It is very unlikely to die directly from acid reflux in your sleep. Acid reflux can cause choking sensations, coughing, burning in the chest, or a sour taste at night, but it is not usually considered an immediate cause of sudden death.
The main concern is not the reflux itself, but possible complications when reflux is frequent or severe. Stomach contents can sometimes reach the throat and be breathed into the lungs, which may lead to irritation, breathing problems, or pneumonia. This risk is higher in older adults, people with swallowing problems, or those with serious medical conditions.
Long-term, untreated reflux can also damage the esophagus. In some people, chronic GERD may lead to inflammation, narrowing, Barrett’s esophagus, or, rarely, esophageal cancer over time. These are not sudden sleep-related events, but they are reasons persistent reflux should not be ignored.
Seek medical care if nighttime reflux is frequent, wakes you often, causes trouble swallowing, unexplained weight loss, vomiting blood, black stools, chest pain, or breathing symptoms. Avoid self-medicating long term without guidance, and consider seeing a gastroenterologist if symptoms keep coming back.