Why Is Heartburn Worse at Night?

Heartburn can be more bothersome at night, and the pain and burning are sure to keep you wide awake. Here are some strategies you can try to put out the flames.

What Causes Heartburn?

Despite its name, heartburn does not affect your heart. Instead, it happens when acid from your stomach backs up into your esophagus (the tube that connects your throat and stomach). It causes symptoms like:

  • Pain or burning in your throat or chest.
  • A feeling like food is backing up in your throat.
  • Coughing or feeling the need to clear your throat.
  • Burping or belching.
  • Excessive mouthwatering.

There’s a muscle at the bottom of your esophagus that opens to let food pass into your stomach when you eat. This muscle should stay closed afterward, but sometimes it relaxes or doesn’t close tightly. This allows stomach acid to come back up (reflux) into your esophagus.

It’s not uncommon to have a mild or occasional case of heartburn after you eat something acidic, or when you eat too much or too fast. But some people get heartburn more frequently. You might be at higher risk if you:

  • Are overweight.
  • Are pregnant.
  • Smoke.
  • Drink alcohol.
  • Take certain medicines for anxiety, pain relief, asthma, or blood pressure.

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Heartburn at Night

If you feel like your heartburn is worse at night, it’s probably due to gravity instead of the time of day. When you stand up, gravity helps to keep food from refluxing upward into your esophagus. However, when you’re lying down, it’s easier for acid to sneak out of your stomach.

For many people, your nighttime meal is also the largest and heaviest meal of the day. That means it takes longer to digest and exit your stomach. If you tend to eat dinner and then crash on the sofa or head right to bed, that can cause nighttime heartburn.

According to UPMC gastroenterologist Ken Fasanella, MD, “In previously published studies, people who ate within three hours of going to bed were over seven times more likely to report nocturnal reflux symptoms. This was confirmed in later research using 48-hour esophageal reflux testing, which showed significantly more reflux when subjects ate two-hours compared to six hours before bedtime.”

Other things that can worsen nighttime heartburn include:

  • Eating too fast or overeating.
  • Wearing a tight belt, clothes, or body shaping undergarments.
  • Exercising, especially sit-ups or crunches after eating.

Most of the time, some simple lifestyle changes can prevent heartburn from acting up at night.

How to Reduce Heartburn at Night

The best thing you can do to reduce heartburn any time is to maintain a healthy weight. Carrying extra weight, especially in your belly, puts pressure on your stomach and esophagus. That can weaken the muscle between your esophagus and stomach and cause more frequent heartburn.

It’s also helpful to avoid eating close to bedtime — and if you’re a midnight snacker, it’s time to break the habit. Try to stop eating at least three hours before lying down, so your food can digest. You might also find it helpful to eat your largest meal earlier in the day and have a lighter dinner.

If your heartburn gets active when you lie down, try raising the head of your bed four to six inches. You can prop up the top of your mattress with blocks or a mattress wedge. Or try using extra pillows to sleep in a semi-upright position.

If these steps don’t work, talk to your doctor, or contact UPMC’s Digestive Health Care. These practitioners may recommend medicines or other treatments that can help.

What to Eat for Heartburn?

Certain foods might trigger heartburn, especially if you eat them in the evening. Common culprits include:

  • Tomato-based foods like pizza, ketchup, or spaghetti sauce.
  • Spicy foods.
  • Fried or fatty foods.
  • Acidic foods like vinegar-based salad dressings or citrus juices.
  • Carbonated soft drinks.
  • Coffee (even decaf).
  • Mint.
  • Chocolate.
  • Alcohol.

Not everyone who gets heartburn is sensitive to these foods. You might find it helpful to keep a food and symptom journal to monitor foods that bother you. Also, working with a dietitian might help you to uncover heartburn triggers.

Eating smaller meals may help too. Large meals take longer to digest and put additional pressure on your stomach and esophagus. Try eating five or six small meals each day instead of three large ones.

It’s not unusual to have occasional heartburn. But if these changes don’t help, talk to your doctor to see if medicine or further testing or treatments are necessary.

Editor's Note: This article was originally published on , and was last reviewed on .

National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. Acid Reflux (GER & GERD) in Adults.LINK

American Gastroenterological Association. What is GERD? LINK

About Digestive Disorders

UPMC Digestive Health Care cares for a wide range of gastrointestinal (GI) conditions and diseases, from diagnosis to treatment. Whether your digestive condition is common or complicated, our experts can help. Upon referral from your physician, we coordinate your testing and treatment. If you have a complicated condition, we can refer you to one of UPMC’s digestive health centers of excellence. Find a GI doctor near you.