Managing Sleep Disturbances and Anxiety After Medication Changes

It seems that the medication has caused shallow sleep, vivid dreams, and frequent awakenings for the past two months?

Hello Doctor, last September, I suddenly started experiencing frequent belching (sometimes several times a minute, and other times every few minutes).
The next day, I visited a gastroenterologist and after two months of consultations, including an endoscopy and ultrasound, no issues were found.
I was prescribed various medications for gastric issues, gastroesophageal reflux, and anxiety, but there was no improvement.
In November, I was referred to a larger hospital for esophageal pressure and pH testing, as well as a chest X-ray, but still no problems were identified.
The doctor later prescribed the following medications: Dexilant (one before each meal) for two weeks, Promethazine (one after breakfast) for two weeks, Chlorpromazine (Winsumin) for seven days (half a tablet after each meal), and Baclofen (Befon) for two days (half a tablet after each meal, but I had to stop due to excessive drowsiness).
A few days later, I began experiencing light sleep (waking up several times), vivid dreams, and difficulty staying asleep (with clear awareness upon waking).
About a week after stopping Chlorpromazine, I was waking up six to seven times a night, and it took two weeks after stopping the medication for it to reduce to two to three times a night.
As of January, there has been no improvement; I can fall asleep and go back to sleep easily, but I used to sleep through the night, rarely dream, and would want to continue sleeping upon waking.
The belching issue remains unresolved, and now I have developed sleep disturbances.
In December, I sought help from my primary care physician, who prescribed Zolpidem (one after breakfast and dinner) to aid sleep.
During that week, my sleep returned to normal, but after stopping the medication, the issues recurred within two to three days.
Since then, I have started feeling anxious and depressed, constantly thinking about these issues.
When I did not have sleep disturbances for the past couple of months, I felt the belching did not significantly affect my life, but once sleep problems arose, my mood began to decline.
I would like to ask the doctor what I should do.
Thank you!

Mr. G, 30~39 year old female. Ask Date: 2023/01/13

Dr. Tian Xinqiao reply Psychiatry

Based on the description in the letter, the symptoms of physical discomfort and sleep issues have significantly impacted the individual's well-being, leading to feelings of low mood.
Anxiety symptoms manifest not only as emotional distress but also through somatic symptoms, such as chronic neck and shoulder pain or headaches.
Gastrointestinal discomfort is also a common symptom.
Additionally, severe sleep problems, particularly difficulty falling asleep, are frequently reported; patients often complain about struggling to fall asleep while simultaneously finding it hard to stop their racing thoughts, resulting in sleep disturbances.
These symptoms are typical manifestations of anxiety disorders.
The recommended treatment approach combines pharmacotherapy and psychotherapy.
Pharmacological treatment primarily involves the use of serotonin-based antidepressants, while psychotherapy may include relaxation training to alleviate anxiety symptoms.
Both approaches can help improve the symptoms mentioned.
Therefore, it is advisable to consult a psychiatrist for evaluation and appropriate medication treatment, with the hope of alleviating your concerns.
Dr.
Tien Hsin-Chiao

Reply Date: 2023/01/13

More Info

Managing sleep disturbances and anxiety, especially after medication changes, can be quite challenging. It appears that you have been experiencing a series of symptoms that have significantly impacted your quality of life, including frequent belching, sleep disturbances, and increased anxiety. Let's break down the situation and explore potential strategies for improvement.

Firstly, it’s important to recognize that the medications you have been prescribed can have various side effects, including those related to sleep. For instance, Chlorpromazine, which you took for a short period, is an antipsychotic that can cause sedation but may also lead to disturbances in sleep architecture, resulting in fragmented sleep and vivid dreams. The fact that you experienced a return to normal sleep while on a different medication (益可寧) suggests that your body may respond differently to various pharmacological agents.
The transition from a stable sleep pattern to one characterized by frequent awakenings and vivid dreams can be distressing. This change, coupled with your ongoing gastrointestinal symptoms, may be contributing to your anxiety and depressive feelings. It’s not uncommon for physical symptoms, such as gastrointestinal issues, to exacerbate mental health conditions, creating a cycle that can be difficult to break.

Given your situation, here are several strategies that may help you manage your symptoms:
1. Consult with a Specialist: Since your symptoms are multifaceted, it may be beneficial to consult both a psychiatrist and a gastroenterologist. A psychiatrist can help assess your mental health and consider alternative medications that may have fewer side effects on sleep. A gastroenterologist can further evaluate your gastrointestinal symptoms to rule out any underlying conditions that may require different treatment.

2. Medication Review: Discuss with your psychiatrist the possibility of adjusting your current medications. There may be alternatives that can help with both your anxiety and sleep disturbances without the side effects you are experiencing. For instance, some medications are specifically designed to improve sleep quality without causing excessive sedation or vivid dreams.

3. Cognitive Behavioral Therapy (CBT): Engaging in CBT, particularly CBT for insomnia (CBT-I), can be highly effective in addressing sleep disturbances. This therapy focuses on changing the thoughts and behaviors that contribute to sleep problems, helping you develop healthier sleep habits.

4. Lifestyle Modifications: Implementing good sleep hygiene practices can also be beneficial. This includes maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and ensuring your sleep environment is conducive to rest (e.g., dark, quiet, and cool). Limiting caffeine and screen time before bed can also improve sleep quality.

5. Mindfulness and Relaxation Techniques: Incorporating mindfulness practices, such as meditation or deep-breathing exercises, can help reduce anxiety and improve your overall emotional well-being. These techniques can also be beneficial in promoting relaxation before bedtime.

6. Physical Activity: Regular physical activity can improve sleep quality and reduce anxiety. Aim for at least 30 minutes of moderate exercise most days of the week, but try to avoid vigorous exercise close to bedtime.

7. Nutritional Considerations: Pay attention to your diet, as certain foods can impact both gastrointestinal health and sleep. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can support overall health.

8. Follow-Up: Regular follow-up appointments with your healthcare providers are essential to monitor your progress and make necessary adjustments to your treatment plan.

In conclusion, managing sleep disturbances and anxiety after medication changes requires a comprehensive approach that addresses both physical and mental health. By collaborating with your healthcare providers, implementing lifestyle changes, and considering therapeutic options, you can work towards regaining a sense of normalcy in your sleep patterns and overall well-being. Remember, it’s important to be patient with yourself as you navigate this process, and don’t hesitate to reach out for support when needed.

Similar Q&A

Managing Anxiety and Sleep Issues: Insights on Mirtazapine and Alternatives

Hello, doctor. I have previously been diagnosed with generalized anxiety disorder (and possibly mild obsessive-compulsive disorder or PTSD) and have been regularly taking mirtazapine for nearly seven months. However, I felt an improvement over time and, due to psychological facto...

Dr. Wu Enliang reply Psychiatry
Hello, netizen: Current scientific evidence suggests that the use of antidepressants is effective in treating major depressive disorder, and it is particularly effective for insomnia associated with major depression. The recommended duration of use is at least six months. However...

Managing Panic and Anxiety: Can You Skip Medication for Self-Adjustment?

Doctor, I have been diagnosed with panic disorder and anxiety. The doctor prescribed me Cloene (clonazepam) and Mesyrel (trazodone) to take at bedtime, but I noticed that the side effects include drowsiness, dizziness, nervousness, and mental confusion. I'm concerned that th...

Dr. Chen Wenyu reply Psychiatry
Hello, Regarding the medications you are taking and the timing of their administration, these two drugs have sedative and antidepressant effects. Taking them before bedtime is intended to induce sleepiness. If you take a sedative or sleep medication and do not sleep, it is natu...

Managing Sleep Issues: Understanding Anxiety and Medication Effects

Last week, I couldn't sleep and started using sleeping pills (a medication that starts with 'Z'). Later, I began to feel anxious about going to bed, and my heart would race, so I took an anti-anxiety medication. After taking one, my mood improved significantly. How...

Dr. Cai Yunlin reply Psychiatry
Hello, due to the varying effects of different medications (such as half-life, onset of action, etc.), it is advisable to discuss your condition and possible solutions further with your physician. Wishing you all the best.

Managing Recurring Depression: Medication Adjustments and Treatment Options

Hello, doctor. I have been taking medication for depression for 12 years without any interruptions, but in the past two years, I have experienced four relapses. In April of this year, I had a relapse, and while I recovered in July and August, in November, during a Saturday off, I...

Dr. Wu Enliang reply Psychiatry
It is advisable to consult your physician directly regarding any adjustments to medication. Additionally, it is recommended to consider non-pharmacological treatments for depression, such as psychotherapy and rTMS (repetitive Transcranial Magnetic Stimulation). Dr. Wu En-Liang.