GERD and Sleep

GERD, also known as acid reflux, is an acronym that stands for gastroesophageal reflux disease. It is a chronic illness that affects 5-7% of the world population and is associated with serious medical complications if untreated. GERD is the 3rd most common gastrointestinal disorder in the U.S. Most patients with GERD also experience nighttime heartburn, which is more bothersome. And according to the 2001 NSF Sleep in America poll, adults in America who experience nighttime heartburn are more likely to report having symptoms of sleep problems/disorders such as insomnia, sleep apnea, daytime sleepiness and restless legs syndrome than those who don’t have nighttime heartburn.

GERD describes a backflow of acid from the stomach into the esophagus. Most patients with GERD experience an increase in the severity of symptoms (usually heartburn or coughing and choking) while sleeping or attempting to sleep. If the acid backs up as far as the throat and larynx, the sleeper will wake up coughing and choking. If the acid only backs up as far as the esophagus the symptom is usually experienced as heartburn.

Most people refer to GERD as heartburn, although you can have it without heartburn. Sometimes GERD can cause serious complications including inflammation of the esophagus from stomach acid that causes bleeding or ulcers. In a relatively small number of patients, GERD has been reported to result in a condition called Barrett's esophagus, which over time can lead to cancer. Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.

GERD is common and may be frequently overlooked in children. It can cause repeated vomiting, coughing, and other respiratory problems. Talk to your child's doctor if the problem occurs regularly and causes discomfort.

No one knows why people get GERD but factors that may contribute to it include:

• age
• diet
• alcohol use
• obesity
• pregnancy
• smoking

Also, certain foods can be associated with reflux events, including:

• citrus fruits
• chocolate
• drinks with caffeine
• fatty and fried foods
• garlic and onions
• mint flavorings
• spicy foods
• tomato-based foods, like spaghetti sauce, chili, and pizza

GERD affects people of all ages, ethnicities and cultures and tends to run in families.

Symptoms

The most frequently reported symptoms of GERD are:

• Heartburn
• Acid regurgitation
• Inflammation of the gums
• Erosion of the enamel of the teeth
• Bad breath
• Belching
• Chronic sore throat

Some patients with GERD experience no symptoms at all. Because of the wide range of symptoms associated with GERD and the need to distinguish it from heart-related problems, the number of medical visits and tests needed to diagnose or rule out the disease tends to be quite high.

Treatment

GERD is a recurrent and chronic disease that does not resolve itself. If you are diagnosed with GERD, there are several methods of treatment which your doctor will discuss with you including behavioral modifications, medications, surgery, or a combination of methods. Over-the-counter medications may provide temporary relief but will not prevent symptoms from recurring.

The lifestyle changes you can make to minimize GERD include avoiding fats, onions, chocolate and alcohol. Losing weight may also help alleviate GERD symptoms.

Because of the association between GERD and sleep apnea, people with nighttime GERD symptoms should be screening for sleep apnea.

Coping

These lifestyle modifications should help minimize reflux:

• Avoid lying down after a large meal
• Eat smaller meals and maintain an upright, relaxed posture
• Avoid fats, onions, chocolate and alcohol
• Avoid potassium supplements
• Always swallow medication in the upright position and wash it down with lots of water

Poll Data

GERD is the 3rd most common gastrointestinal disorder in the US and one of the leading causes of disturbed sleep among people between the ages of 45 and 64, according to the 2002 NSF Sleep in America poll.

Reviewed by William C. Orr, Ph.D.

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