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The Special Risks of Nighttime Heartburn

Nighttime heartburn is painful. It disrupts your sleep and it can lead to serious medical problems.
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For the past seven years, Dave White of Easthampton, Mass., has slept with his head and chest uncomfortably propped up on a pile of pillows.

"It's the most difficult part of living with this condition," White says. "There are times when I've almost wept from the frustration of having to sleep [this way]." But if he doesn't, he risks a flare-up that sometimes "feels like a lit match being pressed to the top of my stomach."

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That condition is chronic heartburn, also known as GERD -- gastroesophageal reflux disease. 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, a relentless condition in which stomach acids back up into the esophagus. According to the American Gastroenterological Association, 25 million people have heartburn every day.

For many of them -- at least 50% according to some research -- nighttime 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 nighttime heartburn increases the risk of developing other serious conditions, including cancer of the esophagus.

The good news is that there's a lot you can do to relieve the pain and discomfort. "If you are experiencing nighttime heartburn, you should know that there are good treatments," says Stuart Spechler, MD, spokesman for the American Gastroenterological Association and chief of the division of gastroenterology at the Dallas VA Medical Center. "There's no reason anyone should be suffering with this."

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.

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