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For centuries, every individual, once in a lifetime, has experienced heartburn or commonly known as acidity, in the morning. Heartburn is a condition of burning sensation in the chest or throat when acid rises from the stomach. Generally, most of the people experience heartburn in the morning due to stomach acid flowing back up into the esophagus while we sleep. Heartburn or acid reflux is commonly called indigestion or acidity, is a symptom of gastroesophageal reflux disease (GERD), which occurs due to the backflow of stomach acid up into the esophagus. The common cause of heartburn or acid reflux may be the inability of the lower esophageal sphincter or LES to relax. It is a muscle that is located between the esophagus and the stomach. If it does not relax appropriately, it results in the backflow of acid from the stomach into the esophagus, which gives rise to heartburn. Some other common causes of heartburn and acid reflux are increased acid production in the stomach and indigestion. Still, many underlying causes may give rise to heartburn and acid reflux.

See: Ayurveda for GERD

GERD is a chronic disorder that affects the esophagus. Many studies have estimated that 20% of the U.S. adult population experience GERD-related symptoms at least once weekly. Studies also have demonstrated that around 79 percent of GERD patients undergo nighttime symptoms. Of these patients with nighttime heartburn, three-quarters reported that the symptoms affected their sleep and almost half said that symptoms affected their ability to operate the next day.

Reflux at night is associated with more aggressive symptoms of GERD. People with GERD encounter multiple, short arousals they are not able to recollect which leads to sleep fragmentation. At precisely the exact same time sleep deprivation, per se, can adversely impact GERD by improving the perception of acidity in the esophagus, and possibly by raising esophageal acid exposure time. For many, heartburn or burning sensation in your chest is worse at night, frequently after eating. Many also feel that the discomfort of acid reflux in the morning. 

See: Buttermilk for heartburn

What causes morning heartburn?

As per studies, it does appear that heartburn and sleep have a directly proportional relationship. Heartburn and acid reflux have been shown to adversely affect sleep by awakening people from sleep during the night. More commonly, people with heartburn experience multiple, short arousals that they are unable to recollect, which results in sleep fragmentation.

See: Hiatal hernia diet for GERD

Similarly, deprivation of sleep can adversely affect heartburn by enhancing the perception of acid in the esophagus (feeling of heartburn) and potentially increase esophageal exposure to stomach acid. Most of the individual’s heartburn in the morning is related to the fact that this type of heartburn is associated with aggressive symptoms of GERD, which involves a higher degree of acid backflow up into the esophagus. Other factors which contribute towards heartburn and acid reflux in the morning are the food habits, sleeping positions, etc. [1,2]

See: Mustard for heartburn & acid reflux relief

Sleep and morning acid refulx

Heartburn and acid reflux in the morning

Many studies have identified poor quality of sleep and a variety of sleep disturbances as extraesophageal symptoms of heartburn in the morning, which include sore throat, wheezing, and cough. Most importantly, the quality of life of those individuals suffering from heartburn in the morning seems to be a lot worse than the quality of life of individuals with daytime heartburn only. In a study, it was demonstrated that during sleep, people suffering from heartburn in the morning woke up multiple times. However, only half of the awakenings were associated with acid reflux. It was also demonstrated that most acid reflux events occurred after the subjects woke up from their sleep. Hence, they experienced heartburn episodes, 20-30 minutes after waking up in the morning.

Research suggests that the following are some of the common symptoms of heartburn in the morning.

Expulsion of sour-tasting acid back up into the mouth or throat

● When food takes longer to swallow, along with the feeling that food is sticking up to the esophagus

● Nausea

● Chest pain

● Sore throat

● Dry cough

Studies suggest that lifestyle habits have significantly contributed to the increasing symptoms of heartburn and acid reflux in the morning. These lifestyle habits include poor diet intake, lack of regular sleeping patterns, improper sleeping positions, etc. Diet or daily food intake significantly affects heartburn and acid reflux in individuals. As per studies, consumption of foods and drinks which are acidic affect the amount of acid in the stomach and thereby increase stomach acidity. Some of the foods and beverages induce the stomach to produce more acid, which also contributes to the greater acidity of the stomach. Heavy, fatty meals also contribute to the increasing acidity of the stomach. These foods may cause indigestion, which may give rise to acid reflux. Smoking and alcohol consumption also negatively affect individuals with heartburn and acid reflux condition. According to research, individuals who consumed late-night snacks or heavy meals at night experienced more significant episodes of heartburn in the morning as compared to those individuals who consumed light meals at night. 

Improper sleeping patterns and sleeping positions also significantly affect heartburn in the morning. According to a study, two groups of individuals sleeping patterns were compared. One group followed a regular sleeping pattern while the other group had an irregular sleeping pattern. Results concluded that the group which had regular sleeping patterns reported fewer heartburn episodes in the morning. Researchers also suggest that sleeping positions that involve sleeping on the stomach or the left side of the body favor acid reflux and result in heartburn in the morning. [3,4,5,6,7]

See: What does heartburn feel like

Heartburn and acid reflux in the morning treatments

Prevention of heartburn and acid reflux in the morning

According to research, it is found that including functional foods that improve digestion and neutralize stomach acid are essential for treating and preventing symptoms of heartburn in the morning. Foods and drinks, which are acidic and induce acid production in the stomach, should be avoided. Intake of heavy meals during the night should be avoided. Caffeine and carbonated drinks before bedtime should also be avoided. It is recommended that individuals who suffer from heartburn in the morning should follow a regular sleeping pattern. Sleeping positions during the sleep should be appropriate where the head should be elevated a few inches above the body to prevent acid reflux. It is always advised that if individuals experience regular episodes of heartburn in the morning, they should consult with a nearby doctor as the symptoms of heartburn and acid reflux can negatively affect digestion and health of the individual. [8]

See: Sleeping on the left side health benefits

Summary

Although most people experience heartburn or acid reflux in the morning, it is always wise to incorporate healthy eating habits to prevent the occurrence of these episodes. Avoid large and heavy meals in the night before sleep and incorporate a regular sleeping pattern. Foods and beverages which reduce the acidity of the stomach should be included to prevent episodes of heartburn in the morning. There are many OTC medicines available for treating the symptoms of heartburn in the morning. Consult a doctor before consuming such medications. Heartburn in the morning is a chronic condition that can always be managed by incorporating healthy lifestyle habits and avoiding triggers that induce episodes of heartburn in the morning.

See: Baking soda for heartburn & acid reflux

References

1. Heartburn and GERD: Overview. (2018). ncbi.nlm.nih.gov/books/NBK279254/

2. Gastroesophageal reflux disease (GERD)/heartburn. (n.d.). cedars-sinai.org/health-library/diseases-and-conditions/g/gastroesophageal-reflux-disease-gerdheartburn.html

3. Acid reflux. (n.d.). gi.org/topics/acid-reflux/

4. Mittal RK, Holloway RH, Penagini R, et al. Transient lower esophageal sphincter relaxation. Gastroenterology, 1995; 109:601–10.

5. Vantrappen G. Janssens J. Ghillebert G. The irritable esophagus- a frequent cause of angina-like pain. Lancet 1987; i: 1232-4.

6. Mayo Clinic Staff. (2019). Gastroesophageal reflux disease (GERD). mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940

7. Sleep and GERD. (2019). aboutgerd.org/sleep-gerd.html

8. 9 ways to relieve acid reflux without medication. (2019). health.harvard.edu/digestive-health/9-ways-to-relieve-acid-reflux-without-medication

See: GERD Cough Natural Treatment

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