Gastrointestinal Issues: Sleep Problems and Liver Health

Hello, doctor?

Hello, Doctor! I have been unable to sleep in July and August this year, only falling asleep around 7 AM the next day.
I have a long history of insomnia and irregular sleep patterns, but it was particularly severe this past July and August.
In September, while taking a train, I experienced discomfort for the first time and felt like I wanted to gag.
I had a sensation of my stomach churning, feeling as if liquid was constantly moving inside, even though I was traveling on an empty stomach.

To summarize: I have been unemployed for a long time due to foot pain and have been suffering from insomnia, which became particularly severe in July and August.
Since July, I have been sitting for long periods while selling gaming items.
For a while, I was eating instant noodles every two days and sitting down after meals while drinking cold water.
From June to September this year, my weight increased from 88 kg to 95 kg.

Starting in October, I began to feel a sense of pressure and discomfort in my abdomen, and my abdomen feels slightly hard to the touch.
I often feel the urge to pass gas at night, which is foul-smelling and lasts about 3-4 seconds.
My bowel movements are regular with no constipation issues, no black stools, and no blood in the stool, but they are slightly brownish and foul-smelling.

I had blood tests done, which showed no hepatitis B or C, but my liver enzymes were abnormal.
My glycated hemoglobin was 7.6, and my fasting blood sugar was 140.
The doctor mentioned I have more severe fatty liver and prescribed medication to lower my blood sugar, blood lipids, and liver function.

Doctor, could you please advise if there is a possibility of something serious going on, or what factors could be involved? Additionally, what should I do? I have been seeing a hepatobiliary and gastroenterology specialist for almost two months, but I still feel some pressure in my abdomen.
When I press lightly on the area between my chest and navel, it feels uncomfortable, slightly painful, and I sometimes feel nauseous.

Furthermore, if I continue to have trouble sleeping, do you recommend that I start taking sleep medication again? I apologize for the lengthy message, and thank you, Doctor!

Awei, 30~39 year old female. Ask Date: 2021/11/15

Dr. Chen Shidian reply Gastroenterology and Hepatology

1.
Fecal occult blood testing can be performed.

2.
Eliminate poor dietary habits / weight loss.

3.
Medications may be necessary to manage digestive symptoms.

4.
Psychological evaluation may be needed for insomnia medication.

Reply Date: 2021/11/15

More Info

Your situation presents a complex interplay of gastrointestinal issues, sleep disturbances, and potential liver health concerns. Let's break down the various aspects of your symptoms and provide some insights into possible underlying causes and management strategies.

Sleep Issues
Your long-standing insomnia, which worsened in July and August, could be attributed to several factors. Chronic sleep deprivation can lead to a range of physical and mental health issues, including increased stress, anxiety, and even gastrointestinal problems. The fact that you have been experiencing significant stress due to unemployment and physical pain may contribute to your sleep disturbances.
In addition, your irregular sleep schedule, where you are going to bed very late and waking up at odd hours, can disrupt your circadian rhythm, making it harder for you to achieve restful sleep. It’s important to establish a consistent sleep routine, aiming for 7-9 hours of sleep per night. If you continue to struggle with sleep, consulting a sleep specialist may be beneficial. They can assess for conditions such as sleep apnea, which can cause fragmented sleep and lead to daytime fatigue.

Gastrointestinal Symptoms
Your gastrointestinal symptoms, including feelings of bloating, pressure in the abdomen, and frequent flatulence, could be linked to your dietary habits and lifestyle changes. A diet high in processed foods, like instant noodles, and low in fiber can lead to digestive issues. The fact that you are experiencing a change in bowel habits, even if you are not constipated, suggests that your gut health may be compromised.

The sensation of liquid moving in your stomach and the pressure you feel could indicate gastrointestinal dysmotility or even gastritis, especially given your history of poor dietary choices and stress. It’s also worth noting that stress can exacerbate gastrointestinal symptoms, leading to conditions like irritable bowel syndrome (IBS).

Liver Health
Your blood tests indicating abnormal liver function and a diagnosis of fatty liver disease (non-alcoholic fatty liver disease, NAFLD) are concerning. Fatty liver can be exacerbated by obesity, poor diet, and sedentary lifestyle, all of which seem to apply to your situation. The elevated blood sugar levels and glycated hemoglobin (HbA1c) suggest that you may be at risk for developing type 2 diabetes, which is often associated with fatty liver disease.

Recommendations
1. Dietary Changes: Transition to a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Reducing processed foods and sugars can help manage your weight and improve liver health. Consider consulting a nutritionist for personalized dietary advice.

2. Physical Activity: Incorporate regular physical activity into your routine. Even light exercise, such as walking, can help improve your mood, aid digestion, and support liver health.

3. Sleep Hygiene: Establish a consistent sleep schedule, create a relaxing bedtime routine, and limit screen time before bed. If sleep issues persist, discuss the possibility of short-term use of sleep aids with your healthcare provider.

4. Stress Management: Engage in stress-reducing activities such as mindfulness, meditation, or yoga. These practices can help alleviate anxiety and improve both sleep and gastrointestinal symptoms.

5. Follow-Up with Healthcare Providers: Continue to work with your gastroenterologist and primary care physician to monitor your liver health and manage your blood sugar levels. Regular follow-ups are crucial for tracking your progress and making necessary adjustments to your treatment plan.

6. Mental Health Support: Given your history of insomnia and stress, consider speaking with a mental health professional. They can provide strategies to cope with anxiety and improve your overall well-being.

In summary, your symptoms are interconnected, and addressing them holistically will likely yield the best results. By making lifestyle changes, seeking appropriate medical care, and managing stress, you can improve your overall health and quality of life.

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