Why night-time reflux keeps you awake
and how to raise your bed properly

Do you wake up at night with an unpleasant burning behind your breastbone, a sour taste in your mouth, or a feeling that you can't breathe? Does morning hoarseness and a "lump" in your throat sound familiar?

Night-time reflux can turn sleep into a nightmare. Two big enemies meet here: the wrong body position and gravity.

As a trainer, I look at the body through anatomy and mechanics. In this article we'll explain why night-time reflux happens, the big mistake most people make when setting up their bed, and how to adjust your bed and evening routine so you wake up rested and without heartburn.

Why reflux is much worse at night

When you stand or sit, gravity naturally helps keep stomach juices down in the stomach. As soon as you lie flat, gravity is no longer on your side.

If your lower oesophageal sphincter is weakened, or your diaphragm is tense (from stress or poor breathing, for example), stomach acid literally has a free path up into the oesophagus.

Two more problems appear at night:

• We swallow less. During the day, saliva keeps flowing into the oesophagus and naturally neutralises any acid. At night saliva production drops.
• Juices stay in the oesophagus longer. Lying flat, it takes much longer for refluxed contents to get back down. The acid irritates the delicate lining of the oesophagus and throat for hours.

The most common mistake: a pile of pillows under your head

The first thing most people do when they have heartburn is add a second or third pillow under their head. But that is one of the worst things you can do.

What happens when you put pillows only under your head?

• You only bend your neck and upper back. Instead of raising the body evenly, you fold at the chest and belly.
• You compress the stomach and diaphragm. This raises intra-abdominal pressure, which pushes acid up through the oesophageal valve even harder.
• You block your breathing. Your neck stiffens and diaphragmatic breathing gets worse.

The golden rule: with reflux it's not enough to raise just your head. You need to tilt the whole upper half of your body so the oesophagus stays higher than the stomach, in one straight line.

How to raise your bed properly

The aim is a gentle slope of the whole body (about 10–15 degrees), with the shoulders and chest higher than the stomach. Gravity starts working for you again.

1. Raise the legs of the bed (the most effective solution). Put sturdy wedges, wooden blocks or special risers of 10 to 15 cm under the two legs at the head of the bed. The bed gets a continuous slope and the whole mattress tilts.

2. Raise the mattress or slats. If you can't raise the bed frame (built-in beds, for example), put a wedge under the mattress at head and chest level, or use an adjustable slatted base.

3. An anatomical wedge pillow. If you use a special reflux pillow, make sure it's a long wedge that starts at the lower back and raises the whole torso smoothly up to the head — not just the neck.

The evening routine: food and drink under control

Fighting night-time reflux doesn't start in bed. It starts with how you began your day.

Ideally: no food for 4 hours before sleep. So that your stomach goes to bed empty and acid has no reason to rise, ideally don't eat for 4 hours before sleeping.

What if unbearable hunger strikes? If hunger won't let you fall asleep, the worst option is anything heavy, fatty or sweet. Instead, have just 2–3 teaspoons of plain white yoghurt or sour cream, or half a banana. A few spoonfuls of yoghurt form a gentle protective film on the lining and mildly neutralise acid without starting a long, demanding digestion. A banana is easy to digest.

No drinking for an hour (or more) before bed. As with food, there's a strict rule for liquids. Don't drink for at least 1 hour before lying down. A lot of water just before bed increases the volume in your stomach — and once you lie down, the liquid easily flows up into the oesophagus.

It all starts with the daily routine and meal prep

So that you don't arrive at the evening ravenous and "making up" a whole day's deficit, adjust your habits during the day:

• Eat smaller portions, regularly. The stomach isn't overloaded at once and can digest as you go. Eating through the day gives you the nutrients you need, so you're not catching up in the evening.
• Plan and pack your meals. When you plan and prepare food in advance, you avoid going hungry during the day and overeating in the evening.
• Don't wash meals down with lots of liquid. The stomach contents swell and overload it.

What exactly to eat and what to avoid is covered in Food as medicine and trigger: a guide to eating with reflux.

More tips for calm sleep without reflux

• Sleep on your left side. The stomach is curved so that, lying on your left side, the entrance to the oesophagus sits higher than the level of stomach juices. Lying on your right side often makes reflux worse.
• Evening calm and breath. Before sleep, give yourself 5–15 minutes of breathing into the lower ribs and releasing the diaphragm. This switches the nervous system into relaxation mode (parasympathetic).

Summary

You don't have to put up with night-time reflux. A combination of mechanical changes and the right routine is often enough: raise the bed, keep a 4-hour gap without food and an hour without drinks before sleep, eat smaller portions during the day and release a tight diaphragm before bed.

Try these changes and see what a difference you feel in your sleep and your mornings. Remember to stick with them for a while, so your body can get used to them. Why reflux happens and what the diaphragm has to do with it, I explain in Why reflux troubles you and how exercise and breathing can help.