Nocturnal Awakenings: Acid Reflux as a Cause

According to the results of a literature review, proton pump inhibitors can help prevent wakening during the night due to acid reflux.

People who have gastroesophageal reflux disease (GERD) often approach what is meant to be the most restful part of the day—sleep—with trepidation. In fact, up to 10% of Americans report nocturnal GERD. The reasons make sense physiologically, because 3 functions that can protect against acid reflux are less effective during sleep: swallowing rate, esophageal sphincter pressure, and gastric emptying. Lying down also forces gastric content to flow toward the esophagus.

The authors of a systemic literature review published in the April 2012 edition of Otolaryngology—Head and Neck Surgery set out to evaluate the effect of proton pump inhibitors (PPIs) on sleep disturbance in GERD patients. Clinicians have no problem finding guidelines for the treatment of GERD in general, but lack specific guidelines to treat patients who have sleep problems secondary to their GERD. The authors focused on studies that used either sleep time or sleep quality as measures of improvement.

Although they identified only 8 papers that met their inclusion criteria, the authors did identify some consistent findings. They determined that using PPIs improves sleep in patients with reflux disease, with 3 of the highest-quality randomized controlled studies bolstering this finding. Most findings were highly statistically significant.

The authors singled out 1 study for its unusual design. In it, the researchers had study subjects eat 1 hour before retiring in order to provoke acid reflux. (Other studies advised not eating for several hours before bed, which is consistent with the advice we give patients who have acid reflux in general.) As might have been expected, the provocative meal resulted in a greater likelihood that patients would experience nocturnal acid reflux. Of note, these patients also had more episodes of nocturnal non-acid reflux, a condition that is currently receiving increased attention. Participants were also more likely to wake up during the night.

Although improved sleep is probably a secondary outcome related to acid suppression, it is clearly of great value to patients who have suffered due to nocturnal wakening.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.