nocturnal reflux is dangerous


SLEEP position and reflux

Reflux of stomach contents into the esophagus and upper aerodigestive tract during sleep poses one of the greatest risks to the individual suffering from gastroesophageal reflux disease (GERD). When we lay flat, the protective effect of gravity is lost, and a straight line – or even a downstream tunnel – is created from the stomach, through the esophagus, and straight into the throat. In addition to laying flat, laying preferentially on one’s right side and other factors, such as snoring and sleep apnea, place additional pressure on the stomach that may promote nocturnal reflux. Surprisingly, the innate protective mechanisms we rely on to protect us against reflux are reduced during sleep, just when we need them the most.


Swallowing is an essential protective mechanism we rely on to combat GERD. The esophagus has intricate pressure and chemical receptors that can detect a reflux event and trigger reflexive peristalsis (automatic swallowing) to push the unwanted material back into the stomach. Saliva, the body’s own antacid, is another natural protective mechanism which helps prevent our organs from self-digestion. During sleep, our swallowing frequency and saliva production are both reduced – leaving us particularly vulnerable to the dangerous effects of nighttime reflux. Fortunately, there are things we can do to protect ourselves when we sleep.

Get Gravity on your Side

The most important intervention we can do to prevent nighttime reflux is to get gravity back on our side. Simply elevating the entire head of our bed or sleeping on a pillow wedge can significantly reduce the amount of reflux at rest. Unfortunately, propping ourselves up on a bunch of pillows is inadequate, as this can cause the acid and gastric contents to pool in the throat, increasing the complications and damage we are striving to avoid. Research suggests the magic number for the required amount of one’s head and torso to be elevated is 7 inches – less is not enough and any more hasn’t been shown to increase the benefit experienced at 7 inches.

benefits of an empty stomach

In addition to sleeping with one’s head and upper body elevated, going to bed on an empty stomach can significantly reduce reflux during sleep. The average stomach takes between four and five hours to empty a meal. Other factors, such as diabetes and numerous medications, can delay gastric emptying even further. The more food in your stomach when you lay down, the more likely it will be to reverse course and reflux into the esophagus and throat. Thus, it is essential to go to bed on an empty stomach. Waiting four hours before laying down can significantly reduce the frequency and amount of nighttime reflux – five hours is even better.
Not only are our body’s innate defenses hindered during sleep, medical therapy for GERD is also less effective. The mainstay for the medical treatment of GERD is the highly potent class of antacids called proton pump inhibitors (PPIs). These drugs work to block the acid pumps in the stomach and decrease the acidity of the stomach contents. Although these medications do not prevent reflux, the altered gastric physiology does help reduce the damaging effects of refluxed stomach contents. Unfortunately, these potent acid blockers work best to decrease acid production during meals and are less effective at reducing baseline acid production when the stomach is empty – overnight. Fortunately, taking alginate therapy before bed can coat and protect the throat and esophagus and can form a raft on top of the stomach to actually prevent the reflux of gastric contents.
Getting a safe and restful night’s sleep is essential for daily function and longevity. There isn’t an operation the body performs that is not affected by lack of sleep. Although the body’s reflux defense mechanisms take a nap when you need them the most, simply sleeping with gravity on your side and a little seaweed standing guard can make a world of difference.
Sweet dreams…


Still curious? Check out these references for even more details.

  1. Scott DR, Simon RA. Supraesophageal Reflux: Correlation of Position and Occurrence of Acid Reflux-Effect of Head-of-Bed Elevation on Supine Reflux. J Allergy Clin Immunol Pract. 2015 May-Jun;3(3):356-61. doi: 10.1016/j.jaip.2014.11.019. Epub 2015 Jan 14. PMID: 25609349. 
  2. Albarqouni L, Moynihan R, Clark J, Scott AM, Duggan A, Del Mar C. Head of bed elevation to relieve gastroesophageal reflux symptoms: a systematic review. BMC Fam Pract. 2021 Jan 19;22(1):24. doi: 10.1186/s12875-021-01369-0. PMID: 33468060; PMCID: PMC7816499. 

  3. Huang HC, Chang YJ, Tseng YL, Fang SY. Effect of Head-of-Bed Elevation on Nocturnal Reflux Symptoms of Esophageal Cancer Patients With Esophagectomy and Reconstruction. Cancer Nurs. 2021 May-Jun 01;44(3):244-250. doi: 10.1097/NCC.0000000000000769. PMID: 31868819. 

  4. Khan BA, Sodhi JS, Zargar SA, Javid G, Yattoo GN, Shah A, Gulzar GM, Khan MA. Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux. J Gastroenterol Hepatol. 2012 Jun;27(6):1078-82. doi: 10.1111/j.1440-1746.2011.06968.x. PMID: 22098332. 

  5. Kitchin LI, Castell DO. Rationale and efficacy of conservative therapy for gastroesophageal reflux disease. Arch Intern Med. 1991 Mar;151(3):448-54. PMID: 1672062.

  6. Huang HC, Fang SY. [A Systematic Review of the Literature Related to Elevating the Head of the Bed for Patients With Gastroesophageal Reflux Disease: Applications in Patients After Esophageal Cancer Surgery]. Hu Li Za Zhi. 2016 Jun;63(3):83-93. Chinese. doi: 10.6224/JN.63.3.83. PMID: 27250962. 

  7. Hamilton JW, Boisen RJ, Yamamoto DT, Wagner JL, Reichelderfer M. Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid. Dig Dis Sci. 1988 May;33(5):518-22. doi: 10.1007/BF01798350. PMID: 3359906.


Reflux Gourmet Pillow is designed by reflux and sleep surgeons to provide the optimal amount of elevation.

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The Reflux Gourmet Pillow design is based on years of clinical research to protect against reflux while promoting maximal comfort. The seven inch height has been shown to provide the optimal amount of chest elevation – less is not enough, and more is unnecessary – the Goldilocks Zone.


Due to the anatomic configuration of your stomach and esophagus, sleeping on one’s left side can also further protect against nighttime reflux.

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