Morning Nausea Associated W/ Dysautonomia

[MelissaCrystal]

Hey guys,

So all three of my mother's children has had morning sickness throughout high school and still has it college. My brother just tried to go to his first job on his first day and ended up throwing up in the office and being sent home because of his morning sickness and getting up early. I'm really worried about him because he's not a school-goer, the economy *****, and he doesn't have all the symptoms of Dysautonomia so his case would be mild and hard to diagnose if Dysauto was the cause of his nausea.

I've been trying to look for the specific reason we get nauseous after sleeping. It has to do with laying down so long, perhaps not having enough fluids throughout the night, and needing to eat right away after waking up or else it's vomit time. It's not postnasal drip, it's probably not hormonal.....I'm looking for a cause that is directly related to nervous system dysfunction and is definitely worsened by motion sickness but motion sickness isn't the direct cause. Gravity is the cause and how it affects our body after laying so long. I guess I am a little more acidic in the morning because it comes out the other end too, very painful, but anti-acids don't really help me. In fact they cause motility issues with me, and my stomach contents don't get digested---more nausea.

I've been trying to do research so that I can somehow find relief for my brother. If you guys have terms, throw them at me. If you've heard explanations from your Dysautonomia doctors, try your best to explain them to me. I've had this explained briefly by my doc at Stanford, but I can't remember what she said.

I'm really upset that my brothers are effected because my family has always struggled medically and I can't imagine all of us going on temp disability or getting through this without severe financial struggle and depression. We're all prone to depression upon hardship, and nausea is definitely a hardship. I'm worried about my family. I wish something would help with the morning sickness... we can't keep down jobs because of it, and in this economy it's hard to find work to work for us.

[Poohbear]

I've never heard of anyone throwing up every morning due to dysautonomia. I know there are many on this site who deal with nausea but I don't recall ever reading anything in all of my research or hearing from any physician why sleeping would cause nausea. To me, based on what you've written, it doesn't sound like a piece of the dysautonomia puzzle. I would certainly be asking your Dr to explain it to you again.

Have medications, including anti-nausea meds been tried?

[MelissaCrystal]

Wha? I thought a lot of people here get morning sickness. Not necessarily throwing up, but the nausea after waking up. If I try to go to work or take a bus/car to work though, that's when it turns into vomiting, but I'm not working right now because I've gotten worse again. I don't know, I've run into a lot of Dysautonomia people who have morning sickness, I thought it was a common symptom. My Dysautonomia specialist at Stanford (Dr. Friday) also said it was one of the more common symptoms.

If you look it up on wrongdiagnosis.com and the MD sites, non-pregnancy morning sickness usually points to nervous system disorders and balance disorders. But I can't find the exact explanation WHY it is attributed to nervous system disorders. Hopefully that clarifies what I'm trying to find out. Specifically, what happens at night to make the morning so bad.

Doctors usually refuse to prescribe anti-nausea meds until last resort because of the long term effects, so no on that last question. Nothing else has really worked. Occasionally ginger pills help with my motion sickness, but not the morning nausea. I just have to sleep like 13 hours in order to get past it, but on bad days sometimes that doesn't work---especially when I have insomnia.

Honestly, it's probably all caused by my gastro issues, but it's an odd type of nausea that fits more into the "morning sickness" category associated with pregnancy. My brothers say the same thing because it's not like food sickness, motion sickness, nor alcohol sickness. It usually comes on when I'm hungry, and of course morning time I'm starving---feels like I haven't eaten for days. Doesn't go away though even when I eat.

I didn't necessarily agree with my Doc about it being related to sleeping and then having your body adjust to gravity again----but I had heard that explanation on these forums by one of the regulars but can't find it by searching (at least easily) so I thought I'd ask.

Wrongdiagnosis.com:

http://www.wrongdiagnosis.com/m/morning_sickness/causes.htm

Adrenal insufficiency:

Common GI findings in adrenal insufficiency include nausea, vomiting, anorexia, and diarrhea.

One possible reason...

Causes of Nausea--->Balance disorders

Any cause of a disturbance in a person's sense of balance. Inner ear, brain, vascular and nervous system problems are the main origin of balance disorders. Balance disorders can range from mild to severe enough to cause vomiting.

And everyone knows we're at our worst in the morning because of the postural change of getting up after laying down for so long... but I'm trying to find out what exactly happens in the body to cause this response.

If you google morning nausea w/ Dysautonomia, gastroparesis is talked about a lot. And I also read that gastroparesis is especially bad during the night because the body functions slow down even more, so that can cause morning sickness. But that's not what my doc was talking about---her's had to do with blood and nerves and something. Can't remember.

http://dinet.ipbhost.com/index.php?showtop...art=#entry33221

Here is a good thread with a lot of people explaining their morning sickness and the thread starter's is a lot like mine. It's very common among the members here I'm pretty sure, but I haven't read a good article about it yet.

[firewatcher]

Melissa, sleep causes certain chemicals to collect in the brain. Just a theory, but I am guessing that when YOU sleep it causes enough of a neurochemical shift that when you get up there is a sudden transition from sleep chemicals to wake chemicals that triggers your nausea centers. I looked into this over a year ago and found that there is a positive correlation between the neurotransmitter that causes nausea and tremors (since I only shook like this after vomitting before my crash.) I just don't remember the explanation right now, sorry.

Pathophysiology of Nausea and Vomiting

Palliative Care Perspectives : Chapter 5: Non-Pain Symptom Management : Nausea and Vomiting: Overview--James L. Hallenbeck

Good evidence exists that various stimuli that affect nausea and vomiting come together in an area in the brain known as the vomit (or emetic) center in the medulla. This "center" is not a discrete nucleus, but a complex array of neurons coordinated by a "central pattern generator."1 Still, for our purpose, it is useful to think of a final pathway that gives rise to vomiting. The vomit center receives input from four major areas: the GI tract, the chemoreceptor trigger zone, the vestibular apparatus, and the cerebral cortex. (The center also has intrinsic chemoreceptors that can modulate, stimulate, and repress nausea.)2,3 Each of these four areas responds to certain types of stimuli, modulated by specific neurotransmitters that bind specific receptors. Understanding how these areas modulate nausea and vomiting helps us tailor specific therapies for specific problems.

The GI tract

As the primary source of toxin absorption is the gut, the effect of the GI tract on the vomit center is complex. Stimulation of the gut chemoreceptors and stretch receptors triggers nausea and vomiting via vagal nerve afferents and afferent fibers associated with the sympathetic nervous system. Serotonin, acetylcholine, histamine, and substance P are major neurotransmitters involved in stimulating these receptors. Chemoreceptors in the gut appear to be major mediators of the toxic effect of certain chemotherapeutic agents, such as cisplatin, even when such drugs are given intravenously via binding to 5HT3 receptors. In addition to being a neurotransmitter that stimulates nausea, acetylcholine also increases gut motility and gut secretion. Histamine mediates transmission of nausea via the vagus nerve. Substance P binds neurokinin 1 receptors in the gut (and directly in the vomit center in the brain).4,5

The chemoreceptor trigger zone (CTZ)

The CTZ senses chemicals in the blood. The CTZ is particularly sensitive to increasing blood levels of potentially toxic substances. If a toxic substance is detected, nausea is experienced and the vomit reflex initiated - hopefully before more toxin is absorbed. It is easy to understand the evolutionary advantage of such a failsafe. The brain detects an "alien" chemical. By itself, this is not so unusual - we have lots of peculiar non-self chemicals floating around in our bloodstreams. However, if the concentration of a chemical is rapidly rising, this could constitute a threat to our health - better to expel any residual substance in the stomach; better safe than dead. Two major neurotransmitters are involved - dopamine, acting on D2 receptors, and serotonin, acting on 5HT3 receptors. Different toxin responses are mediated through different neurotransmitters. Opioid-related nausea appears to be most related to stimulation of D2 receptors. Understanding this has helped with selective blockage of specific receptors in specific disorders.

The vestibular apparatus

Motion and body position are sensed through the vestibular apparatus. Motion sickness, such as car sickness and seasickness, are mediated through the vestibular apparatus, as are inner-ear diseases, such as Meniere's disease. The vestibular apparatus may once have served as a sensor for certain neurotoxins (such as alcohol) that can produce disequilibrium. Stimulation of the vestibular apparatus by alcohol may provide a survival advantage in keeping our species from, literally, drinking ourselves to death. Stimulus of the vestibular apparatus is mediated largely through histamine and acetylcholine receptors.

The cerebral cortex

The cerebral cortex and associated structures in the limbic system modulate complex experiences such as taste, sight, and smell as well as memory (involved in anticipatory nausea) and emotion. Discrete neuropathways are less well understood. However, higher cortical effects are still important and can be extremely powerful in stimulating and suppressing nausea and vomiting.

[jjb]

I often get a lot of morning nausea ... well anytime nausea really, but sometimes I go through periods where I have more morning nausea.

My cardiologist always though I have vagla nerve issues. Maybe so, but the geneticist thought I had chiari malformation.

Chiari is somewhat common in EDS. Both EDS and chiari can be a cause of dys.

Chiari can cause lots of nausea. Do any of you have EDS and/or chiari?

Here an interesting blog that talks about EDS, chiari & dys

http://chiariandsyringomyeliaincanada.blog.../12/nausea.html

[gertie]

Sometimes when I wake up in the middle of the night to go to the BR I will get nauseous. If it doesn't subside within a few min I usually take an Ativan which helps most of the time. I do have a vagus nerve problem so I guess Ativan calms it. I thought maybe it was just the shock to our ANS of waking suddenly. The first few times it happened I thought I had food poisoning. Good luck!

[juliegee]

Melissa-

My son also has "morning sickness." When his dysautonomia is untreated or worsens (like now), he also vomits every AM. A stressful situation, like starting a new job, would definately worsen this for him. The docs at Hopkins indicated that this is quite common with dysautonomic teens. Not sure of your sibs ages, but I'm pretty sure it's common in adults with dysautonomia too.

Mack uses a HUGE variety of tricks to combat this:

-props the head of his bed up with bricks

-takes showers in the PM (when he feels better)

-avoids hot showers anytime

-uses nexium (and tums throughout the day) to deal with excess acid

-uses a tiny (1/4 tsp) pediatric dose of erythromycin (EryPed) before breakfast and bedtime

-takes 8mg of zofran to combat nausea

-eats small frequent meals

-low fiber and low fat

-no dairy

-treats the dysautoonomia with .01 florinef, thermotab, 20mg lexapro, 28mg concerta, extra fluids and salt

-takes a daily probiotic (Culturelle)

Hope your sibs can use some of these tips to feel better!

Julie