Why Is Nighttime Heartburn More Dangerous?Day or night, chronic reflux can gradually damage the esophagus. It may lead to inflammation and scar tissue that narrows the esophagus. In some people, chronic heartburn can lead to Barrett's esophagus, changes in the cells that increase the risk of esophageal cancer.
But nighttime heartburn tends to leave acid in the esophagus 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 esophagus. 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 esophagus 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 esophagus. And because you're lying down, once acids get into the esophagus, 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 neutralize stomach acid. But when you're asleep, the swallowing impulse is suppressed, Spechler says.
Nighttime Heartburn and Insomnia
The effects of nighttime heartburn aren't confined to esophagus. It can also result in chronic insomnia. Nighttime heartburn can wake you up and keep you up.
"The symptoms definitely aggravate insomnia," says Dave White, who has suffered from nighttime heartburn for years. "I'll wake up with cutting heartburn pain and then have to wait for the effects of [medicine] to kick in, which can take an hour or so. When that happens, I'll just get out of bed, since I know I'll be up anyway."
One recent study showed just how common nighttime heartburn can be. Researchers questioned nearly 15,300 average people and found that a whopping 25% reported having nighttime heartburn. The results were published in 2005 in the journal CHEST.
Another 2005 survey of 1,900 people with GERD in the U.S. and Europe found that about half had trouble sleeping at night. In these people, GERD symptoms caused a 22% impairment of leisure activities and a 15% impairment of their ability to work. The findings were presented during the 2005 Digestive Disease Week, an international conference for gastroenterologists. So the pain -- and consequences -- of nighttime heartburn go well beyond that burning in your chest.
