Nocturnal reflux is an underappreciated clinical challenge that many patients with gastro-esophageal disease (GERD) face. One of the main concerns with nocturnal reflux is there is no clear protocol to identify patients with nocturnal reflux. However, it is known that many patients with nocturnal reflux do have respiratory disease, mostly in the form of asthma. Other illnesses included recurrent bronchitis and aspiration pneumonia.
Patients with nocturnal reflux also appear to have a problem with insomnia. In one study that appeared in the medical journal Chest, in a study of 1900 patients, over half of the patients surveyed were found to have difficulty sleeping at night. In another study, it was found that 3/4 of the patients reported that their heartburn symptoms affected their sleep and that of those patients with affected sleep, 40% stated that it did affect their ability to function the following day.
For the treatment of nocturnal reflux, studies have shown that Prilosec is more effective in the reduction of symptoms of heartburn nocturnally than Zantac. Unfortunately, there is much more to be done than to take a Prilosec for the reduction of nocturnal reflux.
Lifestyle changes are far more important in the treatment of nocturnal reflux than taking a proton pump inhibitors (PPI). As I have discussed before, lifestyle changes that are important include at least three hours between dinner and the time you go to bed. No late-night alcohol use. Eliminate caffeine products in the late afternoon and evening. No chocolate in the evening.
In addition, tobacco use needs to be eliminated, especially at night because nicotine causes relaxation of the lower esophageal sphincter. I mention this because of the rise in the number of patients who are vaping. According to multiple studies, vaping actually increases the amount of nicotine you are absorbing into your body, compared to cigarettes. The more nicotine in your system, the worse your nocturnal reflux will be. I actually have a patient who was transitioning to vaping because of her underlying lung disease. Unfortunately for this individual, she still has bouts of bronchitis, most likely being driven by her nocturnal reflux which is worsened by the vaping.
Reflux is a disease that, in itself, may not seem damaging. However, reflux can affect patients in so many different ways – creating a significant negative impact on the quality of their lives. If you are having difficulty sleeping and find yourself waking up several times a night and you are experiencing heartburn like symptoms, please have yourself evaluated to make sure we are not missing heart disease first of all, and that if it is due to nocturnal reflux, that you address it aggressively.
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