Constant Heartburn When You Wake Up? Here’s What to Know

Waking up to a burning sensation in your chest is never a pleasant way to start the day. If morning heartburn (or that bitter taste in your mouth) is becoming a regular occurrence, it might be more than just a fluke. Your body could be trying to tell you something important about your health.

Here, gastroenterologist Niket Sonpal, MD, breaks down the potential reasons why heartburn often strikes before breakfast and what you can do to manage it.

1. You Might Have Gastroesophageal Reflux Disease (GERD)

One of the most common causes of frequent morning heartburn is GERD, a chronic form of acid reflux. GERD happens when stomach acid repeatedly flows back into the esophagus, irritating its lining.

The culprit? A malfunctioning lower esophageal sphincter (LES) the muscle that separates your esophagus from your stomach. When this muscle is weakened or relaxes at the wrong time, it allows stomach acid to creep back up.

Common GERD Symptoms:

• Chest pain

• Difficulty swallowing

• Regurgitation of food or sour liquid

• A lump-in-the-throat sensation

• Chronic cough or laryngitis

• New or worsening asthma

• Disrupted sleep

What to Do:

If GERD is related to excess weight, shedding a few pounds could help reduce pressure on the stomach and minimize reflux. Avoiding trigger foods like spicy or acidic items is also beneficial.

2. Stress Could Be a Factor

Stress not only impacts your mental health but also your gut. Elevated stress levels can relax the LES, allowing acid to move into the esophagus and cause that burning sensation.

"Stress often leads to eating more and usually quickly or unhealthily which can compound heartburn," Dr. Sonpal explains. Overindulgence in caffeine or alcohol when stressed can also relax the LES, making reflux more likely.

How to Manage It:

Try incorporating stress-reducing techniques into your routine. The 4-7-8 breathing method is a quick and effective way to calm your nerves:

• Sit comfortably and inhale through your nose for 4 seconds.

• Hold your breath for 7 seconds.

• Exhale slowly for 8 seconds.

• Repeat the cycle four times.

3. Hiatal Hernia Might Be to Blame

A hiatal hernia occurs when the upper part of your stomach pushes through an opening in your diaphragm. This compromises the diaphragm’s ability to support the LES, increasing the risk of acid reflux.

Signs of Hiatal Hernia:

• Regurgitation of food or liquids

• Trouble swallowing

• Chest or abdominal pain

• Feeling full quickly

• Shortness of breath

• Vomiting blood or passing black stools (a sign of gastrointestinal bleeding)

What to Do:

Maintaining a healthy weight can reduce the risk of hiatal hernia and ease heartburn symptoms. Additionally, lifestyle changes like eating smaller meals and avoiding lying down right after eating can help.

4. Pregnancy Can Trigger Heartburn

Heartburn is a common complaint during pregnancy, especially in the third trimester. Changing hormones slow down digestion, while the growing uterus puts pressure on the stomach, contributing to acid reflux.

According to the Cleveland Clinic, more than 50% of pregnant individuals experience severe heartburn. Elevated levels of progesterone also relax the LES, allowing stomach acid to travel upward.

How to Ease Pregnancy Heartburn:

• Eat small, frequent meals

• Avoid fried, spicy, or fatty foods

• Limit citrus fruits, caffeine, and alcohol

• Sit up straight while eating and avoid lying down right after meals

• Keep the head of your bed elevated

5. Certain Medications Could Be the Culprit

Some medications can trigger heartburn by either slowing down gastrointestinal movement or relaxing the LES.

Medications That May Worsen GERD:

• Anticholinergics: For overactive bladder and irritable bowel syndrome (e.g., oxybutynin)

• Tricyclic Antidepressants: Such as amitriptyline and doxepin

• Heart Medications: Including calcium channel blockers, ACE inhibitors, and nitrates

• Narcotics (Opioids): Such as codeine and hydrocodone-acetaminophen combinations

• Hormonal Medications: Including progesterone

• Sedatives or Tranquilizers: Like diazepam (Valium) and temazepam (Restoril)

• Bronchodilators: For asthma, such as theophylline

What to Do:

If you suspect your medication is causing morning heartburn, speak with your healthcare provider. They may adjust your dosage or switch you to a different treatment. Never stop taking a prescription without consulting your doctor first.

When to See a Doctor

Occasional heartburn is usually manageable with lifestyle changes and over-the-counter treatments. However, if you experience heartburn more than twice a week, it might be a sign of GERD or another underlying condition. Persistent symptoms warrant a visit to a healthcare professional for proper evaluation and treatment.

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