Sleeping Positions for Managing GERD

What is GERD?

(Sleeping Positions for Managing GERD, Part 2 of our Sleep Posture Education Series)

GERD, also called acid reflux or gastroesophageal reflux disease, is a common digestive disease in which stomach acid or bile irritates the food pipe lining.  There are more than 3 million US cases per year.   Symptoms include burning pain in the chest that usually occurs after eating and worsens when lying down.  Relief from lifestyle changes and over-the-counter medications is often temporary and stronger medication may be needed.  It is important that patients understand GERD and proper sleeping positions for managing GERD.

Treatments for Managing GERD

There are 3 types of medications to help relieve GERD.  Antacid medications include aluminum hydroxide, famotidine, cimetidine, ranitidine, calcium carbonate, nizatidine, and sucralfate.  Antacids are used to counteract the effects of stomach acid.  Proton-pump release medications include protonix, omeprazole, esomeprazole, rabeprazole, lansoprazole, and Dexilant.  Proton-pump inhibitors help decrease acid release in the stomach.  Diarrhea medication such as bismuth subsalicylates are used to reduce frequency and urgency of bowel movements.

Self-care treatments to help relieve symptoms of GERD include weight loss and dietary modification.  Dietary modification is used to prevent or treat the disease while weight loss can improve cardiovascular health and reduce the complications related to obesity.  Foods that may help reduce your symptoms include vegetables, ginger, oatmeal, non-citrus fruits, lean meats, egg whites, and healthy fats.  Foods that may trigger GERD include high-fat foods, tomatoes and citrus fruit, chocolate, garlic, onions, spicy foods, caffeine, and mint and products with mint flavoring.

How does GERD cause arm pain?

Advice on sleeping positions for managing GERD is often focused on head position.  Elevating the head of the bed is recommended to reduce reflux symptoms while sleeping.  This recommendation has produced patients in my office who misinterpreted the instructions given by their physician or advice gleaned from the internet.   We have helped several patients who were complaining of radiculopathy (pain, numbness, tingling) into one or both arms.  Further questioning of these patients revealed that they had started to use 2 or 3 pillows only under their head, to raise their head.  As you can see in the photo above, this places the neck into a significant amount of flexion and frequently triggers irritation to one or more cervical nerve roots, discs, or facet joints.  In most cases, removing the additional pillows resulted in the complete elimination of symptoms within 1-2 weeks.

What are Sleeping Positions for Managing GERD?

Achievement of a sleeping position for managing GERD is important for your musculoskeletal health.   So, what is the correct way to modify your bed?  As a physical therapist, I want to see the head raise without putting stress on the neck or thoracic spine.  Some of our clients have placed wood blocks under the legs of the head of the bed.  While this technically works, it’s hard not to feel like you are sliding down out of the bed.  A better solution is either using an adjustable bed or a wedge to raise the head of the bed.  In either case, it is important that the incline of the bed or wedge starts just above the hip joints.  This position places the spine in a neutral alignment in both sidelying and supine positions.   Wedges or adjustable beds that initiate the incline at the mid-back increase your thoracic kyphotic curve during supine sleeping and will leave you walking around hunched forward.

General recommendations for managing GERD:

  1. Take antacids and other medications that reduce acid production
  2. Chew gum that isn’t peppermint or spearmint flavored
  3. Avoid alcohol
  4. Stop smoking
  5. Don’t overeat
  6. Remain upright for at least two hours after eating
  7. Don’t eat for three to four hours before going to bed
  8. Raise the head of the bed four to six inches to reduce reflux symptoms while sleeping

Thank you to the people at Relax the Back in Palm Beach Gardens for the opportunity to take pictures and providing our clients with an exclusive discount for their back pain relieving products.  Be sure to go and say hi to Mitch!

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