The special risks of night-time heartburn

For some people long-term heartburn can be debilitating. Symptoms can become so bad that they are woken several times a night, making them so over-tired that their work performance is affected.

That condition is chronic heartburn, also known as GORD, gastro-oesophageal reflux disease. For most people heartburn is an occasional nuisance. It descends after an all-you-can-eat buffet or an office party. If you have heartburn regularly, it's likely to be a sign of GORD, a relentless condition in which stomach acids back up into the oesophagus. According to the NHS, it’s estimated that between 10% and 20% of people will have an episode at least once a week.

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

The good news is that there's a lot you can do to relieve the pain and discomfort. "If you are experiencing night-time heartburn, you should know that there are good treatments," says Dr Stuart Spechler.  "There's no reason anyone should be suffering with this", says the expert in gastroenterology, an area that concentrates on problems associated with the digestive system.

Why is night-time heartburn more dangerous?

Day or night, chronic reflux can gradually damage the oesophagus. It may lead to inflammation and scar tissue that narrows the oesophagus. In some people chronic heartburn can lead to Barrett's oesophagus, changes in the cells that increase the risk of oesophageal cancer.

Night-time heartburn tends to leave acid in the oesophagus longer, so it can cause more damage than daytime heartburn.

"A good part of the explanation is gravity", says Dr Lawrence Cheskin, co-author of Healing. During the day acids from the stomach may briefly force their way into your oesophagus, 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 oesophagus to the stomach. In people with GORD, which means nearly everyone with chronic heartburn, the sphincter is faulty. It doesn't fully close. So acids can reflux back up into the oesophagus. Because you're lying down, once acids get into the oesophagus 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 neutralise stomach acid. When you're asleep, the swallowing impulse is suppressed, Spechler says.