From the Guidelines
To manage GERD symptoms at night, elevate the head of your bed by 6-8 inches and avoid eating within 3 hours of bedtime, as these lifestyle modifications can help reduce esophageal acid exposure and alleviate symptoms. GERD symptoms often worsen at night due to lying flat, which allows stomach acid to flow back into the esophagus. Common nighttime symptoms include heartburn, chest pain, regurgitation, coughing, choking sensations, and difficulty sleeping.
Key Recommendations
- Elevate the head of your bed by 6-8 inches using blocks or a wedge pillow to reduce esophageal acid exposure 1
- Avoid eating within 3 hours of bedtime to prevent acid reflux during sleep
- Sleep on your left side to help reduce symptoms
- Medications that can help include over-the-counter antacids like Tums for immediate relief, H2 blockers like famotidine (Pepcid) taken 30 minutes before dinner, or proton pump inhibitors like omeprazole (Prilosec) taken daily 1
Additional Considerations
- Avoid trigger foods in the evening, such as spicy foods, citrus, tomatoes, chocolate, caffeine, and alcohol
- Loose-fitting pajamas can reduce abdominal pressure
- For severe symptoms, prescription-strength PPIs may be necessary
- Upper endoscopy may be indicated in patients with heartburn and alarm symptoms, such as dysphagia, bleeding, anemia, weight loss, and recurrent vomiting 1
From the FDA Drug Label
Table 17: Frequency of Heartburn Variable | Placebo (n=43) | Lansoprazole 15 mg (n=80) | Lansoprazole 30 mg (n=86) Median % of Days without Heartburn | Week 1 | 10% | 71% * | 46% * Week 4 | 11% | 81% * | 76% * Week 8 | 13% | 84% * | 82% * % of Nights without Heartburn | Week 1 | 17% | 86% * | 57% * Week 4 | 25% | 89% * | 73% * Week 8 | 36% | 92% * | 80% *
Lansoprazole reduces night heartburn symptoms in patients with symptomatic GERD.
- The frequency and severity of night heartburn were significantly reduced with lansoprazole 15 mg once daily compared to placebo.
- No significant additional benefit from lansoprazole 30 mg once daily was observed for night heartburn symptoms. 2
From the Research
Gerd Symptoms at Night
- Nocturnal gastroesophageal reflux symptoms have a major impact on sleep quality and are associated with complicated gastroesophageal reflux disease (GERD) 3
- Symptoms of gastro-oesophageal reflux disease (GERD) range from mild to severe and, when they occur during night-time hours, can interfere with sleep patterns and reduce overall quality of life 4
Treatment Options
- A sequential treatment strategy, including head of bed elevation, prolonging dinner-to-bed time, promoting left lateral decubitus position and treatment with acid-suppressive medication is recommended for nocturnal gastroesophageal reflux symptoms 3
- Proton pump inhibitor therapy remains the treatment of choice for patients with more severe symptoms and those with erosive oesophagitis 4
- All PPIs suppress gastric acid secretion by blocking the gastric acid pump, H(+)/K(+)-adenosine triphosphatase (ATPase), but the physicochemical properties of these drugs result in variations in the degree of acid suppression, as well as the speed of onset of acid inhibition 5
Lifestyle Modifications
- Head of bed elevation, prolonging dinner-to-bed time, and promoting left lateral decubitus position are recommended lifestyle modifications for nocturnal gastroesophageal reflux symptoms 3
- Patient-initiated, as-needed treatment may not be the best choice for managing persistent night-time reflux because it requires patient arousal from sleep 4
Pharmacological Agents
- Proton pump inhibitors (PPIs) are widely utilized for the treatment of gastro-oesophageal reflux disease, as well as other acid-related disorders 5
- The characteristics of PPIs that have been developed subsequent to omeprazole offer several advantages over this prototype PPI, particularly with respect to the onset of acid suppression and reduced potential for inter-individual pharmacokinetic variation and drug interactions 5
- Rabeprazole has a more rapid onset of H+,K+-ATPase inhibition than the other PPIs and, compared with omeprazole, a greater effect on intragastric pH after the first dose 6