Acid reflux may disrupt sleep

Chronic acid reflux often people can wake up at night, even when no symptoms of heartburn, a small study suggests.

The study, 39 adults with gastroesophageal reflux disease (GERD) and nine adults without GERD, found that those with digestive disorder tends to wake up more frequently during the night - an average of three times a night, compared to just under twice a night for their counterparts without GERD.

Their sleep disruptions are often associated with episodes of reflux, as measured by a tube placed in the esophagus during the night.

However, according to the study, most of awakenings were not stimulated by perceived heartburn symptoms, GERD patients reported symptoms in detecting only 16 percent of sleep disruptions.

The results, although based on a small group of patients suggest that GERD may be contributing to poor sleep more often than has been suspected, said lead researcher Dr. Ronnie Fass, head of gastroenterology at Southern Arizona VA Health Care System in Tucson.

In an interview, Fass said that when physicians evaluate patients for the night GERD problems usually ask about your symptoms. However, current findings suggest that "some to wake up is symptomatic, but many will not," he said.

Fass suggested that people with GERD tell your doctor if you are waking up frequently during the night, even if it feels that the symptoms of heartburn are the cause.

Then they could see if gaining better control of GERD improves your sleep, "said Fass.

Some forms of management of GERD include weight loss, if necessary, avoid foods that stimulate the symptoms and eating small, frequent meals, and for the problems of the night, elevating the head of the bed 6-8 inches using blocks of wood under the bedposts.

Medications for the relief of symptoms include antacids and acid-reducing drugs known as H2 blockers - such as ranitidine (Zantac) and cimetidine (Tagamet). Another class of drugs known as inhibitors of proton pump (IBP) can be prescribed to help prevent episodes of acid reflux, particularly in people with more severe GERD.

The study, published in the journal Clinical Gastroenterology & Hepatology was funded in part by Takeda Pharmaceuticals, which makes the PPI drug Prevacid. Fass served as a consultant and researcher at the company.

The results are based on 39 middle-aged adults with GERD who had been taking at least three episodes of heartburn per week over the previous three months, along with nine other healthy adults.

All participants underwent monitoring of sleep during the night, when a device worn on the wrist recorded their movements and a probe placed in the esophagus measured cases of acid reflux. The H2 blockers stopped using drugs at least three days before entering the study, and any use of PPI was arrested at least three weeks before.

In general, the study found that 90 percent of GERD patients are awakened at least once during the monitoring during the night, with most of awakenings (52 percent) is associated with an episode of acid reflux.

In the healthy comparison group, 78 percent were awakened at least once, but never in relation to acid reflux.

Fass and his colleagues also found that in patients with GERD, reflux episodes do not usually came before, but then woke up. If acid reflux usually happened later, and most of awakenings were not accompanied by symptoms of heartburn, it is unclear why GERD patients tend to wake up more often, researchers say.

One possibility, they say, is that the activity of the nervous system helps trigger the acid reflux actually wake people from sleep before reflux occurs. Why are these episodes so often be free of symptoms is unclear, but one theory is that sleep reduces the sensitivity of the esophagus to stomach acid.

However, Fass and his colleagues note, some previous studies have found that the vast majority of episodes of acid reflux seen in GERD, no matter what time of day, can not actually cause clear symptoms.