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In some patients with sleep disturbance, gastroesophageal reflux disease (GERD) plays a pathogenic role. Nocturnal acid reflux can cause awakenings, due to cognitive recognition of heartburn or regurgitation symptoms. In addition, gastric refluxate into the esophagus can induce sensory arousal to stimulate secondary clearance without cognitive awakening, and this sensory effect might disrupt sleep by interfering with sleep-stage progression. Proton-pump inhibitors (PPIs) benefit patients with GERD-associated sleep complaints, but the response rate for preventing sleep disturbances is considerably lower than the response rate for alleviating traditional GERD symptoms; this distinction suggests that nonacid (bile) reflux events contribute to …