Is Fatigue a Symptom of Gastroesophageal Reflux Disease (GERD)?
GERD and fatigue
Fatigue is more than just being tired because you were up too late or worked too hard. It leaves you feeling tired and lacking energy day after day for a long stretch of time. Fatigue can be a direct result of serious health problems or it can be an indirect result of conditions that interfere with your sleep.
One especially common cause of decreased sleep is gastroesophageal reflux disease (GERD), or heartburn.
GERD occurs when stomach acid moves up into the esophagus. This backward flow is called reflux. The acid can irritate the lining of the esophagus, causing feelings of heartburn. It can also make you cough.
When you lie down, your stomach contents don’t move through your body as well as they do when you’re upright. If you have an excess of stomach acid, it’s more likely to wash back up into your esophagus if you’re lying flat than if your head is elevated. When your head is elevated, gravity helps keep the acid from moving upward.
GERD can affect your sleep because you may end up waiting until the heartburn and cough have passed before going to sleep, or you may experience extreme discomfort and coughing while trying unsuccessfully to sleep.
What else causes fatigue?
Fatigue can occur due to lifestyle factors, such as:
- drug and alcohol use
- too much or too little physical activity
- certain medications
- poor eating habits
Fatigue can also occur with medical conditions, such as:
- anemia
- cancer
- heart disease
- thyroid disease
- sleep apnea
- multiple sclerosis
- mental disorders, including stress and depression
Chronic fatigue syndrome (CFS)
A condition called chronic fatigue syndrome (CFS) can last for years and leave you exhausted, regardless of how little or how much sleep and exercise you get.
CFS is much more common in women than in men. It tends to develop in your 40s or 50s, but anyone can develop it at any age. Little is known about its causes or risks factors. The symptoms of CFS include:
- exhaustion
- joint pain
- a headache
- sensitivity to light
- dizziness
- moodiness
If you have several symptoms of CFS and you’ve experienced fatigue for at least six months, your doctor may diagnose you with this condition. Your doctor may recommend these treatments if you have CFS:
- anti-inflammatory drugs
- antidepressants
- regular, light exercise
- dietary improvements
- psychological therapy
When to see a doctor
Fatigue can be a symptom of many different health problems. It’s important to pay attention to other symptoms you may have. This will help your doctor start to pinpoint the cause and look for a solution.
Feeling exhausted all of the time isn’t a normal condition. It’s not an inevitable sign of getting older or of having young children in the house. If you’ve been feeling tired and weak for several weeks, see your doctor.
A little heartburn once in a while is common. It can occur due to certain combinations of food and beverage. If you experience heartburn at least a few times per month, tell your primary care doctor or see a gastroenterologist.
If symptoms of GERD are keeping you awake, treatments are available to ease your symptoms, and allow you to relax and sleep better at night.
What to expect at your doctor visit
Your doctor will ask you about your symptoms and perform a physical exam. If you’re experiencing symptoms of GERD in addition to your fatigue, your doctor may recommend an endoscopy.
An endoscope is a long, thin, flexible tube that your doctor can lower down your throat and through your esophagus. It has a tiny camera that can send back images to a monitor that your doctor can look at during the procedure. The signs of stomach acid irritation on the lining of the esophagus may be obvious, confirming a GERD diagnosis.
They may ask you about your diet. You should be prepared to talk about foods and beverages you consume and whether some of these may be triggers for GERD. Before you see a doctor, think about the times you had heartburn and what you ate earlier that day.
Spicy foods may be a common and obvious trigger, but citrus fruits, chocolate, and high-fat foods may also cause you problems. Your GERD triggers may differ from those that bother someone else with GERD.
Foods to avoid
- spicy foods
- chocolate
- coffee
- citrus or other acidic foods
- high-fat foods
Your doctor will also want to know about other things that may be interrupting your sleep. Are you going to bed too late or waking up early? Are you consuming a lot of caffeine late in the day? Have you replaced your pillows within the past year, and are you comfortable in your bed? These and other questions can help your doctor better understand your sleeping behaviors and rule out environmental or behavioral factors.
What treatments are available for GERD?
For some people, over-the counter antacids that neutralize stomach acid may be enough to ease the burn of GERD. Two other types of drugs, H2 receptor blockers and proton pump inhibitors (PPIs) are also available in over-the-counter varieties, though more serious GERD cases may require prescription-strength versions. They both reduce acid production, but PPIs can also help heal damaged esophageal tissue.
Avoiding trigger foods and drinks is also advised, even if you’re taking medications. You should also avoid lying down too soon after eating. Elevating the head of the bed can help. Tight clothes may make symptoms of GERD worse, so you should try to avoid them as well. GERD is more likely if you’re obese, so maintaining a healthy weight may help. You should also quit smoking, as it can harm your esophagus and all your organs.
If GERD is the cause of your fatigue, then successful heartburn management may translate to better sleep and less fatigue.
If there isn’t an obvious cause of your fatigue, talk with your doctor about ways you can try to get your energy back, whether it’s through more exercise, dietary changes, or other lifestyle modifications.
Tips to manage GERD
- Avoid trigger foods and drinks, like coffee, chocolate, or spicy foods.
- Don’t eat right before bed.
- Maintain a healthy weight.
- If you smoke, talk to your doctor about ways to help you quit.
- Make exercise a part of your regular routine.
What is the outlook?
CFS can last for years, but many conditions that cause fatigue are treatable. With treatment comes renewed energy. Your odds of regaining your energy depend greatly on how well you treat the cause of your fatigue.
GERD can be chronic, but it’s possible to control it with medications, a healthy lifestyle, and the avoidance of trigger foods and drinks. You can still enjoy a varied diet while avoiding the foods that cause symptoms.
Tips for prevention
Follow these tips to prevent fatigue and the symptoms of GERD:
- Exercise for 30 to 40 minutes per day.
- Follow a healthy diet that limits or avoids GERD triggers.
- Turn off electronic devices at least 30 minutes before bedtime.
- Avoid alcohol and caffeine close to bedtime.
- Eat a smaller dinner, and don’t eat right before going to bed.
- Make sure your bedroom is cool and dark.
Acid Reflux and Shortness of Breath
Overview
Difficulty breathing is one of the more frightening symptoms of acid reflux and the chronic form of the condition, which is called gastroesophageal reflux disease (GERD). GERD can be associated with breathing difficulties such as bronchospasm and aspiration. These difficulties can sometimes lead to life-threatening respiratory complications.
Shortness of breath, also called dyspnea, occurs with GERD because stomach acid that creeps into the esophagus can enter the lungs, particularly during sleep, and cause swelling of the airways. This can lead to asthma reactions or cause aspiration pneumonia. Such airway damage can affect breathing by causing coughing or wheezing.
GERD and asthma
Shortness of breath can occur in GERD alone, but it also often occurs in conjunction with asthma. The two conditions are often linked. In fact, the Cleveland Clinic estimates that:
- more than three-quarters of people with asthma also experience GERD
- people with asthma are twice as likely as those without asthma to have GERD
- people with a severe, chronic form of asthma that’s resistant to treatment are most likely to also have GERD
Although research has shown a relationship between asthma and GERD, the exact link between the two conditions is uncertain. One possibility is that acid flow causes injury to the throat lining, airways, and lungs. This can bring about an asthma attack in those who have preexisting asthma. Another reason may be that when acid enters the esophagus, it triggers a nerve reflex that causes airways to constrict to keep acid out. This leads to shortness of breath.
Just as GERD may worsen asthma symptoms and vice versa, treating GERD often helps improve asthma symptoms, like shortness of breath. Doctors are more likely to attribute GERD to be the cause of asthma when asthma:
- starts in adulthood
- worsens after stress, eating, exercise, lying down, or at night
- fails to respond to standard treatments
Lifestyle changes
Whether your shortness of breath is related strictly to GERD or is due to GERD-related asthma, there are small steps you can take to prevent and treat it. Often, the most effective steps to prevent GERD involve making some lifestyle changes. Here are some tips:
- Modify your diet. Eat smaller, more frequent meals, and avoid bedtime snacks or meals.
- Lose weight if you are overweight.
- Identify triggers for GERD symptoms and avoid them. For example, if tomato sauce irritates your GERD, avoid foods and meals that contain tomato sauce.
- Quit smoking and reduce or eliminate alcohol intake. Smoking and alcohol consumption can aggravate GERD symptoms.
- Elevate the head of your bed by 4 to 8 inches. This helps the food in your stomach remain there instead of traveling into your esophagus while you’re sleeping.
- Avoid using too many pillows when you sleep. This can put your body into an awkward position that worsens your GERD symptoms.
- Avoid wearing tight belts and clothing that puts pressure on your abdomen.
Other ways to help GERD symptoms
If lifestyle changes alone don’t improve reflux-related breathing problems, your doctor may also recommend drug treatments for GERD symptoms. Drugs that your doctor may recommend include antacids, H2 receptor blockers, and proton pump inhibitors. In rare cases, surgery is needed.
If you have both GERD and asthma, continue to take your prescribed asthma medications (and medications for GERD if your doctor has prescribed them) — and limit exposure to your asthma and GERD triggers.
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