Struggling to Sleep: Gastroesophageal Issues and Remedies

Recently, I've been feeling uncomfortable when lying down, making it difficult to fall asleep?

Hello, doctor.
About five months ago, I underwent an upper gastrointestinal endoscopy, and the doctor mentioned that I had a slightly loose gastroesophageal junction, gastroesophageal reflux disease (GERD), and Barrett's esophagus.
As a result, I was prescribed Nexium (esomeprazole) and malate promethazine, one tablet each in the morning.
However, later on, I developed a somatoform disorder, experiencing insomnia, anxiety, and panic attacks.
Following the recommendation of my psychiatrist, I stopped taking malate promethazine and switched to taking one tablet of Nexium 40 mg after breakfast each day.
After three months, my condition stabilized, but my gastroenterologist suggested continuing the medication for another three months.
I am currently in the last month of this course.
Until a few days ago, my stomach condition was quite good, but starting from December 18, I began to feel a warm sensation in my throat when lying down, as if warm water from my stomach were flowing into my throat.
This has made it very difficult for me to sleep, to the point where I can hardly fall asleep.
Since starting the gastrointestinal medication, my diet has consisted of approximately 40% vegetables, 40% rice, and 20% protein per meal, avoiding fried and spicy foods, and I have not been eating late-night snacks.
Occasionally, I drink unsweetened black tea and Pu-erh tea at noon.
Up until two weeks ago, I was exercising regularly, but after having a tooth extraction, I have been taking Ponstan (flurbiprofen) 500 mg three times a day after meals and before bed for three days.
My weight is moderate, with a BMI of about 23.

Current medication regimen:
- Gastroenterology: Nexium after breakfast
- Psychiatry: (due to stable condition, I am gradually reducing the dosage)
- Evening: half a tablet of Ativan (lorazepam) 0.5 mg
- Before bed: 25 mg of Trazodone
- Otolaryngology (for allergic rhinitis): Mo-Bi-Ka 120 mg after breakfast
- Traditional Chinese Medicine (for insomnia and adjunct treatment for gastrointestinal issues): I have been prescribed a herbal powder to take after lunch, dinner, and before bed, which includes ingredients like valerian root, licorice, jujube, sand ginger, poria, sour jujube seed, and a decoction of bupleurum and cinnamon.
All doctors, except for the gastroenterologist, are aware of my medication regimen.
The TCM practitioner has been coordinating treatment for insomnia and somatoform disorder for some time, while I recently visited the ENT specialist due to severe nasal congestion.

Currently, I often feel a sensation of fullness in my stomach, but eating is not an issue.
My stomach occasionally makes noises, and I sometimes burp without any taste.
When lying down, I feel a warm sensation in my throat, as if warm water is flowing from my stomach to my throat.
Additionally, I occasionally feel my heartbeat and sometimes cough up phlegm (which has been attributed to post-nasal drip from allergic rhinitis), with a lighter color.
I would like to ask the doctor whether I should first discuss changing medications with my TCM practitioner or stop taking Nexium, or where I should start to improve my condition.
Although I have occasionally had trouble sleeping in the past, I have been making continuous progress and have not felt as uncomfortable as I do now.
I hope the doctor can provide me with some advice.
Thank you for taking the time to respond.

Wei De, 30~39 year old female. Ask Date: 2021/12/19

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is recommended to discuss adjustments with the gastroenterologist.

Reply Date: 2021/12/19

More Info

It sounds like you are experiencing a complex interplay of gastrointestinal issues and sleep disturbances, which can be quite challenging to manage. Based on your description, you have a history of gastroesophageal reflux disease (GERD) and Barrett's esophagus, and you are currently taking medications such as Nizatidine and other supportive treatments for both your gastrointestinal and psychological symptoms.
Firstly, the sensation of warmth in your throat when lying down, which feels like warm fluid rising from your stomach, is a classic symptom of GERD. This occurs when stomach acid flows back into the esophagus, causing irritation and discomfort. It can significantly impact your ability to sleep, as lying down can exacerbate reflux symptoms.
To address your sleep issues, it is essential to consider both your physical and psychological health. Stress and anxiety can worsen gastrointestinal symptoms and disrupt sleep patterns. You mentioned that you have been experiencing anxiety and panic attacks, which can lead to a cycle of poor sleep and increased gastrointestinal discomfort.
Here are some recommendations that may help improve your situation:
1. Medication Review: Since you are currently on Nizatidine, it might be worth discussing with your gastroenterologist the possibility of adjusting your medication regimen. Sometimes, a proton pump inhibitor (PPI) may be more effective for controlling acid reflux symptoms than H2 blockers like Nizatidine. However, any changes should be made under medical supervision.

2. Lifestyle Modifications: Continue to maintain a balanced diet, as you have been doing. Eating smaller, more frequent meals can help reduce the burden on your stomach and minimize reflux symptoms. Avoiding trigger foods (such as spicy, fatty, or acidic foods) and beverages (like caffeine and alcohol) is also crucial.
3. Sleep Hygiene: Establish a calming bedtime routine to signal to your body that it is time to wind down. This can include activities such as reading, gentle stretching, or meditation. Ensure your sleeping environment is conducive to rest—dark, cool, and quiet. Elevating the head of your bed can also help reduce nighttime reflux.

4. Stress Management: Since you have a history of anxiety and panic attacks, incorporating stress-reducing techniques such as mindfulness, yoga, or cognitive-behavioral therapy (CBT) can be beneficial. These approaches can help you manage anxiety and improve your overall mental health, which in turn may help alleviate some of your gastrointestinal symptoms.

5. Consultation with Healthcare Providers: It may be beneficial to have a multidisciplinary approach to your care. Discuss your current symptoms with both your gastroenterologist and your mental health provider. They can work together to ensure that your treatment plan addresses both your gastrointestinal and psychological needs. If you feel that your current medications are not effective, do not hesitate to discuss alternative options with your healthcare providers.

6. Monitoring Symptoms: Keep a symptom diary to track your food intake, medication usage, and any symptoms you experience. This can help you and your healthcare providers identify patterns and triggers that may be contributing to your discomfort and sleep issues.

In conclusion, managing your symptoms will likely require a combination of medication adjustments, lifestyle changes, and psychological support. It is essential to communicate openly with your healthcare providers about your concerns and progress. By taking a comprehensive approach, you can work towards improving both your gastrointestinal health and sleep quality.

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Should have no impact.