In this blog we will see the relation of gastroesophageal reflux disease (GERD) or heartburn and its relation with increase in level of stress and/or associated sleep interruption or insomnia.
Gastroesophageal reflux disease or heartburn may be experienced by a burning sensation in the stomach or mid chest area, or sometimes reflux of acidic fluid into the mouth, or of a similar discomfortable sensation. In general, GERD is felt as a burning sensation or cramps. At times, people may experience unusual burping.
This may be in association with inflammation in the stomach, esophageal or gastrointestinal tract. There are multiple possible causes ranging from inadequate sleep, medication related side effects such as long-term NSAID use (non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, etc.), chronic constipation, sleep interruption, and/or stress which have a significant relation and exacerbate the symptoms. Some patients may have an infection called H. pylori infection (helicobacter pylori). This has been known to be a risk factor for peptic ulcer disease and can be treated with a course of antibiotics.
Chronic sleep interruption, which is sleep initiation difficulty, maintaining sleep, early awakening or difficulty falling asleep after one is awake, does have some relation to increase in GERD symptoms. Other symptoms a person may feel may be a sense of indigestion increase in abdominal gas or intolerance to different foods like milk. Many may have symptoms of lactose intolerance.
Stress, which is subjective feeling and a very subtle finding which people may experience in relation to family situations, financial conditions, work or health related issues, the loss of a dear one, etc., may affect digestion. Generally, it is manifested in the form of increase acid secretion and frequent eating. With stress there is some sleep disruption present in many cases and this again affects the digestion and gastric acid secretion.
Depending on the underlying cause of the GERD, the treatment may vary. Proton pump inhibitors are generally used in most cases. Healthcare professionals may need to treat the H. pylori infection if present, and if the condition is mild there are other alternative treatments which may help.
Lifestyle changes, such as quitting smoking, decreasing or limiting use of alcohol, medication related causes such as long-term NSAID use that may possibly be decreased, will help. There are different foods that trigger GERD-like symptoms, which are spicy foods, chilies, garlic, onions, tomatoes, peppers, bananas, high caffeine intake, chocolate, and eggplant to name a few. The foods that may help alleviate the symptoms are generally apples, pears, grapes, and regular intake of vegetables.
Some people may have a hiatal hernia in association with GERD and may have associated diarrhea-like symptoms. If they sleep with the head of the bed at a 45-degree elevation and avoid eating late in the evening by eating smaller portions throughout the day rather than a few big meals, it may help their GERD symptoms. People who are overweight or obese may consider weight loss as the hiatal hernia may improve.
Some patients may have associated constipation and with regular daily bowel movements and associated passing of abdominal gas on a regular basis this decreases the gastro colic reflex and thereby helps decrease GERD symptoms.
Keeping the same sleep-wake cycle may further help decrease sleep interruption. Sleeping before 10:00 pm and waking up around 6:00 am will synchronize the body’s circadian rhythm and decrease acid secretions. Generally, sleeping later than 10:00 pm will trigger increase in gastric acid secretions and exacerbation in GERD symptoms. Regular exercise such as a brisk walk for 20-30 minutes and breathing exercises of Yoga such as the Pranayama, which helps improve circulation and oxygenation in the body, will thereby improve sleep but needs to be done for many months regularly to see improvement.
Once sleep is better, people are generally able to manage stress better. Improvement in stress again improves sleep and both are interdependent. Many patients do have improvement in sleep and with stress management by decreasing their GERD symptoms. Goes to bed early by 10pm is usually a key factor in life style management with management of food, breathing exercise and stress management. If one still has persistent GERD symptoms in spite of making changes, they may consider seeing a physician or healthcare provider.
Disclaimer: The blog is for information purpose only. One should not stop, change, or modify any treatment or management started by their healthcare provider without consulting them.