For some people who are medicated for heartburn, there is a breakthrough at night. How often does this happen?
MICHAEL WOLFE, MD: The classic example are the proton pump inhibitors which block the final step of acid production in the stomach. They're a wonderful medication. And most people actually successfully relieve their heartburn by taking one pill a day in the morning. But there are a significant number of people who actually will breakthrough at night. It's called "nocturnal acid breakthrough." And it will occur right in the middle of the night, when someone is sound asleep. Not a good way to start the next day.
But if these medications are turning off acid production, why is there acid there to get through?
JAMES FRESTON, MD, PhD: Well, proton pump inhibitors are used in the morning. And their effect gradually wears off. As their effect is wearing off, the person is lying down. The wearing off of the medication, the loss of gravity, and reduction of saliva and swallowing combine to drive the heartburn in.
What can people do?
MICHAEL WOLFE, MD: Well, staying up all night is one method. Another is to elevate the entire head of the bed. That's great for the patient, but for the person sleeping with the patient, it's not too cool sometimes.
There are certain wedges one can use to raise the entire thorax -- not just the head of the bed with pillows, but rather from the waist up.
