Abdominal discomfort, alcohol use and trouble sleeping

May 21, 2013 7:55 AM

I'm having some abdominal discomfort that might be related to my alcohol use. But I don't know what to do about it, for reasons related to sleep issues. Long story within.

For 15+ years I've been a daily drinker - 2-3 drinks in the evening while watching TV. Never enough to get drunk (I hate getting drunk, but love the daily ritual of drinks in the evening). About a year or so ago, I started getting an occasional pain in the middle right side of my stomach, right at the top of the belly. Not a sharp pain, but just like a thing is there.

In the past few months, that feeling is always there, and it feels like it's getting worse. I went to the hospital and had scans done, and they said I have a few small gall stones. So I guess I'm going to get my gall bladder out.

But I'm increasingly worried, because the liver is in that same spot. And I'm wondering if what I'm feeling might not be my liver instead of my gall bladder. I've read up on the symptoms of liver pain and liver disease and whatnot, and I don't have any of them - discolored skin/eyes, bloody stool, itchy skin, nausea, lack of appetite, I don't have any of that. Just this mild discomfort in my gut.

I went in to get a colonoscopy done, and as part of that, had to go without alcohol for a few days. Which was not a problem. Despite my long history as a daily drinker, it was no problem for me to not drink. So that's good. But here's where I'm getting to the real thing: On any night when I don't have a few drinks, I consistently have night-long, horrible horrible nightmares, and that's after hours of struggle to fall asleep. Every single time. I've abstained nights here and there in the past, went a week without drinking not too long ago, and it's always the same. If I don't have my "night-caps," I have nightmares.

And they're awful. So awful that I'm actually afraid to give up drinking, which I want to do, just to see if this pain will go away on its own (which I suspect it will).

So I guess there are a couple of questions here, the smaller one is: Is it possible that this discomfort in my gut is something other than alcohol-related? Any diet tricks or fasts or whatever that I might try to find out?

And the larger question: If I go the route of eliminating alcohol in the evenings, what are some things I might do to help myself fall asleep and not have the terrible dreams? Sleepytime tea and melatonin aren't doing the trick.

(Complicating factor: I live in a noisy house with a lot of kids, so falling asleep is difficult in the first place.)

posted by anonymous to Health & Fitness (22 answers total)

I had a roommate who had the same relationship with alcohol - daily drinker, trouble sleeping if she abstained but no other difficulty giving it up. She finally went to her doctor when she started to have other health complications, and they tried a few sleeping aids and ultimately went with, I think, Lunesta - and she stopped drinking except socially (and moderately,) lost a bunch of weight, and her other health issues resolved.

So, short version: you're self-medicating, and there are other medication options available that have fewer nasty side effects. Talk to your doctor!
posted by restless_nomad at 8:02 AM on May 21, 2013 [4 favorites]

It appears that you did what I or anyone else here would tell you, which is to see your doctor. I would recommend that you keep doing that. As a layman, I would suspect that since you directed your doctor to that area of your body in the first place, your liver was also considered as a source of the problem. If this is still a concern, voice it again to your doctor.

FWIW, recent research has suggest that alcohol is not necessarily a sleep aid.

Nightmares can be treated to some extent. I would consult with your doctor and see if you can get a referral to a sleep specialist.
posted by Tanizaki at 8:04 AM on May 21, 2013

I've heard that melatonin causes awful nightmares in some people, so if you're only using that on the nights you don't drink, try going without to see if your nightmares go away. If they do, you can address the falling asleep issue some other way.
posted by Safiya at 8:15 AM on May 21, 2013 [1 favorite]

I would absolutely give "Rescue Remedy" a shot. It's available on amazon, and has worked really well for me in the past..
posted by Glendale at 8:35 AM on May 21, 2013

Is it possible that this discomfort in my gut is something other than alcohol-related?

It's possible. When you saw the doctor, were you up front about about your drinking and your concerns? If not, it would be best to go back and be as honest as you can. Your doctor needs complete information to decide what tests are necessary and then make an accurate diagnosis and treatment plan. Liver function tests exist, but if the doctor needs to know there is a reason to run them - I believe that they are not part of standard bloodwork in most cases (please correct me if I'm wrong, more knowledgeable folk!).

If I go the route of eliminating alcohol in the evenings, what are some things I might do to help myself fall asleep and not have the terrible dreams?

I'd stop taking melatonin; it causes very vivid dreams for many people, including me. Benadryl works for a lot of people, but can cause a hangover. You can talk to your doctor about prescription sleep aids - some are okay for long term use, some are okay for occasional or short term use only (but might be helpful in transitioning you off of using alcohol for sleep).
posted by insectosaurus at 8:45 AM on May 21, 2013

Seconding melatonin can cause vivid nightmares (if you google "melatonin nightmares" there are over 344,000 hits), so if you were taking them when you weren't drinking, they could have been the problem.

Definitely talk to a doctor.
posted by kinetic at 8:46 AM on May 21, 2013 [1 favorite]

I can't address most of your concerns, but I will say how much I like the new OTC sleep aid, ZQuil. It helps me fall asleep when I am having trouble with that and I don't feel groggy the next day. It claims to be non habit-forming.

Best wishes to you.
posted by michellenoel at 9:00 AM on May 21, 2013

Do you have a primary care doctor? A full exam and big-picture perspective might set your mind at ease.

If you got blood work done at the hospital, did they measure your AST and ALT levels? These can indicate liver damage (not conclusively).

For sleep, an OTC antihistamine like Benadryl might work in the meantime. Get a "white noise" app to drown out the noise.
posted by RobotVoodooPower at 9:00 AM on May 21, 2013

Try Unisom (or drugstore brand doxylamine succinate), starting with a half the first night, instead of melatonin.

(on preview: ZzzQuil is dyphenhydramine HCl (Benadryl), the same sleep ingredient in NyQuil, TylenolPM, and most cold medicines. Many people find it dries the hell out of their sinuses, making them snore, and is also like being hit with a brick.)

Don't convince yourself that not drinking automatically equals nightmares. Give yourself a treat on your next non-drinking night, preferably something carby to help make you sleepy (is there any better excuse for Nutella toast?), maybe a book you've been wanting to buy, sheets fresh from the dryer. Have a nice bedtime, try to curb your anxiety about not drinking or about nightmares.
posted by Lyn Never at 9:04 AM on May 21, 2013

Alcohol can also increase your stomach acid, which can in turn cause all sorts of discomfort, including difficulty with sleeping. Pop some Tums or Prilosec or something and see if it makes any difference.
posted by spilon at 9:06 AM on May 21, 2013 [1 favorite]

Are you male or female? Fibroids also come to mind. But I think dealing with the gallstones sounsds like your next move.
posted by Riverine at 9:24 AM on May 21, 2013

Perhaps you are addicted to alcohol and the nightmares are part of your withdrawal. I would request a sleep aid and commit to 1 month of no drinking, using the sleep aid to control the nightmares and then see how it goes. Along with that, you are drinking for a reason. There are wonderful medications for anxiety and depression that can help and that won't cause liver damage. You are drinking too much. Even if the stomach pain isn't caused by drinking, there are a whole bunch of other problems that are. Talk to your doctor. It's time to get healthy.
posted by myselfasme at 9:31 AM on May 21, 2013 [1 favorite]

"Rescue Remedy" is "homeopathically prepared" and "the one thing that might have any real effect is the brandy used to dilute" it, but not if taken in normal quantities. Total quackery.

+1 "talk to your doctor," about sleeping pills -- if you find nothing improves after a good trial period; it doesn't sound like you've tried more than a few days in a row without the "nightcaps"?
posted by kmennie at 9:37 AM on May 21, 2013 [3 favorites]

Go back to your doctor about the pain. He will either reassure you or he can organise some liver function tests. Alcohol can cause all sorts of irritation to your mouth stomach etc.

Now for the alcohol. Two or three drinks is a pretty bad description. It could mean almost anything from a benign tipple to hardcore drinking Be honest with yourself. Assuming you are drinking enough to feel an effect every day you need to stop. People with an alcohol problem often don't get drunk cos they are habituated and know their limits. I would put your nightmares down to withdrawal from alcohol. You ought to do a home detox under medical advice as alcohol withdrawal can be fatal. Be prepared for other withdrawal symptoms too.

I am not a big fan of sleeping pills or sedatives. You would be astounded how many folk turn up for alchol rehab addicted to them too.

Oh rehab is the next step. Educating yourself primarily and learning how not to be dependent.

I hated AA but others love it.
Good luck.
posted by BenPens at 10:19 AM on May 21, 2013

This is a bit unrelated but re the nightmares: I have wild nightmares if I eat a lot of nuts in the evening. Perhaps the alcohol has masked something that triggers nightmares for you?

My wife found that meditating for 20 minutes with some meditation mp3s significantly improved her sleep (I'm a sceptic but I realize I could be wrong).
posted by srboisvert at 12:00 PM on May 21, 2013

There are other things that may be depleted in your body from your frequent alcohol use. Alcohol is notorious for depleting b vitamins. Think about taking a b-complex around dinner time, and some D3 in the morning. Those will help move your hormones back toward a normal level, which should start to move you toward a more normal sleep experience. I've had huge sleep problems for years related to anxiety, and have recently started a similar vitamin regimen. It's helping.

It won't hurt you to start taking some vitamins today, but do go back to your doctor and have some bloodwork done and your levels checked.
posted by vignettist at 12:18 PM on May 21, 2013

To answer your second question: Do you snore? Have you ever been tested for sleep apnea? My husband also struggles with nightmares/vivid dreams that disturb him even when they aren't "nightmares", and was diagnosed with sleep apnea. It's not that he has more nightmares than other people, it's that he remembers them all because he's never getting in that truly deep REM sleep; his body keeps waking him up screaming "Oxygen!!" (This has changed somewhat since he got a CPAP machine.) A combination of Ambien and the CPAP have truly made a new man of him. Obviously, I don't know if this is your problem as well, but it may be worth looking in to.

Re: your nightcaps--what happens if you cut back to one instead of having two or three? Could you achieve the result you want (good sleep with no nightmares) with less alcohol? Would you feel better about your drinking and your liver if you could do this? It seems like it would help you feel a lot better if you talked about this with your doctor and came up with a plan of action to assess the source of your pain, how well your liver is functioning, and how much alcohol you can consume in a day/week and be healthy.
posted by epj at 1:02 PM on May 21, 2013

IANYD. The standard blood work that is done for upper abdominal pain is a panel that includes liver function tests (LFTs, which include AST and ALT, markers for liver damage). Given that you have an ultrasound of the gallbladder and are on your way to having your gallbladder out, I think it is highly likely you have already had this blood work done. If you want to know what your liver function tests showed exactly, ask your doctor.

However, regardless of what your blood work showed, it is clear that your drinking is causing trouble for you and that you are relying on it for things that you shouldn't be. I agree with the comment that you are self medicating, and that isn't healthy. Please discuss this with your doctor, and be honest with them about your drinking before your surgery. It is likely to be relevant to your care, even if you know you can go without drinking without going through severe withdrawal symptoms. Your doctor can also help discuss ways of quitting drinking with you that you may find helpful.

Please bear in mind that the symptoms of liver disease that you found in your internet searches (jaundice, etc) are symptoms that you get in late stage liver disease. Many people with significant liver disease have NO noticeable symptoms whatsoever. Your liver is such a vital organ that you need to have severely damaged it before it starts to fail. Don't let it get that far. Talk to your doctor now.
posted by treehorn+bunny at 1:08 PM on May 21, 2013

I should add that gallstones can bump your liver function tests even if you have no baseline liver damage. So please have your doctor interpret your test results in the context of your current situation.
posted by treehorn+bunny at 1:09 PM on May 21, 2013

You seem to think that your level of drinking is OK from the point of view of alcohol abuse. You say "2-3 drinks". Make sure you understand how a drink is defined from a medical point of view:

Center for Disease Control and Prevention:

"What is a standard drink in the United States?
A standard drink is equal to 14.0 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in:
12-ounces of beer.
8-ounces of malt liquor.
5-ounces of wine.
1.5-ounces or a “shot” of 80-proof distilled spirits or liquor (e.g., gin, rum, vodka, or whiskey)."

One "drink" is a really, really small amount, usually much smaller than most people think. For example, people think "a glass of wine" is one drink, but in reality, depending on the glass and alcohol content of the wine, it is usually 2-4. Even if you measure out half a glass of wine as 1 drink, don't just fill it willy-nilly with any old wine - the alcohol content of wine differs, and it makes a big difference if it's 12.5% or 16% alcohol.

Now, the best medical outcomes are for light to moderate drinking, unless alcohol is counterindicated for you. Anything above that, is excessive drinking. So how much is moderate?

What does moderate drinking mean?

"According to the Dietary Guidelines for Americans,1 moderate alcohol consumption is defined as having up to 1 drink per day for women and up to 2 drinks per day for men. This definition is referring to the amount consumed on any single day and is not intended as an average over several days. The Dietary Guidelines also state that it is not recommended that anyone begin drinking or drink more frequently on the basis of potential health benefits because moderate alcohol intake also is associated with increased risk of breast cancer, violence, drowning, and injuries from falls and motor vehicle crashes."

So even if you're a man, anything above 2 drinks a day is likely medically suboptimal, including your 2-3.

Remember, for a man it's 2 drinks a day - and a drink is a really tiny amount.

There is also research showing that you should regularly give your system an alcohol rest, so drinking every single day, even within the moderate guidelines, is probably suboptimal. The suggestion is to have at least 2 days a week alcohol-free (I have 1-2 drinks of usually red wine, Monday, Wednesday, Thursday, Saturday, Sunday - off Tuesday and Friday).

Finally, medical research clearly shows, that drinking with food is preferable to drinking without food.
posted by VikingSword at 1:27 PM on May 21, 2013

In addition to everything said above, alcohol messes with your normal sleep patterns and you don't get as much deep sleep. So it could be that when you finally sleep without alcohol, there is a rebound effect.
posted by BibiRose at 1:58 PM on May 21, 2013

I recently got a CPAP for what turned out to be a severe case of sleep apnea and I feel like a whole new person now. And my dreams are much, much better. I used to have nightmares or really disturbing dreams and now it's mostly fluffy kittens, unless I've had a stressful day.

My favorite OTC sleep aid is plain old magnesium - I like the Natural Calm brand. It does a great job of helping me relax, with no weird dreams and no hangover. Other things that help me sleep well: an air purifier which emits white noise, a dark cool room, clean and sweet-smelling sheets, no computer games or stimulating reading for an hour or two before bed (light reading or mindless games only), and booting all pets out of the bedroom.

If you really and truly cannot sleep without a drink, it's time to see the doctor. For me, it turned out that a severe and long-standing case of insomnia was sleep apnea. Treatment (a CPAP) is helping me so, so much.
posted by Rosie M. Banks at 12:25 PM on May 22, 2013