Sleeping Position for Patients with GERD
Patients with gastroesophageal reflux disease (GERD) should sleep in the left lateral decubitus position to reduce nocturnal reflux symptoms and improve sleep quality. 1, 2, 3
Optimal Sleeping Position for GERD
- The left lateral decubitus (left side down) position is associated with decreased acid exposure time and improved acid clearance compared to right lateral decubitus or supine positions 1, 2
- Sleeping on the right side is associated with greater percentage of time with pH <4 and longer esophageal acid clearance times, making it the least favorable position for GERD patients 2
- Randomized controlled trials have demonstrated that electronic sleep positional therapy promoting left-side sleeping significantly reduces nocturnal reflux symptoms and increases reflux-free nights 3
Physiological Rationale
- Left-side sleeping positions the gastroesophageal junction above the level of gastric contents, reducing the likelihood of reflux 4
- Right-side sleeping positions the gastroesophageal junction below the level of gastric contents, increasing reflux risk 2
- A sleep positioning device that maintains left lateral position while elevating the head/torso has been shown to significantly reduce esophageal acid exposure compared to other positions 4
Additional Recommendations for GERD Management
- Elevation of the head of the bed is recommended for patients with nighttime symptoms or regurgitation when recumbent 5, 6
- Avoid lying down for 2-3 hours after meals to reduce esophageal acid exposure 5, 6
- Weight loss should be recommended for all overweight or obese patients with GERD 5, 7
- Avoid trigger foods on an individualized basis, particularly alcohol, coffee, chocolate, and fatty foods 7, 6
Impact on Sleep Quality
- GERD is associated with decreased sleep efficiency, increased wake time after sleep onset, and altered sleep architecture 8
- These negative sleep quality impacts are more pronounced when sleeping on the right side and mostly ameliorated when sleeping on the left side 8
- A randomized controlled trial showed that promoting left-side sleeping effectively alleviates nocturnal reflux symptoms compared to sham treatment 3
Common Pitfalls and Caveats
- Elevating the head of the bed alone without attention to lateral position may be insufficient for optimal GERD symptom control 4
- Patients may naturally change positions during sleep, so devices that help maintain the left lateral position may be beneficial 3
- For patients with both GERD and sleep apnea, addressing both conditions simultaneously is important as they can exacerbate each other 6
- Despite common concerns about aspiration risk with supine positioning in GERD patients, multiple studies have not shown increased aspiration incidence with supine sleeping 5