This topic is about managing overactive night-time output from a long-term loop ileostomy. The person in question has been experiencing increased stoma activity at night, which disrupts sleep and affects mood. Here are some helpful suggestions and insights to consider:

1. Review the timing and dosage of loperamide:
- Try taking loperamide 15–30 minutes before meals instead of at bedtime to help it work while food is being digested.
- The dosage can be increased safely, but only with medical advice. Some people use up to 6 capsules, 4 times a day.

2. Adjust your diet to help thicken and slow down output:
- Include bulking foods like white rice, potatoes, plain pasta, bananas, applesauce, marshmallows, and creamy peanut butter.
- Reduce or eliminate caffeine from tea and coffee, as it can increase output, especially with high-output stomas.
- Have your last solid meal by 6 pm and keep it light.
- Limit fluids in the evening.

3. Consider using soluble fiber supplements:
- Psyllium husk powder, found in products like Metamucil, can be added to food or mixed with water. Start with 1 teaspoon and adjust as needed.
- It helps thicken the output and can be taken at any convenient time, including bedtime, if it suits you.

4. Try positioning and lifestyle changes:
- Some people find that sleeping partially upright in a recliner reduces night-time flow compared to lying flat.
- Pay attention to how different meals affect your pouch activity to identify any personal trigger foods.

5. Seek professional support:
- Ask for a formal assessment by a colorectal consultant and a dietitian who has experience with high-output or loop ileostomies to help optimize your medication and diet.