Heartburn at night: how to improve sleep quality with heartburn

Heartburn symptoms

If you have heartburn, you'll feel a burning sensation in the top of your stomach or chest that travels up your neck. This is a symptom of acid reflux - where acid and food leaks from your stomach up into your throat (oesophagus). Despite the name, heartburn has nothing to do with your heart.

Heartburn may be common, but this doesn't mean you should ignore it if it keeps happening. Regular heartburn could mean that you have gastro-oesophageal reflux disease (GORD), a condition where the wall of muscle separating your stomach and oesophagus - called the lower oesophageal sphincter muscle - doesn't work properly. Occasionally, regular heartburn is a sign of something more serious.

What causes heartburn at night?

Heartburn keeps a lot of people up at night. In most cases, the reasons behind this are nothing to worry about and can be resolved by making a few changes at home. These slight changes can have a significant impact, because getting good quality sleep allows your body to repair and restore itself. As a result, sleep helps protect against several health conditions - from mental illness to heart disease and beyond.

Foods that cause heartburn at night

As a rule, eating or drinking anything spicy, fatty, or acidic in the evening makes nighttime heartburn much more likely. But these aren't the only causes.

Other causes of heartburn at night

It's not always about what and how late you eat. Heartburn at night may also be triggered by other lifestyle or medical factors.

These include:

• Experiencing high stress levels - can increase your stomach acid and aggravate acid reflux, heartburn, and GORD.¹

• Being overweight or obese - can increase pressure on your stomach or cause inflammation that damages your sphincter muscle.²

• Taking certain medications - such as ibuprofen, aspirin, antibiotics, steroids, and some heart medicines. If you suspect your medication could be causing issues, don't stop taking it. Instead, ask your doctor's advice before making any changes.

• Smoking - can affect your sphincter muscle and increase stomach acid and inflammation. Quitting has been shown to significantly reduce heartburn and other GORD symptoms in around half of cases after one year.³

• Wearing tight fitting clothing - can place extra pressure on your midsection, forcing stomach acid to rise and escape.

• Being pregnant - hormonal changes, stress, added pressure in your body, and weight gain during pregnancy can make you more vulnerable to heartburn. In fact, up to 45% of pregnant women experience heartburn.⁴

• Having a hiatus hernia - is a condition where your stomach pushes up into your chest, making you more prone to acid reflux and heartburn.

How to help get rid of heartburn at night

Several over-the-counter medicines can help relieve heartburn, allowing you to get a good night's rest. If you're pregnant, ask your doctor's advice first.

Antacids

These work by neutralising your stomach acid, which reduces the damage to your stomach and provides relief for both heartburn and indigestion that lasts a few hours. Ask your pharmacist for advice on what is best for you.

Acid reducers

These decrease the production of acid in your stomach. There are two main types - proton pump inhibitors (PPIs) are generally better at reducing stomach acid than histamine antagonists - also called H2 blockers. However, the latter are now prescription only and some have been taken off the market completely, for example ranitidine.

Both antacids and acid reducers can relieve heartburn, and it may be a case of trial and error to find what works best for you. As with all medications, there's a small chance of side effects, which includes digestive disturbances such as diarrhoea, constipation, and stomach pain, and other symptoms such as nausea, headache, and a sore throat.

These options are short-term treatments and shouldn't be used to manage an ongoing issue. If you experience heartburn at night for more than two consecutive weeks, see your doctor to find out the underlying cause and for stronger prescription medications.

How to improve sleep with heartburn

Heather Darwall-Smith is a psychotherapist and spokesperson for the UK Council for Psychotherapy (UKCP).

"Understanding your circadian rhythm - your internal body clock - can also help reduce heartburn and improve sleep," says Darwall-Smith.

She highlights some ways you can use this knowledge:

• Eat meals at regular times - this can help regulate your body's digestive processes and prevent digestive issues that can interfere with sleep. Aim to eat your last meal at least 2-3 hours before bedtime to allow time for digestion to slow down.

• Avoid late-night snacking - this can disrupt your body's natural rhythm and interfere with sleep quality. It's best to avoid eating or drinking anything except water in the hours leading up to bedtime.

• Limit caffeine - this can disrupt your circadian rhythm and interfere with sleep, so it’s best to avoid it in the evening and close to bedtime.

• Get plenty of natural light - exposure to natural light during the day can help regulate your circadian rhythm and promote better sleep at night. Try to get outside for at least 30 minutes each day and consider using bright light therapy if you can't get enough natural light.

How to address the underlying issue

Medications for heartburn at night may feel like all you need, but a recurring heartburn issue - that's not going away after changing your diet, evening routine, and sleep hygiene habits - needs to be investigated by a doctor.

Heartburn is often a symptom of GORD and sometimes of a condition known as Barrett's oesophagus, where cells in your oesophagus act in an abnormal way. While these conditions are both manageable, they can occasionally lead to more serious issues - such as oesophageal cancer.

According to Heartburn Cancer UK, around one in 10 people with heartburn unknowingly have Barrett’s oesophagus, which equates to around half a million people across the UK. Of these, around one in 10 may go on to develop oesophageal cancer, meaning as many as 50,000 people could be affected.

Some other underlying causes of heartburn - such as obesity, pregnancy, or a hiatus hernia - can be difficult to manage. It's important to find a more permanent solution by seeking support from a healthcare professional.