Morning Nausea and Gut Dysautonomia: Mental Health Impacts

Daily morning nausea and autonomic nervous system of the intestines?

Current Medical History: Abdominal pain, frequent flatulence, irritable bowel syndrome (esophagogastroduodenoscopy revealed gastritis and GERD grade A = Dexlansoprazole 1# QD), bowel sounds, occasional abdominal pain, morning nausea, bloating, frequent foul gas, obsessive-compulsive disorder, generalized anxiety disorder (GAD), difficulty falling asleep, post-traumatic stress disorder (PTSD, diagnosed during military service).
Past Medical History: Gastric ulcer (stress ulcer) treated with Nexium.
Current Challenges: The hospital director has allowed me to return home to prepare for the national exam (extreme stress).
I experience frequent yawning during the day and feel fatigued, leading to the discontinuation of self-paid Ritalin 10mg (half in the morning and half at noon; no ADHD, used for exam preparation and recent yawning = no improvement).
I attempted to take a nap to alleviate the yawning (but I can't fall asleep).
Recently, I discontinued Sertraline 50mg 1# BID due to excessive sedation, but after stopping, my irritable bowel syndrome recurred, so I self-prescribed Mocalm 1# HS on 2020/11/29.
Environmental Factors: Monday to Friday during the day (my home community is undergoing construction on the 7th floor, extremely noisy).
I wonder if chronic stress is the cause; I can't figure it out.
Sleep Pattern: Bedtime between 10 PM to midnight, with up to 9 hours of sleep, no late nights.
Psychiatric Medications: Estazolam HS 0.5# 1mg, Inderal TID 1# 10mg (no palpitations, for anxiety-related tachycardia), Diazepam [1mg formulation] TID 1#, Zolpidem 10mg 1# HS, Clonazepam [0.5mg formulation] HS 0.5# 0.25mg (no history of seizures, used solely for stable sleep, but recently discontinued due to oversleeping), Sertraline 50mg 1# BID (self-discontinued, switched to Mocalm (Flu 0.5 + Mel 10)/tab due to severe drowsiness), Ritalin (self-discontinued).
Gastroenterology Medications: PPI, KASCOAL, probiotics, anticholinergic medications (for IBS), Trancolon (for IBS).
I humbly seek help from the physician, as I am a stressed-out national exam candidate (I have fatty liver).
I understand the importance of antidepressants; I have tried SSRIs, SNRIs, and NDRIs, but I have not yet tried the SNRI milnacipran.

Gao Yi Da Wa Fen Shou, 20~29 year old female. Ask Date: 2020/11/29

Dr. Lin Mianzhang reply Psychiatry

Hi there! It seems that you are experiencing severe gastrointestinal discomfort, anxiety, compulsions, sleep disturbances, and daytime fatigue.
Given your diagnosis of PTSD, this condition can lead to autonomic nervous system dysregulation, which affects the functioning of various organs throughout your body, including the stomach, small intestine, large intestine, heart, brain, and lungs.
Consequently, autonomic dysregulation can manifest in numerous uncomfortable symptoms such as gastritis, bloating, abdominal pain, nausea, tachycardia, anxiety, and insomnia.

To improve these symptoms, I recommend that in addition to medication, you also engage in psychotherapy to address the root causes of your PTSD.
This approach will facilitate more fundamental improvements in your condition.
Furthermore, while you report feeling fatigued during the day despite getting nine hours of sleep, this suggests that your sleep quality may not be adequate, and the underlying reasons should be clarified.

One not uncommon cause could be sleep apnea.
I wonder if you snore while sleeping; if you do, and regardless of how long you sleep, you still feel tired, especially with risk factors such as obesity, it would be prudent to consider the possibility of this condition.
However, a sleep study would be necessary for further confirmation.

In summary, your situation requires a comprehensive assessment and treatment approach, addressing both psychological and physiological aspects to fundamentally resolve your concerns.
Wishing you a speedy recovery!

Reply Date: 2020/11/29

More Info

Morning nausea and gut dysautonomia can be particularly challenging, especially when compounded by mental health issues such as Generalized Anxiety Disorder (GAD), obsessive-compulsive disorder (OCD), and PTSD. Understanding the interplay between gastrointestinal symptoms and mental health is crucial for managing your overall well-being.

Firstly, it's important to recognize that the gut and brain are closely connected through what is known as the gut-brain axis. This connection means that psychological stress can significantly impact gastrointestinal function. In your case, the chronic stress from preparing for exams, combined with your history of gastrointestinal issues like IBS (Irritable Bowel Syndrome), GERD (Gastroesophageal Reflux Disease), and a previous stress ulcer, can exacerbate symptoms like nausea, abdominal pain, and bloating.

The medications you are currently taking, including various anxiolytics and antidepressants, can also influence your gastrointestinal health. For instance, SSRIs (Selective Serotonin Reuptake Inhibitors) like Sertraline can sometimes lead to gastrointestinal side effects, including nausea and changes in bowel habits. It’s worth noting that while these medications can help manage anxiety and depression, they may also contribute to feelings of nausea, especially when starting or adjusting dosages.

Your experience of frequent yawning and feeling excessively tired during the day could be related to several factors, including the sedative effects of some of your medications (like Estazolam and Zolpidem), poor sleep quality, or even the stress of your current situation. The construction noise in your environment could also be a significant disruptor of your sleep, leading to increased fatigue and daytime sleepiness.

Given your complex medical history, it’s essential to approach treatment holistically. Here are some strategies that may help:
1. Medication Review: Since you have been self-managing your medications, it would be beneficial to consult with a healthcare professional about the best regimen for your current symptoms. Discussing the potential side effects of your medications, especially in relation to your gastrointestinal symptoms, can help tailor a more effective treatment plan.

2. Stress Management Techniques: Incorporating stress-reduction techniques such as mindfulness, meditation, or cognitive-behavioral therapy (CBT) can be beneficial. These methods can help manage anxiety and may also improve gastrointestinal symptoms by reducing the overall stress response.

3. Dietary Adjustments: Since you have IBS, maintaining a diet that minimizes triggers is crucial. Consider keeping a food diary to identify any foods that exacerbate your symptoms. Eating smaller, more frequent meals rather than large meals may also help reduce nausea and discomfort.

4. Regular Sleep Hygiene: Establishing a consistent sleep routine can improve sleep quality. This includes going to bed and waking up at the same time each day, creating a restful environment, and avoiding stimulants before bedtime.

5. Physical Activity: Engaging in regular physical activity can help alleviate symptoms of anxiety and improve gastrointestinal motility, which may help with bloating and discomfort.

6. Professional Support: Given the complexity of your situation, seeking support from a mental health professional who understands the interplay between mental health and gastrointestinal issues could provide you with additional coping strategies and treatment options.

In summary, the relationship between your mental health and gastrointestinal symptoms is multifaceted. Addressing both aspects through a comprehensive approach that includes medication management, stress reduction, dietary adjustments, and professional support can lead to improved outcomes. Always consult with your healthcare provider before making any changes to your treatment plan.

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