Acid Reflux Worsens Sleep Quality, and the More (and Longer) You Have It, the Poorer Your Sleep


A large prospective study found large, statistically significant effects of heartburn on sleep quality.

To all the potential reasons for getting a poor night’s sleep, add this: acid reflux.

A long-term prospective investigation of nearly 50,000 participants in the Nurses’ Health Study II found a clear relationship between gastroesophageal reflux (GER) symptoms and disturbed sleep overall as well as each type of sleep problem measured.

@ Azat Valeev

@ Azat Valeev

The relative risk for poor sleep was 1.53 for participants who reported symptoms of heartburn more than once a week compared with those who experienced them less than once a month, according to study findings published July 19 in JAMA Network Open.

The risk of specific sleep issues among those who reported GER two or more times per week compared with those who reported none were similar for difficulty falling asleep, excessive daytime sleepiness andfor restlessness during sleep.

Duration of acid reflux showed bigger differences: Compared with those who had not had symptoms once or more per week, the relative risk for poor sleep quality overall was 1.22 for women with GER symptoms at least weekly for less than four years, 1.38 for four to seven years and 1.36 for those reporting symptoms over eight years or more.

Related: Insomnia and its Harms

About 20% of the U.S. population experiences GER at least weekly, and the prevalence of gastroesophageal reflux disease (GERD) has been rising globally. It has decidedly unpleasant effects on quality of life and can have complications in the long term.

As much as 10% of the population has chronic insomnia, which is associated with all sorts of problems, from daytime sleepiness and trouble paying attention to high blood pressure and depression.

Andrew T. Chan, M.D., M.P.H.

Andrew T. Chan, M.D., M.P.H.

Last author Andrew T. Chan, M.D., M.P.H., a professor of medicine at Harvard Medical School and a gastroenterologist and chief of the Clinical and Translational Epidemiology Unit at Massachusetts General Hospital in Boston, and colleagues, identified 48,536 women beginning in 2005, of whom 16.3% developed poor sleep quality during four years of follow-up, which continued every four years until 2015. Those who had reported sleep problems on an earlier questionnaire were excluded.

Large numbers of participants who developed acid reflux used proton pump inhibitors — a class that includes Prevacid (lansoprazole), Prilosec (omeprazole) and Nexium (esomeprazole) and/or histamine-2 receptor antagonists — a class that includes Zantac (ranitidine) and Pepcid (famotidine). The medications lessened the association between GER symptoms and sleep quality but did not erase it.

It's unclear to what extent the study findings apply to the general population: participants were 100% female, all aged 48 to 69 (median age: 59) and 95.2% white, although none of the above were listed as limitations by the authors.

It’s also unclear why exactly acid reflux contributes to poorer sleep quality. But the authors noted that lying down is associated with GER symptoms and that elevating the head helps reduce them.

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