Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Hernia Surgeon · Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
In short
- Lying flat removes the help gravity gives, so acid that would drain back down in the day stays in the gullet at night.
- Raising the head of the whole bed by six to eight inches works. Extra pillows bend the neck and often make it worse.
- Night symptoms that carry on despite a regular acid tablet are the pattern that most often leads to a discussion about repair.
People manage all day and then lose the night. That pattern is so common with a hiatal hernia that it is almost a clue in itself.
There is a simple reason for it.
What changes when you lie down
Standing up, gravity is on your side. Anything that comes up out of the stomach drains back down in a few seconds.
Lying flat, that help is gone. What comes up stays up, and it sits against the lining of the gullet for minutes at a time.
Saliva, which washes acid down, also slows while you sleep. So the two things that protect the gullet both switch off together.
The night pattern people describe
Burning that starts within minutes of lying down. Waking at two or three with fluid in the throat. A dry cough that comes in bouts. A voice that is rough until mid-morning.
Many people have stopped calling it reflux by the time they come in. They call it a cough, or poor sleep, or asthma.
Night symptoms with a hiatal hernia and what helps
| What you notice | Why it happens at night | What helps |
|---|---|---|
| Burning on lying down | No gravity to drain the gullet | Raise the head of the bed |
| Sour taste or fluid in the mouth | Acid reaches the throat while flat | Nothing to eat for three hours |
| Waking with a dry cough | Acid irritating the voice box | Left side, head raised |
| Hoarse voice in the morning | Hours of exposure overnight | Review the tablet timing |
| Chest pain that wakes you | Can be reflux, can be the heart | Get it checked, do not assume |
Woken by reflux most nights despite tablets? Bring your endoscopy report and we can look at the cause.
Raising the head of the bed
This is the change that helps most, and it is the one most often done wrongly.
Pillows do not work. They fold you at the neck and leave the stomach as flat as before, and bending at the waist can push the pressure up.
Raise the head end of the bed itself by six to eight inches. Blocks under the legs, or a wedge under the mattress. The whole body should slope.
Which side to lie on
The left, if you have a choice.
The join between the gullet and the stomach sits on the right. Lying on the left keeps the pool of stomach contents below that join; lying on the right puts it level with it.
It is a small effect next to raising the bed, but it costs nothing.
The three hours before bed
A full stomach lying flat is the worst combination of the day.
Keep three hours between the last meal and bed, and treat a late dinner as the thing to move rather than something to take a tablet for. Our page on diet goes through meal size and the foods that trouble people most.
When night symptoms change the plan
Night symptoms carry more weight than daytime ones, because the gullet is exposed for longer and the voice box and lungs are in the way.
If they continue on a regular tablet, with the bed raised and the late meal moved, that is the point at which repair is usually discussed. Tests come first: an endoscopy, and sometimes a study of acid and swallowing.
Frequently asked questions
Why does my hiatal hernia only trouble me at night?
Lying flat removes gravity and saliva slows in sleep, so acid stays in the gullet far longer.
How high should I raise the bed?
Six to eight inches at the head end of the bed itself. Extra pillows bend the neck and rarely help.
Which side should I sleep on?
The left. It keeps the stomach contents below the join with the gullet rather than level with it.
Do night symptoms mean I need surgery?
Not on their own. Night symptoms that persist on regular tablets are what usually open that discussion.
Related pages
The main page on this site is hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Bring your reports. Second opinions are welcome.