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

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

Hello Dr.
Wu, I started taking PPIs (proton pump inhibitors), sympatholytics, and relaxants for my stomach issues in May.
Since August, I've been experiencing urgency to urinate at night, waking up either due to a slight urge or difficulty sleeping, leading to multiple trips to the bathroom.
From May to October, despite feeling very tired, I find it hard to fall asleep and often wake up in the early morning feeling restless.
From October 11 to October 13, I took a dose of Diazepam to help relax my sympathetic nervous system, but I still experienced insomnia during those nights.
However, after October 19, I found it easier to fall asleep.

Starting November 14, I suddenly began waking up around 4:30 AM, and sometimes as early as 4:00 AM, unable to go back to sleep.
For the past two weeks, I've been taking anti-anxiety medication prescribed by a psychiatrist, which has helped reduce nighttime urgency, allowing me to sleep more soundly.
However, I still wake up around 4:00 AM, and recently it has escalated to waking up at 3:00 AM, resulting in only about five hours or less of 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, and how can I resolve this issue? After all, the psychiatric medication has not allowed me to sleep through the night.
Additionally, I initially thought that the psychiatric medication would quickly resolve my insomnia, but the prescription for Apo-Paroxetine indicates that I need to take it continuously for six months without interruption (the other medication is ESZO).
When I asked the doctor, they mentioned that I would likely need to take it for about four months for improvement.
Is this correct? This treatment duration seems excessively long.
Are there any medications that can effectively treat insomnia in the short term?

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

Dr. Wu Enliang reply Psychiatry

There is currently no clear scientific evidence to prove that long-term use of gastric medications causes insomnia.
Initially, I believed that taking psychiatric medications would quickly resolve my insomnia, but the prescription for Apo-Paroxetine indicated that I must take it continuously for six months without interruption (the other medication is ESZO).
When I asked my doctor, he mentioned that I would likely need to take it for four months before seeing improvement.
Is this correct? This treatment duration seems excessively long; are there any medications that can effectively treat insomnia in the short term?
A: Antidepressants like Apo-Paroxetine can improve depression and anxiety, but the time frame varies by individual, generally requiring more than a month.
For short-term relief of insomnia, it is advisable to use sleep medications such as Eszo.
Since there are many potential causes of insomnia, it is essential to identify the underlying reason to provide targeted treatment.
Some individuals may even need to spend a night at a sleep center for further analysis.
It is recommended to discuss this further with your physician.
Dr.
Wu Enliang.

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 in the medical literature. However, there are several factors to consider that may contribute to your symptoms.

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 potential side effects such as nutrient malabsorption (e.g., magnesium, calcium, and vitamin B12), which can lead to various health issues, including neurological symptoms that might affect sleep. Additionally, some studies suggest that long-term PPI use may be linked to an increased risk of kidney disease, which could contribute to urinary symptoms.

Frequent urination at night, known as nocturia, can be influenced by several factors, including fluid intake before bed, bladder irritability, or even anxiety and stress. The medications you mentioned, such as diazepam and other anxiolytics, can also have sedative effects that might disrupt your sleep architecture, leading to fragmented sleep and early awakenings. It's important to note that while these medications can help with anxiety, they may not address the underlying causes of insomnia.

Regarding your experience of waking up at 3 or 4 AM, this is a common issue among individuals with anxiety or depression. The medications prescribed by your psychiatrist, such as Apo-Paroxetine and ESZO (Escitalopram), are selective serotonin reuptake inhibitors (SSRIs) that can take several weeks to show their full effect. It is not uncommon for patients to be advised to continue these medications for several months to achieve optimal results, especially if they are being used to treat underlying anxiety or depressive disorders that can contribute to insomnia.

If you are looking for short-term solutions to improve your sleep, it may be beneficial to discuss the possibility of using sleep aids or adjusting your current medication regimen with your healthcare provider. Non-pharmacological approaches, such as cognitive-behavioral therapy for insomnia (CBT-I), can also be effective in managing sleep disturbances without the need for long-term medication.

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, underlying health conditions, and lifestyle factors can contribute to these symptoms. It is crucial to maintain open communication with your healthcare providers about your concerns and to explore both pharmacological and non-pharmacological treatment options for your insomnia.

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