on the lower esophageal sphincter, which helps to keep food down, resulting in reflux.

• What does "sleep hygiene" mean?

  The term "sleep hygiene" refers to the habits and practices that are helpful to sleeping well on a regular basis. It includes your sleep environment, the times at which you go to bed and wake up, your bedtime routine, and other habits you do leading up to going to sleep each night.