heartburn and trouble sleeping
 

One theory:

Heart burn related issues supposedly led to other symptoms such as throat spasms and eventually even migrated up to my temples causing spasms there. so the doctor(ENT), who is a great doctor put me on prilosec. it has def tempered down these spasms. but in other ways it may have caused other issues.

These spasms all began when I recall a year ago, i had the same type of issue with heartburn, but more importantly prototypical heartburn sympoms. so i begin to take nexium. and the heartburn leaves, but at the time I am really into alternative health stuff. and nexium supposedly causes your body to deplete itself in electrolytes like calcium, or magnesium. so i tell my doc, I'm going to discontinue Nexium and take something else. I was thinking of taking digestive enzymes, which are known to help gastro issues, and also take betaine HCL. But anyways back to the story soon after I discontinued nexium, these spasms which i never had before came up.

and since at the same time I discontinued nexium I discontinued gabapentin. to see if i could go without it. These spasms increased. so i decided to go back to taking the gabapentin to see if it would go away, it did initially but after awhile it didn't matter. I was convinced that it was actually the stopping of the gabapentin(not the nexium) that made it worse.

so even though these enzymes, PPIs, and betaine HCL could decrease my heartburn gastro issues. they def may have been causing other issues like trouble sleeping etc. I feel like maybe with no acid production in my stomach there is no acid to metabolize the medications. anyone experience this?

2. then there is one another theory i had....when i went off lexapro for a sustained amount of time 1 1/2 or 2 weeks. i def had some trouble sleeping during that phase, although during the day i could function quite well, my anxiety was there at times, but overall i could function. Music sounded better, tv shows started to actually be interesting. but it was so hard just not sleeping at all for like 2 nights in a row. it was actually so shocking that i had to go back on them. so, this theory could be true, that since i went off lexapro for such a duration as to make it not work as effectively when i came back on it. this is my main theory.

You poor thing. It sounds like you have more a case of gastric reflux going on. I deal with that from time to time and I've noticed that it comes back when I've taken some kind of new medication. Fortunately for me Nexium usually does the trick after just a few doses.

I sure hope you find the answer and get some decent rest. Heartburn is just so awful. :hug:

right, but if u read a little more carefully you'd understand that the heartburn medication itself may be causing more insomnia. because it's cutting off the acid used to absorb the other psych meds i take.

altho yes, heartburn for awhile was a big issue for me.

I don't believe that stomach acid enhances absorption of medications.

But stomach acid CAN affect negatively some compounds. This is why peptides are not given orally, since stomach acid breaks them up/digests them. Some drugs are enteric coated for this reason. Peptides are small proteins, and the bonds between the amino acids are broken by acid.
Also many people don't know this, but Prilosec has to have a basic non acid vehicle to be used orally. So does Prevacid. They are inactivated by stomach acid. We add bicarb to them when making them into liquids. The Prilosec beads(caps) and tablets are enteric coated.
This wiki explains it:
http://en.wikipedia.org/wiki/Omeprazole

You may notice motility changes when going off or on SSRI drugs like Lexapro. Since this drug increases serotonin in the synapse, it affects gastric functioning for some people. Some people have nausea/vomiting on it or diarrhea. Serotonin is the main neurotransmitter in the GI tract.

Here is an article explaining drug absorption, where most is accomplished in the small intestine. By the time drugs reach the intestine, the acids in the stomach have been neutralized by the pancreatic bicarb that is provided by the pancreas.
http://www.merck.com/mmpe/sec20/ch303/ch303b.html
Solubility in water, is the most critical factor for absorption, but even then, some insoluble things do get thru. Giving highly lipophilic drugs with a fatty meal, can help absorption of this type.

I have not been aware of drugs needing acid to be absorbed...I wonder who told you that.

In fact long term use of PPI drugs leads to gas and more reflux.
This is because the protein you eat is not digested properly and is fermented by bacteria in the intestine instead forming gas.
The gas then come back up or down depending along with diarrhea for some people. This is why those side effects are listed for those drugs. Gas coming back up as a belch, will also reflux food if it is present.

well it wasnt a firmly held belief
 

well it wasnt a firmly held belief about stomach acid, it was just a theory that it was causing medications to become less effective. i was just having trouble sleeping, and looking for a reason for this.

There is an antacid that coats the esophagus and is useful for resistant heartburn. It is called Gaviscon. If you don't have warnings on your pill bottles, about calcium etc, you can try this before bedtime. It usually does the trick for many people.

Insomnia is listed for all the PPI meds in that family as a side effect. I tried looking for the mechanism and could not find it.

Just having an upset stomach can cause sleep disturbances. I have a birth defect of the GI tract that when it starts, begins with insomnia, before I feel the cramping which comes later.

yah i mean i much rather not take gaviscon every night, instead of a PPI. because the PPI seems to be able to take away the spasms ive been having, and im trying to live with the insomnia. i mean before i even started taking the PPI i had insomnia. so like i said it was just a "theory" that it would be causing insomnia. i actually didn't see insomnia listed as a common side effect for PPI meds.

PPIs do nothing for spasms. They only reduce the secretion of acid.

What happens sometimes is that chronic irritation of the esophagus leads to a spasm there. By using an antacid for a week or so,this may heal up and stop. You may not need the Gaviscon every day after that.

Some drugs are irritating too. If you take your medications at night, you might consult your doctor and ask if you can take them in the daytime instead. Or take at least one hour before you lie down, and make sure you drink enough water with them.
The stomach has a mucus coat to protect it, but the esophagus does not. So some drugs may actually be irritating you.

hmm, not completely sold on using an antacid for a week, and then not using it. cause with me calcium carbonate doesn't seem to really help out my heartburn. I read somewhere that antacids aren't effective for heartburn, as you may need more and more of them, and they are just a temporary solution. and they cause heartburn to come back more and more worse when they do come back. not that PPIs don't do that. but my ENT doctor, who looked down the back of my throat said that my heartburn, or my stomach acid, is causing the spasms.

maybe i just need to cut back on the dosage of the PPI, cause I am taking 40 mg which was prescribed. but, they do have a 20 mg dosage. I didnt find anything that said PPIs can cause insomnia.

Gaviscon is not like other antacids. It sticks to and coats the esophagus.
This is how it works:
http://www.netdoctor.co.uk/medicines/100001145.html

It is a unique product and very effective.

hmmm ill think about it. but for now i think im gonna go the medical doctor route with the PPIs and cut back on the dosage, even if they dont let me absorb vitamins etc. cuz last time when i stopped taking them, i had all sorts of issues(headaches were worse, spasms increased)

i think i weighed the risks and benefits and decided to forgo the PPIs again for now. because i really am desperate for sleep, and i think the PPIs are interrupting absorption of my other sleep meds. it's not for lack of effort tho, cuz i tried my hardest to pull through. cuz i knew what would come back, the muscle/throat spasms and headaches. so im gonna forgo the PPIs at least for now.

and try for now to just deal with the muscle/throat spasms and headaches with what my neuro prescribed me, a muscle relaxer and possibly an nsaid or two.

as for the gaviscon ive decided to try in lieu of the PPI regimen. and maybe using the ppis on an as needed basis. because usually they say to use the Prilosec OTC delayed release capsules for 2 weeks, and you don't have to use them again for another 4 months(on the packagin)http://www.prilosecotc.com/en_US/con...ur-package.jsp

I'm wondering what all this means. i tried my best to absorb the merck with the ionizing and unionzing. it seems a bit complicated. and what if anything, my poor tolerability of aspirin has to do with this.

everytime i take aspirin, i feel like it really does a number on my throat, it's hard to describe but it causes an immediate weakening of me, along with crepitus in my throat region. and i end up having trouble sleeping the night, and so for a few days i don't feel myself.

i hate having to deal with this stuff, and having to go through doc after doc, just to have him kick me out of the office, with his payment in hand. I know that there's just this truth out there that they haven't gotten to yet.

because u know when there's something wrong, and ive known since about 7 years back and i think i can pretty much tell the difference between somatic and non somatic. hell, i even read 'house of god', in which the whole point of the whole story was that none of us are sick, we're just in need of love and I also tried to get into a hypochondriac study just to cancel out some variables.

Just take my word for it.... drugs do not need acid to be absorbed. In fact the acid in the stomach can interfere with some drugs (peptide types, etc). Some drugs are enteric coated for this reason. Some nutrients do need acid environment for absorption, and acid is needed to digest protein.

Crepitus is the sound that joints make when they are grinding against each other. The clicking you hear when you swallow is from your eustachian tubes trying to equalize the pressure for the middle ear.

If you have problems swallowing, often, or feel weak all over, you should be evaluated for Myasthenia gravis. I'd suggest you read our forum here. There are several men who participate who can help you find appropriate medical interventions, tests.
Myasthenia gravis is an autoimmune disorder where the antibodies attack the neuromuscular junction, and produce weakness.

right, my doctor just ordered a cervical xray, and bloodwork as i was having trouble swallowing and he wrote that on the order. i think he was checking acetycholine values, cbc, and ck

That's good. You need to know what is going on.

I hope you don't have MG tho.

i just got the EMG done. this wasn't a bad EMG like i had before on my shoulder. but just a reflexive kind. it showed that i had a tendency towards myasthenia gravis. so he put me on a medicine to further confirm the diagnosis. the medicine is mestinon(pyridostigmine) 60 mg tablets. take 1/2 3 x day. then 1/2 4x day. then titrate up to 1 3 xday, and up to 4xday if tolerable. if i do well on this medicine it confirms the diagnosis. he says the side effects are as follows diarhea, nausea. then he has to do a muscle biopsy to further confirm it.

Oh, my. I'd start reading our Myasthenia gravis forum now, since this is a very tricky thing to treat. There are alot of very friendly and experienced posters there to help you!

I'll be following your postings there.

yah ive started up on gaviscon again, since it was pretty helpful before about a year ago. its very chalky so anything, that leaves a weird film in my mouth isnt too pleasant, but i guess ill hafta deal with it if it heals up.

there are two types of gaviscon, i think the gaviscon regular which is made with magnesium trisilicate, and then the gaviscon extra strength whihc is just made with a different magnesium(carbonate) at a different amount.

i still haven't gotten the biopsy, as i had to swithc primary care. and in general do not believe i have MG. but i will in teh future look into it, after i get the other problems solved. supposedly MG can affect respiratory muscles or opening as well. anyways, thanks for the help on that

i also have been trying the ppis again, as my doctor recommeneded to try it again to see exactly what happens. the first day i was fine, i actually felt really good and responded well, the second day wasn't that good, but i was still feeling ok. the third day after taking my third dose, i was almost panicking, and having anxiety and a rapid heart beat. so this in particular is what happens when i go on the ppis, so i generally stop taking them do to this effect.

I mean if i could take these ppis in seperate doses and then stop taking them, and then take them again, that would be good, but probably not good for my health, or either that or i hafta discuss it with a doctor. they do have some sort of benefit. i think the real reason why ppis dont work with me, is they screw up your intestinal tract, so that serotonin doesnt get produced through there. and i can actually feel myself getting hungrier from the ppis, maybe cause less serotonin is produced due to the lessening of acid. but that is just a theory.


i still am actually going to try to eat less. and hopefully that works things out, i already feel slightly better, from not eating as much. but still have the other symptoms which ill get checked out when im back on insurance, i actually have to get on masshealth, or on my parents insurance for antoher 3 months, until i get the masshealth

but more specifically eating alot isnt bad, it's just bad if u eat alot all at once. in other words, if u eat till your extremely bloated, or full. i know have to adjust that, to eat till i feel at least contented, and then leave the dinner table. it's a simple philosophy, and so far i havent lost weight, but my symptoms are somewhat less.

update: doing good, cut out soda. Fatigue is still there, im thinking it's still a mental issue. As far as the heartburn/GERD, I think that gaviscon is helping. I see my gastro in August, I haven't had an actuall office visit with him yet, but i'm hoping he can help me. Maybe an antibiotic would help if he still insists on the PPIs. maybe he will know if gabapentin can really screw up my digestion so much so, that i get the fatigue/weakness while on the PPI's. I do not that antacids aren't supposed to be taken with gabapentin, but with lyrica that isn't an issue.

I also love my neurologist, he has been extremely helpful in terms of communicating with other doctors, I mean what doctor talks with another doctor about the patient(not many) I don't hear stories about it, but my friend said every doctor does that. and i was like what effing doctors do u go to? ones that kiss your butt? lol just had to say that. so anyways he talked to my Primary Care about my high levels of C-reactive protein, or at least sent him a note about it. he also prescribes me flexeril, which works out really good for me.

I just wish i wasn't so braindead or energy-less all the time.