Sudden Vomiting at Night: Causes & What to Do

Key takeaways:

• Vomiting in the middle of the night has many causes, most of which are not considered serious or life-threatening.
• If you feel nauseous before going to sleep, prop your head up with pillows to help alleviate symptoms and reduce the risk of complications.
• Implementing lifestyle changes prior to sleeping and knowing when to seek medical attention can improve outcomes.

Being woken in the middle of the night is bad enough – but being suddenly woken up by the urge to vomit can be even worse.

The good news is that sudden vomiting at night is typically not cause for concern, though it can be frustrating. From medications to dietary habits and viral infections, there are several potential causes of vomiting at night. Chronic vomiting at night may not necessarily be a sign something is seriously wrong, but it may still warrant a visit to your healthcare provider so that you can identify and treat the underlying issue.

Causes of vomiting or nausea in the middle of the night

Some causes of nausea and vomiting in the middle of the night are completely out of your control.

Others can be managed with small changes on your end. Knowing the different causes of vomiting in the middle of the night can help you take steps to prevent it and know when to speak to a doctor.

Gastroenteritis

Viral gastroenteritis, commonly referred to as the stomach flu or stomach bug, is one of the most common causes of vomiting.

This infection is usually the result of a virus or due to food poisoning from contaminated food. It leads to inflammation of the stomach and intestines, causing symptoms like nausea, vomiting, diarrhea, and abdominal pain. Gastroenteritis can strike at any time, and it has the potential to wake you from your sleep feeling the urge to vomit. Fortunately, symptoms usually resolve on their own within a few days.

Diet

Dietary choices can trigger a few different conditions that may lead to vomiting in the middle of the night. Overeating, particularly before bed, can cause nausea and vomiting.

This is especially true when laying horizontally to sleep before you have time to fully digest your food. If you eat or drink anything before going to bed that can aggravate symptoms of acid reflux, this may also lead to sudden nausea, regurgitation, and vomiting in the middle of the night. Certain food intolerances, such as sensitivities to dairy or gluten, can also cause nausea and vomiting in the middle of the night if you consume foods containing these ingredients before bed.

Cyclic vomiting syndrome

A disorder known as cyclic vomiting syndrome is characterized by nausea and vomiting that start at the same time of day, last the same length of time, and occur with the intensity of previous episodes.

Although it is most common for cyclic vomiting syndrome to begin in the morning, symptoms from this disorder can be experienced at any time of day, including in the middle of the night.

Medications

Some medications come with instructions to be taken at night or before bed.

Sometimes, the reasoning behind this recommendation is that the medications are known to cause nausea and it is thought that they will be better tolerated while sleeping. It is possible for medications with common side effects of nausea and vomiting that are taken before bed to cause waking up with vomiting in the middle of the night.

Causes of vomiting at night while experiencing another symptom or condition

As previously stated, vomiting in the middle of the night can be caused by several different factors. It is important to let your healthcare provider know of any additional symptoms or medical conditions that can help lead them to an accurate diagnosis.

Heartburn and vomiting at night with GERD

Gastroesophageal reflux disease or GERD is most commonly referred to as heartburn or acid reflux. Patients with GERD can experience both daytime and nighttime symptoms.

Nighttime symptoms are associated with waking up frequently due to a sensation of choking or gagging, which can then lead to regurgitation or vomiting.

Cough and vomiting at night

Paroxysmal cough attacks refer to numerous and rapid coughing attacks that can trigger a gag reflex and lead to vomiting.

This type of coughing attack occurs most frequently at night and can be the cause of sudden vomiting in the middle of the night. Conditions that can cause these coughing attacks include bronchitis, pneumonia, and most commonly, whooping cough.

Bloating and vomiting at night

Bloating, or the feeling of increased pressure in the stomach can be caused by a wide array of conditions.

Irritable bowel syndrome, food intolerances, gastroenteritis, and impaired emptying of the stomach known as gastroparesis are just a few of the causes of bloating that may also be associated with vomiting. These conditions can strike at any time of day, including in the middle of the night.

Vomiting at night while pregnant

Pregnant people may experience nausea and vomiting at any time, and that unfortunately includes in the middle of the night.

This can be due to hormonal changes and is particularly common during the first trimester. Pregnant people are also more likely to experience GERD, which may likewise be a cause for nausea and vomiting when lying down.

Read our guide on different types of vomit and its colors for more.

When to see a doctor when vomiting at night

If you experience sudden vomiting at night that doesn’t go away after a few days, worsens, or comes alongside other symptoms, it may be best to check in with a healthcare professional.

You should see a doctor if:

• Your vomiting persists for more than 24 hours.
• You show signs of dehydration, such as dry mouth, increased thirst, and decreased urination.
• You have additional symptoms such as abdominal pain, diarrhea, or fever.

You should go to the emergency room if:

• You experience severe headaches or confusion associated with vomiting.
• You have chest pain or difficulty breathing.
• You vomit continuously or cannot keep any fluids down.
• You notice blood in the vomit.

Questions to ask your doctor about vomiting at night

• What could be causing my vomiting in the middle of the night?
• Am I considered contagious? And if so, for how long?
• What treatment options are available for my symptoms?
• What red flags should I look for that would indicate the need to be evaluated again?

Treatment options for vomiting at night

If you experience vomiting at night, there are several treatment options available to manage your symptoms. Treatment may vary based on the diagnosed underlying cause.

Medication

If your nausea and vomiting are severe, your provider may prescribe anti-nausea medications to minimize your symptoms.

If your vomiting in the middle of the night is thought to be due to acid reflux, you may be prescribed an acid-reducing medication. If your nausea is caused by your current daily prescriptions, your medication regimen may be changed to a better-tolerated alternative.

Hydration

Staying hydrated is an important step after vomiting. Sipping clear fluids like water, broth, or oral rehydration solutions can help replenish lost fluids and electrolytes.

If you are unable to tolerate any fluids by mouth, your healthcare provider will likely recommend IV fluids.

Dietary changes

Dietary changes can help manage certain causes of vomiting in the middle of the night. If you are diagnosed with acid reflux, it is recommended that you avoid spicy and acidic foods, as well as drinks containing caffeine and alcohol.

It is also recommended that you do not lie down to sleep within an hour of eating. Other specific dietary recommendations will be made if you are found to have a particular food intolerance.

Read our guide on what to eat or drink after vomiting for more.

Frequently asked questions: sudden vomiting in the middle of the night

Understanding more about vomiting in the middle of the night can help you prepare so that you can sleep soundly. Below are answers to some of the most common questions healthcare providers encounter regarding this symptom that may provide further guidance.

Why are you throwing up stomach acid at night only?

If you vomit in the middle of the night, you most likely have not eaten for several hours and will have an empty stomach.

When you throw up on an empty stomach, the vomit typically consists of stomach acid and digestive fluids such as bile.

What should you do if you feel nauseous or feel like throwing up in the middle of the night?

If you feel nauseous or like you may vomit, propping your head up with some pillows may help alleviate symptoms and can prevent aspiration – or choking – in the event that you do vomit while sleeping.

What should you eat or drink after throwing up in the middle of the night?

After vomiting, you should focus on hydration by taking small sips of water. You should avoid eating any solid foods immediately after vomiting.

Final thoughts: navigating nighttime nausea

While there are much more pleasant ways to be woken in the middle of the night, nighttime nausea and vomiting should not cause you to panic. In most cases, vomiting resolves on its own. In others, you may need treatment from a healthcare provider to address the underlying cause of your symptoms.

Regardless, by understanding what to look for, how to take care of yourself, and when to seek medical attention, you will be back to sleep in no time.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Lane Thaut, DO.

Sources

Centers for Disease Control and Prevention (CDC). “Clinical Features of Pertussis.” CDC, 15 Apr. 2024, www.cdc.gov/pertussis/hcp/clinical-signs/index.html. Accessed 16 Oct. 2024.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “Cyclic Vomiting Syndrome.” National Institute of Health, 2017, www.niddk.nih.gov/health-information/digestive-diseases/cyclic-vomiting-syndrome. Accessed 11 Oct. 2024.

Iovino, Paola et al. “Bloating and functional gastro-intestinaldisorders: where are we and where are we going?.” World Journal of Gastroenterology, vol. 20, no. 39, 2014, pp. 14407-19, https://pmc.ncbi.nlm.nih.gov/articles/PMC4202369/. Accessed 16 Oct. 2024.

Orr, William C. “Management of nighttime gastroesophageal reflux disease.” Gastroenterology & Hepatology, vol. 3, no. 8, 2007, pp. 605-6, https://pmc.ncbi.nlm.nih.gov/articles/PMC3099296/. Accessed 16 Oct. 2024.

MedlinePlus. “Viral Gastroenteritis (Stomach Flu).” MedlinePlus Medical Encyclopedia, 4 May 2022, medlineplus.gov/ency/article/000252.htm. Accessed 16 Oct. 2024.