Can Long-Term Use of Stomach Medications Cause Insomnia and Frequent Urination?

Can long-term use of stomach medications cause frequent urination and insomnia?

Hello Dr.
Chen, I started taking PPIs (proton pump inhibitors), sympatholytics, and relaxants in May.
Since August, I have been experiencing some urgency to urinate at night, waking up either due to a slight urge or difficulty sleeping, resulting in multiple trips to the bathroom throughout the night.
From May to October, I have often felt very tired at night but have difficulty falling asleep due to restlessness, or I wake up in the early morning feeling agitated and take a long time to fall back asleep.
From October 11 to October 13, I took one dose of Diazepam, a sympatholytic relaxant, but those three nights I still experienced insomnia despite being in bed.
However, after October 19, I found it easier to fall asleep.
Starting on November 14, I suddenly began waking up around 4:30 AM, and as early as 4 AM, unable to fall back asleep.
In the past two weeks, I have been taking anti-anxiety medication from a psychiatrist, which has helped reduce the urgency to urinate at night, allowing me to sleep more soundly, but I still wake up at 4 AM.
Recently, it has become severe enough that I wake up at 3 AM, resulting in only about five hours or less of restful sleep each night.
I found online that long-term use of stomach medications can cause insomnia.
What is the relationship between these medications and insomnia? How can I resolve this issue? After all, the psychiatric medication is also not allowing me to sleep through the night.

Mr. Chen, 40~49 year old female. Ask Date: 2022/12/18

Dr. Chen Shidian reply Gastroenterology and Hepatology

There should be no correlation between stomach medication and insomnia; please discuss this with a psychiatrist.

Reply Date: 2022/12/18

More Info

Long-term use of stomach medications, particularly proton pump inhibitors (PPIs), can indeed lead to various side effects, but the direct link between these medications and insomnia or frequent urination is not well established. However, there are several factors to consider when evaluating your symptoms and the medications you are taking.

Firstly, PPIs are commonly prescribed for conditions like gastroesophageal reflux disease (GERD) and peptic ulcers. While they are effective in reducing stomach acid, long-term use has been associated with several side effects, including potential impacts on gut health, nutrient absorption, and even alterations in the gut microbiome. Some studies suggest that changes in gut health can indirectly affect sleep quality, possibly due to the gut-brain axis, which is the bidirectional communication between the gastrointestinal tract and the brain.

Regarding insomnia, it is important to consider the medications you are taking alongside PPIs. For instance, benzodiazepines like Diazepam, which you mentioned using, can initially help with anxiety and promote sleep. However, they can also lead to dependence and may disrupt sleep architecture over time, causing issues like early morning awakenings or difficulty returning to sleep. This could explain your experience of waking up at 3 or 4 AM and struggling to fall back asleep.

Frequent urination at night, or nocturia, can be influenced by several factors. Medications that affect the nervous system, such as those used for anxiety, can lead to increased urination due to their effects on the bladder and the body's overall fluid balance. Additionally, if you are consuming fluids close to bedtime, this could also contribute to nocturia.
To address your concerns about insomnia and frequent urination, here are some recommendations:
1. Medication Review: It is crucial to have a thorough review of all medications you are currently taking. Consult with your healthcare provider or a pharmacist to assess potential interactions and side effects. They may suggest alternatives or adjustments to your regimen.

2. Sleep Hygiene: Implementing good sleep hygiene practices can significantly improve sleep quality. This includes maintaining a consistent sleep schedule, creating a restful environment, limiting screen time before bed, and avoiding stimulants like caffeine in the afternoon and evening.

3. Fluid Management: Monitor your fluid intake, especially in the hours leading up to bedtime. Reducing fluid consumption in the evening can help minimize nocturia.

4. Cognitive Behavioral Therapy for Insomnia (CBT-I): If insomnia persists, consider seeking therapy specifically designed for sleep issues. CBT-I has been shown to be effective for chronic insomnia and can provide you with tools to manage your sleep better.

5. Lifestyle Modifications: Regular physical activity and a balanced diet can also contribute to better sleep and overall well-being. Engaging in relaxation techniques such as mindfulness, meditation, or yoga may help reduce anxiety and improve sleep quality.

6. Follow-Up with Your Doctor: Since you have been experiencing these symptoms for an extended period, it is essential to follow up with your healthcare provider. They may want to conduct further evaluations or consider alternative treatments for your gastrointestinal issues that may have fewer side effects.

In summary, while there is no definitive evidence linking long-term use of stomach medications directly to insomnia and frequent urination, the interplay of various medications and lifestyle factors can contribute to these symptoms. A comprehensive approach involving medication review, lifestyle changes, and possibly therapy may help alleviate your concerns and improve your overall quality of life.

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