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According to the National Institutes of Health (NIH), GERD can cause stomach juices to flow up into your esophagus all the way up to your throat. When this happens at night, you may wake up with the sensation of choking on your saliva, but you are really experiencing nighttime acid reflux. GERD is very common and may affect about 2 out of 10 adults.
What Causes Acid Reflux at Night?
Stomach digestive juices are very acidic, which helps your stomach break down food. The lining of your stomach can tolerate these acids. When you swallow foods or liquids, a valve between your swallowing tube (esophagus) and stomach opens. It should close tightly after swallowing to prevent stomach acids from flowing back into your esophagus.
The valve is called the lower esophageal sphincter (LES). For many reasons, lots of people have a leaky LES, that does not close tightly enough to prevent reflux. Although your stomach can tolerate acid, your esophagus can’t. Acid reflux causes burning pain in your esophagus, commonly called heartburn. But it’s your esophagus that’s burning, not your heart. This pain can also feel like chest pain.
Acid reflux is often worse at night mainly due to gravity. When you are standing up, stomach juices naturally flow downhill into your intestines. When you are lying down, stomach juices are more likely to build up in your stomach and push through your LES into your esophagus. Sometimes these juices can flow all the way up into the back of your throat or your mouth. Reflux juices can even “go down the wrong pipe” into your breathing tube (trachea) and cause choking and coughing.
GERD Symptoms At Night and Risk Factors
Some risk factors for GERD are being overweight, having a family history of GERD, smoking, and having a hiatal hernia. A hiatal hernia is a weakening of the muscle separating your belly from your chest. The top of your stomach pushes through the weak area and bulges into your chest. Symptoms of GERD include:
- Heartburn, which may be worse at night or after eating
- Tasting stomach acid in your throat, which may make you gag or choke
- Chest pain
- Difficulty swallowing or feeling like there is a lump in your throat
- Cough or hoarse voice
How to Prevent Acid Reflux at Night
There are over-the-counter (OTC) medications that can reduce acid reflux and there are some simple steps you can take on your own. The first medication option could be an antacid at bedtime like a Tums or Rolaids that neutralize the acid. If that does not help, you can take an OTC medication that blocks acid production. These medications include proton pump inhibitors like Prevacid or Prilosec and H2 receptor blockers like Pepcid or Tagamet. Proton pump inhibitors may cause side effects, learn more in our article on surprising PPI side effects.
These lifestyle modifications also help:
- Avoid foods or liquids that trigger your heartburn. These triggers may be different for different people, but common triggers include fatty foods, spicy foods, alcohol, coffee or tea, citrus juices, and caffeinated beverages.
- Lose weight if you are overweight.
- Avoid eating for at least three hours before bed.
- Raise the head of your bed, or sleep with your upper body propped up on pillows or a wedge.
- Try to sleep on your left side, which takes the pressure off your LES.
What Else Causes Choking at Night?
Choking on saliva is much less common than acid reflux, but it could happen if you have a condition that weakens or blocks your esophagus, called dysphagia. Dysphagia usually occurs in elderly people with neurologic disease or a growth in the esophagus that blocks the swallowing of solids and liquids. Long-term acid reflux can cause dysphagia due to swelling and narrowing of the esophagus.
Another condition that may feel like choking at night is obstructive sleep apnea. Like acid reflux, this condition is very common. It causes more of a gasping for air than a choking sensation. People with sleep apnea have loud snoring and periods when they briefly stop breathing called apnea. Apnea can wake you up suddenly gasping for breath.
If you experience choking at night that does not respond to OTC medications or lifestyle modifications, let your doctor know. It is important to rule out other causes like or sleep apnea or dysphagia. There may be a prescription strength medicine that will help reduce acid. When all else fails. There is a very effective surgical procedure that can tighten the LES and stop acid reflux.