Have you ever been awoken by a burning sensation in your chest or coughing and choking from stomach acid that has flowed back up to your throat?

These unpleasant events are what you call heartburn and acid reflux, respectively. If you experience them frequently, the condition is known as Gastroesophageal Reflux Disease (GERD), which can unfortunately worsen when you lie down at night.

Read on to discover the causes of GERD, its nighttime symptoms, and the sleeping positions that’ll ease the discomfort, as well as other ways to find relief.

• The best sleeping position for GERD is sleeping on your left side, as it positions the stomach below the esophagus, making it harder for gastric acid to travel upward.

• GERD symptoms worsen at night because lying down doesn’t allow gravity to prevent the backwash of stomach acid, swallowing slows during sleep, and the production of acid-neutralizing saliva decreases.

• Reduce GERD symptoms by avoiding heavy meals before bedtime, wearing loose-fitting clothing, and maintaining a healthy weight, among other measures.

GERD is a gastrointestinal disorder that occurs when gastric acid flows back to the tube that connects your stomach and mouth, known as the esophagus (or the food pipe). The backwash irritates the lining of your esophagus, manifesting as heartburn. It can also burn your throat.

Sounds a lot like acid reflux, doesn’t it? The symptoms of the two are in fact identical. GERD is simply the more serious and chronic form of acid reflux. If you have severe acid reflux at least twice a week, you qualify for a diagnosis of GERD.

GERD is caused by your esophagus’ inability to prevent acid from your stomach from flowing back upwards. Several factors contribute to the issue:

• Being obese or overweight increases your risk of GERD. The extra weight around your middle puts more pressure on your abdomen, forcing the stomach acid back up.

  Excess weight also weakens the lower esophageal sphincter (LES), which is the muscle that ensures the one-way path of stomach acid. It may also lead to the sphincter relaxing when it shouldn’t, resulting in the acid backflow.

• Expectant mamas often experience GERD. According to the Cleveland Clinic, it occurs in 30% to 80% of pregnant women.⁽¹⁾ During pregnancy, the body produces more progesterone, relaxing the muscles to prepare for the big day. However, it also relaxes the LES, which leads to acid traveling back upwards. GERD usually resolves after the pregnancy.

• Smoking can lead to GERD. The inhalation of smoke relaxes the LES, which also triggers coughing, allowing acid to flow back up. Smoking also produces more stomach acid and slows digestion, contributing to the backflow.

• A hiatal hernia can also be the cause of GERD. It occurs when the upper part of your stomach pushes up and over your diaphragm and beside your food pipe. The hernia weakens your LES and separates it from the diaphragm, which plays a part in helping keep stomach acid down.

• Certain medications can also trigger GERD. For example, NSAIDs (ibuprofen and aspirin) increase the production of stomach acid and irritate the esophagus. Some blood pressure medications can relax the LES. The same goes for anxiety medications, such as benzodiazepines and lorazepam.

The star symptom of nighttime GERD is acid reflux. It can disrupt sleep, causing you to wake up coughing or choking on sour gastric acid.

Your swallowing reflex slows when you sleep, which means you can’t swallow gastric acid as much as you should. Lying down also means you don’t have gravity’s downward pull to prevent acid backwash.

Other nighttime GERD symptoms include:

• A dry and persistent cough, caused by stomach acid triggering an uncomfortable feeling in your throat

• Asthma flare-ups caused by small drops of stomach acid that enter your lungs, irritating your bronchial tubes. The acid can also make your food pipe constrict, triggering wheezing and coughing.

• A sore throat when you wake up, caused by stomach acid that remains in your esophagus, irritating your throat when you lie down.

• Feeling like something is stuck in your throat when there isn’t anything there. You may have difficulty swallowing because the throat muscles are inflamed from the acid.

• Chest pain linked to GERD feels like a weight on the chest, and may even feel like a heart attack. Stomach acid burns the lining of your esophagus, triggering nerve endings that cause referred pain in your chest.

  It can also cause muscle contractions in the esophagus that are felt in the chest. If the pain persists or happens often, seek medical help.

• You might also experience a post-nasal drip from GERD when the acid irritates your throat and upper airways. As an anti-inflammatory response, your body produces more mucus.

Side sleeping positions help with certain medical conditions, acid reflux included. The optimal position for GERD is sleeping on the left side.

It’s the best side to sleep on because your stomach rests on the left side of your abdomen. In this position, your stomach sits lower than your esophagus, making it harder for acid to travel backward.

A study published in the Journal of Clinical Sleep Medicine found that right-side sleeping participants with GERD experienced lower sleep quality than those who slept on their left.⁽²⁾ However, consider sleeping on your right side as the runner-up.

Here’s how to sleep on your left side with GERD:

• Lie down on your left side completely. Your right shoulder should point towards the ceiling. Position your arms comfortably, such as under the pillow or resting on your side.

• Bending your knees slightly relieves pressure on the stomach and relaxes the spine. A pillow between the knees can promote optimal spinal alignment. A full-body pillow also helps to maintain proper alignment. It’ll also discourage turning to a stomach sleeping position.

• Use a wedge pillow to elevate your head by six to eight inches. This comfortable angle helps gravity keep stomach acid down. Don’t elevate your head too high, as it may cause neck discomfort.

Sleeping on your back with GERD also works. Use a supportive pillow or an adjustable bed frame to keep your head elevated by a few inches. An elevated upper body position helps gravity prevent acid backflow.

The worst sleeping posture for acid reflux is on your stomach. The prone sleeping position puts direct pressure on your abdomen, squeezing stomach contents upwards.

Your head is also turned to one side, twisting your neck and spine, creating an angle between your stomach and food pipe that allows for easier acid backflow.

Apart from the recommended sleeping positions, there are other ways to ease the symptoms of nighttime GERD:

• Lay off spicy, greasy, acidic and fatty foods that trigger GERD. Avoid drinking alcohol and caffeine. Eat alkaline foods like bananas and cauliflower to maintain a healthy gut acidity.

• Maintain a healthy weight, as excess weight can put more pressure on the abdomen. Dropping a few pounds can reduce symptoms.

• Ditch tight clothing like shapewear, high-waist skinny jeans, and belts that put pressure on your abdomen. Wear loose-fitting clothes.

• Avoid heavy meals before bedtime because they increase pressure on your abdomen. Give your stomach time to empty itself by eating at least 3 hours before bedtime.

• Avoid gulping down food or liquids. It increases your intake of air, which puts pressure on your abdomen. Not chewing your food properly also makes it harder to digest.

• Don’t lie down immediately after a meal because it puts pressure on the LES and slows food movement to the digestive tract. The longer food remains in your stomach, the more acid your body makes.

• Sip on a cup of chamomile tea at least 30 minutes after a meal and another before sleeping. While it doesn’t neutralize acid, a study published in the journal Nutrients suggests that chamomile tea has anti-inflammatory properties and can soothe the digestive tract.⁽³⁾

• Chew sugar-free gum because it helps increase the production of acid-neutralizing saliva. It needs to be sugar-free because sugar triggers GERD in some people.

Living with GERD doesn’t mean you’re forever doomed to nights of discomfort and poor sleep quality. The correct sleeping positions (left side is best), an appropriate diet, and lifestyle changes can reduce its symptoms.

We hope this article helped you make your GERD experiences more bearable. Do you have any tips for others with acid reflux? Leave a comment below.

Acid reflux worsens at bedtime because when you’re lying down, gravity can’t help keep stomach acid down. Swallowing also slows during sleep, so you can’t clear gastric acid from your food pipe as often. You also produce less acid-neutralizing saliva during sleep, which doesn’t help matters either.

You can sleep on your back when you have acid reflux, provided you keep your upper body elevated at six to eight inches. Use a wedge-shaped pillow or an adjustable bed frame.

Acid reflux can make you throw up in your sleep, but it’s more a case of severe regurgitation than actual vomiting. It happens because you can’t clear acid from your esophagus due to a slower swallow reflex.

If you wake up choking on acid reflux, sit up immediately.. Drink small sips of water and stay upright for at least 30 minutes. Take an over-the-counter antacid to neutralize the acid and a teaspoon of honey to soothe your irritated throat.

Sources:  

(1) ““Heartburn During Pregnancy.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/12011-heartburn-during-pregnancy. Accessed 18 July 2025.

(2) “Relationship between gastroesophageal reflux disease and objective sleep quality.” Journal of Clinical Sleep Medicine, jcsm.aasm.org/doi/10.5664/jcsm.10198. Accessed 18 July 2025.

(3) “Functional Food in Relation to Gastroesophageal Reflux Disease (GERD).” Nutrients, www.mdpi.com/2072-6643/15/16/3583. Accessed 21 July 2025.

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