Sleeping on the Left Side is Best for Gastroesophageal Reflux
For adults with hyperacidity (gastroesophageal reflux), sleeping on the left side is the recommended position to reduce nocturnal reflux symptoms and esophageal acid exposure. 1
Why Left-Side Sleeping Works
The left lateral decubitus position provides measurable benefits for GERD patients:
- Significantly reduces esophageal acid exposure time compared to right-side or supine sleeping (median 0.0% vs 1.2% for right side, p=0.022) 2
- Faster acid clearance from the esophagus occurs in the left position (median 35 seconds) compared to right-side (90 seconds, p=0.002) or supine positions (76 seconds, p=0.030) 2
- The right lateral position is associated with the worst outcomes—greater percent time with pH <4 (p<0.003) and longer acid clearance times (p<0.05) compared to all other positions 3
Anatomic Explanation
The benefit of left-side sleeping relates to the anatomy of the gastroesophageal junction:
- When lying on the left side, the gastric cardia (where the esophagus meets the stomach) is positioned higher than the gastric acid pool, making reflux mechanically more difficult 4, 3
- Right-side sleeping positions the gastroesophageal junction below the acid pool, facilitating reflux 3
Additional Sleep Modifications
Combine left-side sleeping with head-of-bed elevation for optimal symptom control:
- Elevate the entire upper body (not just pillows) by raising the head of the bed 20-28 cm with blocks 1, 5, 6
- Elevating only the head with pillows can worsen reflux by creating abdominal compression 1
- Head elevation reduces supine reflux time, improves acid clearance (p=0.001), and decreases sleep disturbances in 65% of patients 6
Timing Considerations
- Avoid lying down for 2-3 hours after meals to minimize postprandial reflux regardless of position 1, 7
- Reflux episodes occur within 1 minute of position changes 28% of the time, so maintaining the left lateral position throughout the night is important 3
Common Pitfall to Avoid
Do not sleep on the right side. Despite being a lateral position, right-side sleeping consistently shows the worst outcomes in multiple studies, with increased acid exposure and prolonged clearance times compared to all other positions 4, 3, 2
Important Clarification About Aspiration Risk
Contrary to common concerns, supine sleeping does not increase aspiration risk in GERD patients 1, 7. However, the left lateral position still provides superior acid control compared to supine positioning 2.