Lifestyle changes for GERD: sleep, weight, exercise, smoking and alcohol

For many people, a few small but consistent changes are enough to keep reflux under control, and they make medicine work better for those who need it. This page sets out the changes with the best evidence, and how to put them into practice.

Sleep and night-time reflux

Reflux at night tends to last longer, because you swallow less often and make less saliva while asleep, so acid stays in the oesophagus. Three changes work together.

Raise the head of the bed

Raising the head end of the bed by 15 to 20 cm (6 to 8 inches) puts your whole upper body on a slope, so gravity helps keep acid in the stomach. Studies using pH monitoring have shown less night-time acid exposure with the bed raised. You can use:

• bed risers or blocks under the legs at the head end, the cheapest and most effective option
• a wedge pillow that slopes from your hips to your head
• an adjustable bed base, if you are replacing your bed anyway

Stacking ordinary pillows does not work as well. It bends you at the waist and neck rather than tilting your body, which can press on the stomach.

Sleep on your left side

The stomach sits mostly to the left of the oesophagus. Lying on your left side keeps the junction between them above the pool of stomach contents; lying on your right side puts it below. A study that tracked sleep position and acid at the same time found that acid exposure and acid clearance time were lowest on the left side and highest on the right. A body pillow can help you stay on your left.

Leave a gap between dinner and bed

Finish your last meal at least two to three hours before lying down. The meal-timing planner works out a schedule from your bedtime.

Weight

Extra weight around the abdomen raises the pressure on the stomach and pushes contents upwards. It is also linked with hiatus hernia. Weight loss has the strongest evidence of any lifestyle change: studies have shown that people who lose weight have fewer symptoms, and some no longer need medicine. Even a modest loss of 5 to 10% of body weight can help.

Healthy targets often used are a body mass index (BMI) of 18.5 to 24.9 (lower thresholds apply for people of South Asian, Chinese, Black African or Caribbean background), and a waist below 80 cm (31.5 inches) for women and 94 cm (37 inches) for men. Your doctor can tell you about local weight-management support.

Smoking

Smoking weakens the LOS, reduces saliva and is linked with Barrett's oesophagus and oesophageal cancer. Stopping smoking is recommended for everyone with reflux. Free stop-smoking services, combined with nicotine replacement or prescription medicine, give you a much better chance of quitting than willpower alone. In the UK, your pharmacy or the NHS Stop Smoking Service can help.

Alcohol

Alcohol relaxes the LOS and can irritate the oesophagus. Wine and beer are often reported as the worst. Practical steps:

• drink less overall, and have alcohol-free days
• do not drink on an empty stomach
• stop at least two to three hours before bed
• avoid mixing spirits with fizzy drinks

Exercise

Regular activity helps with weight, sleep and stress. Most adults should aim for at least 150 minutes of moderate activity a week. Some types of exercise are kinder to reflux than others:

• Usually well tolerated: walking, swimming, upright cycling, gentle yoga (without inversions), light resistance training with steady breathing.
• Can trigger symptoms: running, high-impact classes, heavy lifting with breath-holding, crunches and sit-ups, and inverted yoga poses.

Timing matters more than the activity itself. Wait one to two hours after a light meal, or two to three hours after a larger one, before exercising hard. Many people with reflux find morning exercise before breakfast easiest. Sip still water rather than fizzy or energy drinks.

Stress

Stress does not seem to increase the amount of acid that refluxes in most people, but it can make the oesophagus more sensitive, so the same reflux feels worse. If you notice symptoms flare during stressful periods, stress management is a legitimate part of treatment. Approaches people find useful include regular physical activity, good sleep habits, and diaphragmatic (belly) breathing, which has shown promise in small studies for reducing reflux. Cognitive behavioural therapy (CBT) can help when worry about symptoms becomes a problem in itself.

Everyday habits

• Loose clothing: tight belts, waistbands and shapewear press on the stomach, especially after meals.
• Bend at the knees: bending forward at the waist after eating makes reflux more likely. Schedule gardening, cleaning or lifting before meals.
• Lift carefully: breath-holding while lifting sharply raises abdominal pressure.
• Sit upright: slouching over a laptop or a low table compresses the stomach.
• Review your medicines: some common medicines can worsen reflux. Ask your doctor or pharmacist for a review, and never stop a prescribed medicine on your own. See medicines that can worsen reflux.

Your lifestyle checklist

Changing one or two things at a time is more sustainable than trying everything at once. Tick off what you already do; your ticks are saved on this device only.

• Finish eating two to three hours before bed
• Eat smaller main meals
• Raise the head of the bed by 15 to 20 cm
• Sleep on your left side
• Take a short walk after main meals
• Avoid tight waistbands after meals
• Aim for 150 minutes of moderate activity a week
• Stop smoking, or get support to quit
• Drink less, and not in the hours before bed
• Identify your personal trigger foods
• Ask for a review of your other medicines

If you have tried these changes for a few weeks and still have regular symptoms, the next step is usually medicine. See the medications guide, or speak to a pharmacist or doctor.