PPIs include brand name medications such as Nexium, Prevacid, and Prilosec, among others. If your symptoms resolve with PPI therapy, it is likely you have GERD. GERD symptoms can significantly impact the quality of your sleep, but there are measures you can take to reduce those symptoms. Longer-term lifestyle changes like losing weight are options to consider if you’re having trouble sleeping because of GERD.
Sometimes, a trial of treatment begins with a PPI and skips the H2 antagonist. If treatment relieves the symptoms completely, no further evaluation may be necessary and the effective drug, the H2 antagonist or PPI, is continued. As discussed previously, however, there are potential problems with this commonly used approach, and some physicians would recommend a further evaluation for almost all patients they see.
Antacids containing these ingredients may produce unwanted diarrhea or constipation. Antacids containing calcium carbonate are the most potent in neutralizing stomach acid. Popular brands are Tums and Titralac.
That’s because when you are lying down for several hours, acid has a lot of time to linger in the esophagus and damage the tissue. When we are awake, we swallow saliva throughout the day.
a sleep wedge
If you’re struggling, there are many guidebooks available to help you quit. You can also buy nicotine patches and gum online to help ease off of the cigarettes. Being a smoker increases your risk of acid reflux. A study published in the scientific journal Gut found that smoking acutely increases the frequency of acid reflux episodes. This is due to two main reasons.
It can also change cells that line the esophagus. This is known as Barrett’s esophagus and it increases the risk of developing esophageal cancer. When you swallow food, it travels down the esophagus and passes through a muscular ring known as the lower esophageal sphincter (LES). This structure opens to allow food to pass into the stomach. It is supposed to remain closed to keep stomach contents where they belong.
If you are unsure of which heartburn treatment to take, have a discussion with your doctor. Your physician can evaluate your condition and take into account any additional medical conditions you have and medications you may be taking and make an appropriate treatment recommendation.
If the PPI is ineffective, a higher dose of PPI may be tried. The second option is to go ahead without 24 hour pH testing and to increase the dose of PPI. Another alternative is to add another drug to the PPI that works in a way that is different from the PPI, for example, a pro-motility drug or a foam barrier. If necessary, all three types of drugs can be used.
As a result, we recently embarked on a study where we assessed the value of a prescription drug that promotes falling asleep, ramelteon (a melatonin receptor agonist), on gastroesophageal reflux related symptoms during sleep. People with GERD received only ramelteon prior to going to sleep during a period of 6 weeks; a comparative group was treated with placebo. The study demonstrated that those who received ramelteon at bedtime for 6 weeks reported significantly less GERD related symptoms during nighttime. The effect was mediated by improving sleep quality, as documented by a questionnaire.
Foods that trigger reflux and its symptoms vary from person to person. By paying close attention to your diet and symptoms, you may be able to identify those foods that repeatedly contribute to reflux. Common trigger foods include alcohol, caffeine, fatty foods, and some spices. Avoiding large portions at mealtime and eating smaller, more frequent meals might aid in symptom control.
As many as one in four people who experience sleep disturbances report that they have nighttime heartburn. If complications of GERD, such as stricture or Barrett’s esophagus are found, treatment with PPIs also is more appropriate. However, the adequacy of the PPI treatment probably should be evaluated with a 24-hour pH study during treatment with the PPI. (With PPIs, although the amount of acid reflux may be reduced enough to control symptoms, it may still be abnormally high. Therefore, judging the adequacy of suppression of acid reflux by only the response of symptoms to treatment is not satisfactory.) Strictures may also need to be treated by endoscopic dilatation (widening) of the esophageal narrowing. With Barrett’s esophagus, periodic endoscopic examination should be done to identify pre-malignant changes in the esophagus.