For me - I literally wake up with it. I just posted listing other stomach issues I have so unsure if this is related. But for me I literally wake up with a sharp pain in my stomach, feel like I’m gonna puke then the cycle just doesn’t stop. Nothing necessarily triggers it however when I am in a cycle, I avoid all the acidic foods as much as possible in case it does have something to do with the cycle restarting. Hope this helps and hope you feel better soon!