Why Reflux Gets Worse at Night — and What You Can Do About It

Do your reflux symptoms seem manageable during the day — but significantly worse at night?

If you experience nighttime acid reflux, chest burning when lying down, chronic coughing at bedtime, or waking up choking, you are not alone. Research shows that nocturnal gastroesophageal reflux disease (GERD) is common and can be more damaging than daytime reflux.

At Tampa Bay Reflux Center, specialists focus on identifying the root cause of reflux — especially when symptoms persist at night despite medication.

Let’s explore why reflux gets worse at night and what you can do about it.

Why Reflux Gets Worse When You Lie Down

1. Gravity No Longer Helps Keep Acid Down

During the day, gravity helps keep stomach contents in the stomach. When you lie flat, acid can more easily flow back into the esophagus.

Studies show that esophageal acid clearance is significantly slower in the supine position compared to upright posture (Katz et al., 2013).

2. Reduced Swallowing During Sleep

Swallowing helps clear acid from the esophagus. At night, swallowing frequency decreases, which prolongs acid exposure.

Research confirms that nighttime reflux episodes last longer and cause greater mucosal damage due to delayed acid clearance (Fass et al., 2005).

3. Increased Risk of Hiatal Hernia–Related Reflux

A hiatal hernia weakens the natural barrier between the stomach and esophagus. When lying down, this mechanical defect can allow reflux episodes to occur more frequently.

The American College of Gastroenterology identifies hiatal hernia as a major risk factor for persistent GERD symptoms (Katz et al., 2013).

4. Delayed Gastric Emptying at Night

Eating close to bedtime increases the likelihood that food and acid remain in the stomach while lying down, increasing reflux risk.

Studies show that late evening meals are associated with increased nocturnal acid exposure (Fass et al., 2005).

Why Nighttime Reflux Is More Dangerous

Nocturnal reflux is not just uncomfortable — it may be more harmful.

Research has linked nighttime GERD to:

  • Increased risk of esophagitis

  • Higher rates of Barrett’s esophagus

  • Sleep disruption

  • Reduced quality of life

Patients with nighttime reflux report significantly worse symptom severity and disease burden compared to those with daytime-only reflux (Mody et al., 2009).

Common Nighttime Reflux Symptoms

  • Burning chest pain when lying down

  • Regurgitation while sleeping

  • Waking up coughing or choking

  • Sour taste in the mouth

  • Chronic nighttime cough

  • Hoarseness in the morning

  • Sleep disturbances

If these symptoms occur frequently, further evaluation may be needed.

Evidence-Based Ways to Reduce Nighttime Reflux

1. Elevate the Head of the Bed

Raising the head of the bed by 6–8 inches has been shown to significantly reduce nocturnal acid exposure (Katz et al., 2013).

2. Sleep on Your Left Side

Studies indicate that left-side sleeping reduces reflux episodes compared to right-side positioning (Katz et al., 2013).

3. Avoid Eating 3 Hours Before Bed

Late-night meals increase supine acid exposure and worsen symptoms (Fass et al., 2005).

4. Maintain a Healthy Weight

Obesity increases intra-abdominal pressure and reflux frequency (Katz et al., 2013).

5. Seek Evaluation for Structural Causes

If lifestyle modifications and medications fail, structural issues such as hiatal hernia or lower esophageal sphincter weakness may require advanced evaluation.

At Tampa Bay Reflux Center, diagnostic tools may include:

  • pH impedance testing

  • Esophageal manometry

  • Upper endoscopy

  • Evaluation for hiatal hernia

For appropriate candidates, minimally invasive surgical correction may provide long-term relief by addressing the mechanical cause of reflux — not just suppressing acid.

When to See a Reflux Specialist

You should seek further evaluation if you experience:

  • Nighttime choking or coughing

  • Persistent reflux despite medication

  • Regurgitation while lying down

  • Chest discomfort at night

  • Difficulty sleeping due to reflux

Chronic nighttime reflux should not be ignored, as prolonged acid exposure increases the risk of complications.

Reflux often worsens at night due to gravity, reduced swallowing, and mechanical factors like hiatal hernia. Nighttime GERD is not only disruptive — it can be more damaging than daytime reflux.

If you are in the Tampa Bay area and struggling with persistent nighttime reflux symptoms, Tampa Bay Reflux Center provides advanced, evidence-based evaluation and treatment options designed to address the root cause and restore restful sleep.

Works Cited

Fass, R., Quan, S. F., O'Connor, G. T., Ervin, A., & Iber, C. (2005). Predictors of heartburn during sleep in a large prospective cohort study. Chest, 127(5), 1658–1666. Link

Katz, P. O., Gerson, L. B., & Vela, M. F. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. The American Journal of Gastroenterology, 108(3), 308–328. Link

Mody, R., et al. (2009). Burden of nocturnal gastroesophageal reflux disease. American Journal of Gastroenterology, 104(7), 1662–1667. Link

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