Heartburn at Night: Causes and Treatment

By Sarah Malka, MD
Medically reviewed
October 14, 2021

Some people associate big meals, like Thanksgiving dinner, with easily dozing off to sleep.

Yet for many, big meals make sleep very difficult because they experience heartburn. 

This uncomfortable burning sensation in the heart or throat is often nothing to worry about.

Still, when experienced at night, it can lead to poor sleep and the negative effects of inadequate or disrupted rest the next day.

And in some instances, heartburn at night can be a sign of gastrointestinal reflux disease (GERD), which can damage the esophagus.

To help you determine if your heartburn at night is a concern, in this article, I’ll discuss what heartburn is.

Then I’ll dive into nighttime heartburn, detailing the symptoms, causes, and treatments.

I’ll also explain how to tell if you have GERD and when to see a doctor about your heartburn symptoms.

What Is Heartburn

Heartburn is a burning sensation in the chest typically felt right behind the breastbone.

This feeling can last anywhere from a few minutes to a couple of hours, and it may occur only once in a while or frequently.

While about 60 million Americans experience heartburn at least once a month, more than 15 million have symptoms daily.

Although it’s uncomfortable, occasional heartburn typically isn’t cause for concern.

However, if it happens frequently, it may point to an underlying health problem.

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Symptoms of Heartburn at Night

It’s common for heartburn to become more pronounced in the evening.

People who experience heartburn at night typically report the following symptoms:

  • A burning sensation in the chest or throat
  • Worse pain when lying down or bending over
  • A bitter or acidic taste in the mouth

These heartburn symptoms can last anywhere from a few minutes to a couple of hours.

Causes of Heartburn at Night

Despite its name, heartburn has nothing to do with the heart.

Heartburn happens when the lower esophageal sphincter (the ring of muscle creating a valve separating the stomach from the esophagus) does not work properly. 

Normally, the lower esophageal sphincter opens to let food and liquid into the stomach, then closes to keep the contents inside.

When you have heartburn, the lower esophageal sphincter weakens or relaxes too much.

This allows stomach acid (which the stomach produces in order to digest food) to leak into the esophagus.

Called reflux or acid reflux, this causes a burning sensation, i.e., heartburn.

Acid reflux, and therefore heartburn, is often worse at night because lying down makes it easier for the contents of the stomach to flow through the lower esophageal sphincter and back into the esophagus.

Think about it: When you’re standing up, gravity is on your side. When you’re horizontal, it’s not. 

While they do not cause heartburn, certain factors can increase the risk of heartburn:

  • Being pregnant
  • Taking medications such as anti-inflammatory drugs and aspirin
  • Drinking alcoholic, caffeinated, or carbonated beverages
  • Eating certain foods such as tomatoes, citrus, and fatty foods
  • Smoking
  • Being overweight/obese

Treating Heartburn at Night

Nighttime heartburn can be treated at home, but if you experience it frequently, see a healthcare professional to rule out any underlying health problems. 

Most often a combination of medication (prescription, over the counter, or both) and lifestyle changes can remedy heartburn.

Medication

Over-the-counter (OTC) and prescription medications can be used alone or together to effectively treat heartburn. The three most common types of medications are:

  • Antacids: These OTC medications help relieve symptoms by neutralizing the acid in your stomach. They provide short-term relief, but they do not help fix any underlying issues. Common antacid brands include Tums, Maalox, Mylanta, and Alka-Seltzer. 
  • H2 receptor blockers: These medications work by reducing stomach acid production, helping relieve symptoms and allowing the esophagus lining to repair itself. Most H2 receptor blockers, such as famotidine (Pepcid) and cimetidine (Tagamet), are available OTC, though your doctor may recommend a stronger prescription version.
  • Proton pump inhibitors (PPIs): These medications also work by lowering the amount of acid that your stomach makes, but they’re thought to be more effective than H2 receptor blockers and better at allowing the esophagus lining to heal. PPIs like omeprazole (Prilosec) and lansoprazole (Prevacid) are available OTC, while others must be prescribed by doctors for long-term GERD treatment.

Lifestyle changes

You can make several changes in your everyday life to help treat and prevent nighttime heartburn.

Some of these shifts are easier than others, and not everything works for everyone.

Use some trial and error to determine which of the following work best for you: 

  • Quitting smoking 
  • Maintaining a health weight
  • Changing your diet to avoid triggering foods (such as chocolate, coffee, tomatoes, citrus, and onions)
  • Avoiding eating too close to bedtime
  • Elevating your upper body when sleeping
  • Wearing loose-fitting clothing to bed to avoid putting pressure on your stomach
  • Staying upright after eating
  • Checking with your doctor or healthcare provider to see if other medications you may be taking have heartburn as a side effect

Heartburn or GERD?

Although they are often talked about synonymously, heartburn and GERD are not the same thing.

Heartburn is a symptom of GERD, which is a digestive disorder that impacts the lower esophageal sphincter.

With GERD, frequent acid reflux causes the lining of the esophagus to become irritated.

If left untreated, this can narrow and scar the esophagus.

While many people experience heartburn from time to time, a doctor may diagnose you with GERD if: 

  • You experience mild acid reflux at least twice a week
  • You experience moderate to severe acid reflux at least once a week

Other than heartburn, other symptoms that can indicate you may have GERD include:

  • Persistent regurgitation
  • Pain or problems when swallowing
  • Sore throat

Suffering from heartburn at night? Chat with a doctor today for just $23.

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When to See a Doctor

Intermittent heartburn at night can be normal, and many times you can identify a culprit, such as a big meal, eating too close to bedtime, or eating certain foods.

But if you experience frequent heartburn, you should see a healthcare provider. Persistent heartburn can scar and narrow your esophagus if left untreated, and it can even lead to esophageal cancer. 

See a provider if you think you may have GERD, or if your heartburn doesn’t get better after using OTC medication (especially if you’ve been using it for longer than two weeks) or attempting to make some lifestyle changes. 

You should also check in with your provider if you experience any of the other symptoms of GERD beyond just heartburn.

How KHealth Can Help

Abdominal pain and chest pain caused by heartburn can be treated.

Did you know you can get affordable primary care with the K Health app?

Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

Frequently Asked Questions

Why is heartburn worse at night?
Because heartburn is generally caused by acid reflux, it is often worse at night when you are lying down. Acid reflux is more likely to occur then because being horizontal makes it easier for the acid in your stomach to leak through your lower esophageal sphincter and back up into your esophagus, which causes the feeling of heartburn.
Will drinking water help heartburn?
Although it may make you feel a bit better short term, drinking water won’t do much to stop heartburn after it has already started. Still, staying hydrated may help with digestion overall, potentially preventing heartburn. Just make sure you’re drinking plain (flat) water, not sparkling water, as carbonated beverages can increase heartburn. It is also best to drink in between mealtimes, rather than with meals, to avoid overfilling the stomach.
Are GERD and heartburn the same thing?
GERD and heartburn are not the same thing. Heartburn is a symptom of GERD, which is a longer-term digestive disorder that causes frequent and persistent heartburn and other symptoms.
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Sarah Malka, MD

Dr. Sarah Malka is a board certified emergency medicine physician with K Health. She completed her residency at Harvard Medical School.