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Call him "John." This 35-year-old paralegal came to me complaining of sleep-maintenance insomniainsomnia, a condition that prevents people from getting a full night of shut-eye. Because of his job's demanding hours, he was getting home and eating late. He also reported that his diet included a lot of spicy foods and diet sodas.
My diagnosis? John had GERDGERD (gastroesophageal reflux disease). It was not so pronounced as to bother him while he was falling asleep. But it would act up during the predawn hours before his sleep cycle was complete, leaving him exhausted and cranky each morning.
GERD is caused by recurrent reflux of acid into the esophagus, which commonly leads to chronic heartburnheartburn. Other (though less common) problems include a sore throatsore throat, a sour taste, and bad breath; the acid refluxacid reflux can even erode your tooth enamel. If severe enough, this burning feeling can also keep you awake through the night.
John was one of the 5% to 7% of Americans who suffer from GERD. Experts haven't yet been able to pinpoint a cause, but several conditions seem to bring it on. These include smoking, being overweight, and eating certain foods. Having dinner or a snack right before bedtime can aggravate the condition, since our bodies weren't built for eating and then lying down immediately afterward.
Exactly how many hours should separate eating and sleeping can be hard to say, because everyone's metabolism and rate of digestion differ. I advise my GERD patients to experiment a little and see what works for them.
When I worked with John, I suggested that he make some lifestyle changes to see if they lessened his GERD-caused insomnia. He was to try the following for a week and report back to me with the results:
Stay upright. Avoid lying down for two to three hours after eating. Lying down can push stomach juices into your esophagus, causing heartburn. Similarly, be careful when bending and lifting for the same reason.
Eat early. Since you don't want to lie down for two to three hours after eating, skip meals and snacks just before bedtime.
Loosen up. Avoid tight clothing over your stomach.
Get a raise. Raising the head of the bed 6 to 8 inches can help those who have GERD or acid reflux. Using extra pillows won't work; put blocks underneath your bed frame, or place a foam wedge under the head of your mattress.
John returned in a week and reported that he was dining earlier, forgoing his favorite spicy Chinese takeout, and -- success! -- sleeping through the night. If you're grappling with GERD, consider making some lifestyle changes. They can make all the difference in getting the slumber you need.
Published August 2006.