The Special Risks of Night time Heartburn
Night time heartburn is painful. It disrupts your sleep and it can lead to serious medical problems.
R. Morgan Griffin
That condition is chronic heartburn, also known as GERD --.
For most people, heartburn is an occasional nuisance. It descends after an all-you-can-eat buffet or an office party. But if you have heartburn regularly, it's likely a sign of GERD (gastroesophageal reflux disease), a relentless condition in which stomach acids back up into the oesophagus.
For many people night time heartburn is a special problem. Since lying flat can aggravate the symptoms, trying to sleep can be painful and difficult. There can also be more serious long-term consequences. Studies show that night time heartburn increases the risk of developing other serious conditions, including cancer of the oesophagus.
Why Is Night time Heartburn More Dangerous?
Day or night, chronic reflux can gradually damage the oesophagus. It may lead to inflammation and scar tissue that narrows the oesophagus. In some people, chronic heartburn can lead to Barrett's oesophagus, changes in the cells that increase the risk of oesophageal cancer.
But night time heartburn tends to leave acid in the oesophagus longer, and therefore may cause more damage than daytime heartburn.
"A good part of the explanation is gravity," says Lawrence J. Cheskin, MD, co-author of Healing Heartburn and associate professor of medicine at the Johns Hopkins School of Medicine in Baltimore, Md. During the day, acids from the stomach may briefly force their way into your oesophagus. But gravity quickly pulls them back down to the stomach.
When you're lying down, gravity isn't pulling in the right direction. Instead, the stomach contents are pressing on the sphincter muscle that connects the oesophagus to the stomach. In people with GERD - which means nearly everyone with chronic heartburn - the sphincter is faulty. It doesn't fully close. So acids can reflux back up into the oesophagus. And because you're lying down, once acids get into the oesophagus, they can sit there for much longer than during the day. That can increase the damage.
Gravity isn't the only factor. When you're awake, you naturally swallow whenever acid begins to reflux. This pushes the acid back down into the stomach. Saliva also contains bicarbonate, which can neutralise stomach acid. But when you're asleep, the swallowing impulse is suppressed, Spechler says.
The link between night time heartburn and insomnia
The effects of night time heartburn aren't confined to the oesophagus. It can also result in chronic insomnia. Night time heartburn can wake you up and keep you up.
Heartburn symptoms checklist
Think you may have night time heartburn or GERD? Look for these signs.
One of the problems with chronic heartburn or GERD is that you may not know you have it. Many people aren't completely woken up by the symptoms at night. In some cases of GERD, there may be no symptoms at all, even when you're awake. However, there are a number of things you should look for.
In some cases of GERD, the acid can rise so high in the oesophagus that a person can actually breathe it in. This can lead to respiratory problems, such as cough or hoarseness.
- Waking up to a bitter, acidic taste in your mouth
- Sharp, burning pain in your chest that can extend up to your neck and throat
- Fatigue during the day
- Chronic cough or fits of coughing that wake you up in the night
- Sore throat, hoarseness, or asthma attacks
Sleeping with heartburn carries special cancer risks
There are other symptoms that experts call "warning signs." Any of them should be checked out right away.
Keep in mind that the symptoms of heartburn are similar in some ways to the symptoms of heart trouble. If you're experiencing pain that feels different from your usual heartburn, get it checked out immediately. Pain after physical activity -- as opposed to after a spicy meal -- is also a worrisome sign. If you have even the slightest doubt about your chest pain, err on the side of caution. Treat it as a medical emergency and go to the nearest emergency room.
- Trouble swallowing or painful swallowing
- Coughing up or vomiting blood
- Blood in the stool
- Unexplained weight loss
Tips for sleep without heartburn
If you've been waking up at night with heartburn, here are tips to help you sleep better:
- Raise the head of the bed by 4 to 6 inches, so you can sleep with your head and chest elevated. You can lift the top end of the bed by sticking blocks underneath -- although your spouse may object once he or she has slid out of the bed a few times. You could also lie on special wedge pillows designed to help you sleep on an incline.
- Eat meals two to three hours before bed, since this will reduce the risk of night time heartburn. Avoid bedtime snacks.
- Don't wear clothes that fit tightly around the waist, since they can aggravate your symptoms.
- Chew gum during the evening. This can boost the production of saliva, which neutralises stomach acid.
- Try sleeping on your left side. Some studies have shown that this helps with digestion, simply because of a quirk of the body's design. Sleeping on your right side seems to be most likely to aggravate symptoms.
- Avoid foods that can trigger reflux or irritate the oesophageal lining. These include alcohol, chocolate, peppermint, coffee, carbonated drinks, citrus fruits and juices, tomatoes, pepper, vinegar, catsup and mustard, and spicy or fatty foods.
- Don't use medicines that can worsen reflux. Examples include aspirin, other painkillers, and calcium-channel blockers. Check with your doctor about alternatives if you are currently taking any reflux-worsening medications. Never stop a medication without first talking to your doctor.
- If you smoke, stop.
- If you're overweight, try to lose some of your excess pounds.
(R) thedailystar.net 2006