Sleeping comfortably with reflux during pregnancy

Heartburn and reflux are very common in pregnancy, and they often get worse at night when you lie down. Small changes to your evening habits and your bed setup can make your sleep noticeably more comfortable.

Why is it worse at night?

Pregnancy hormones relax the muscle between your stomach and your esophagus (the tube that carries food to your stomach), and your growing baby presses on your stomach. This lets stomach acid escape into your esophagus more easily. Symptoms are more common after week 12 and later in pregnancy. Because reflux can happen more often when you lie down, the burning is often more noticeable at night.

Typical symptoms are a burning feeling or pain in the chest, a feeling of fullness or bloating, burping, nausea and food coming back up into your mouth. They usually start soon after eating or drinking.

Plan your evening meal

• Eat smaller meals more often instead of three large ones.
• Finish your evening meal about 3 hours before bed.
• Sit upright while you eat and for a while afterward; don't lie down right after a meal.
• Cut down on spicy, fatty and rich food, and limit caffeine. Total daily caffeine should not exceed 200 mg.
• Notice which foods bother you, such as citrus fruit, tomatoes or fried food, and try having them earlier in the day rather than in the evening.
• Avoid clothes that are tight around your waist.
• Don't smoke, and avoid alcohol completely; both can make heartburn worse and are risky for your baby too.

Set up your bed for reflux

Raising your head and shoulders together can reduce acid coming up while you sleep. A pile of pillows that only bends your head forward can increase pressure on your belly; instead, support your whole upper body, or raise the head end of the bed by about 10 to 20 cm by putting something sturdy under the legs at that end.

Lying on your left side may also help. Since you are advised to go to sleep on your side after 28 weeks anyway, the left side serves both purposes.

Before you take any medicine

Medicines that neutralize stomach acid (antacids) and medicines that stop acid from rising into your esophagus can ease symptoms, but some are not suitable in pregnancy. Always tell your pharmacist or doctor that you are pregnant. Don't take them at the same time as iron or folic acid; leave at least 2 hours between them, because they can reduce how well these supplements are absorbed. If these steps aren't enough, your doctor may suggest another medicine that reduces stomach acid.

“Heartburn is usually harmless, but burning that does not go away with medicine, or that comes with other symptoms, needs to be taken seriously.”

When should you see your doctor?

See your doctor if your symptoms continue despite these steps, or if you have difficulty swallowing, a hoarse voice, a cough that won't go away or keeps coming back, or weight loss.

Especially after week 20, if heartburn that does not go away with medicine comes with pain below your ribs, a severe headache, vision problems, vomiting or sudden swelling of your face or hands, it can be a sign of preeclampsia; go to the hospital right away. If you measure your blood pressure at home: rest for 5 minutes and measure again; if it's still 140/90 or higher, call your doctor today. If a reading is 160/110 or higher, rest for 15 minutes and measure again; if it's still that high, go to the hospital right away or call your local emergency number.