Exploring the Relationship Between Sleep and Irritable Bowel Syndrome (IBS)
It’s common for IBS patients to report a correlation between the quality of their sleep and their IBS symptoms. While there are many factors contributing to IBS, research indicates there is a two-way relationship between sleep disturbances and IBS symptoms. Sleep disturbances are one of the most common non-GI complaints of those with IBS, and people with sleep disturbances are 1.6x times more likely to have IBS than those who don't!
Individuals with IBS often experience poor sleep quality, characterised by frequent awakenings, difficulty falling asleep, and non-restorative sleep. Studies have shown that people with IBS are more likely to need the toilet during the night compared with the general population, and they report being awoken or kept up by abdominal pains, cramps and bloating. Frustratingly, disrupted sleep patterns can also exacerbate IBS symptoms, leading to heightened pain perception, increased bowel sensitivity, and altered gut motility – so it can be a vicious cycle for IBS sufferers who are already struggling!
The Role of the Gut-Brain Axis in the Relationship between Sleep and IBS
The gut-brain axis, which is the communication network linking the gut and the brain, serves as a crucial mediator in the interplay between sleep and IBS. Disturbances in this axis, influenced by factors like stress, inflammation, and microbial imbalance, can disrupt both sleep quality and gut functioning. Stress, is a common trigger for both IBS flares and sleep disturbances. Chronic stress can dysregulate the hypothalamic-pituitary adrenal axis (HPA), which is a vital body system connected to the central nervous system and endocrine system. Parts of HPA axis, include the hypothalamus, pituitary gland and adrenal glands; these work together to balance the hormones of the body and regulate our stress response. So, when the HPA axis is dysregulated, it can also impact on our sleep-wake cycles, immune function, and gut-functioning. This dysregulation perpetuates a cycle of heightened stress, poor sleep, and exacerbated IBS symptoms.
Some preliminary research also suggests if you have a bad night’s sleep, some of your IBS symptoms like abdominal pains and fatigue may be worse the next day, and you may feel more anxious. Knowing this, you may want to make adjustments to your daily routine on these days. For example, you could build in more self-care activities, which help calm the nervous system. You may be tempted to want to drink more caffeinated drinks or energy drinks to power through, but try to avoid these as these will likely make symptoms worse! Luckily, research suggests that having a bad IBS day, does not seem to affect the quality of sleep the following night – so if you are having symptoms during the day, don’t worry about how you’ll sleep that night! It’s also important to remember we tend to underestimate our quality of sleep, so don’t panic about your IBS symptoms if you have a bad night of sleep. Studies that objectively measure sleep quality using polysomnography, found discrepancies between IBS patient reports of poor sleep quality and the objective data.
Tips for Better Sleep:
Sleep Hygiene:
Prioritise good sleep hygiene practices, like maintaining a consistent sleep schedule and limiting day time naps will also help. Create a relaxing bedtime routine, by minimising light and noise, optimising room temperatures and making sure your bedding is comfortable. Avoid doing anything in bed except sleeping and sex, including avoiding using your phone or devices in bed and in the hour prior to sleep. Also, try to exercise during the day and expose yourself to natural daylight, but limit this in the few hours before bed.
Stress Management:
Stress-reduction techniques such as mindfulness meditation, yoga nidra, deep breathing exercises, progressive muscle relaxation or a warm bath before bed, can all help to reduce the impact of stress on both sleep quality and IBS symptoms. There’s also good evidence for the benefits of hypnotherapy on both insomnia and IBS!
Dietary Changes:
Try to avoid eating heavy meals, and high fat / sugary snacks in the 2-3 hours before you go to bed. Avoid caffeine intake after 3pm, as it’s a stimulant, which can make it difficult to fall asleep. Try to also avoid excess alcohol intake, as this can affect our sleep quality. Additionally, dietary strategies, such as the low-FODMAP diet, can help to identify and eliminate trigger foods that exacerbate IBS symptoms.
Addressing sleep disturbances is a crucial component of holistic management strategies for individuals with IBS. By understanding the underlying mechanisms linking sleep and gastrointestinal function, we can optimise therapeutic interventions to improve both sleep quality and IBS symptom control. As well as my clinical experience working with IBS patients, I also am trained to deliver CBT Hypnotherapy for insomniacs, so please reach out to me if you’re struggling with either of these!
However, if you have either of the following, its best to reach out to your GP for further support:
· If you’re snoring or have sleep apnoea (where you temporarily stop breathing)
· If you have severe anxiety or low mood, which you think may be contributing to your sleep quality (sleep disturbances tend to be more pronounced in IBS patients who suffer from anxiety and depression).
References:
Tu, Q. Heitkemper, M.M., Jarrett, M.E., Buchanan, D.T. (2016) Sleep disturbances in irritable bowel syndrome: a systematic review. Neurogastroenterology & Motility;29(3).
Buchanan, D.T., Cain, K., Heitkemper, M., Burr, R., Vitiello, M.V., Zia, J., Jarrett, M. (2014) Sleep measures predict next-day symptoms in women with irritable bowel syndrome. J Clin Sleep Med;10(9):1003-1009. doi:10.5664/jcsm.4038
Sleep and Irritable Bowel Syndrome (2020) International Foundation for Functional Gastrointestinal Disorders.
Jarrett M, et.al. (2008) Autonomic Nervous System Function During Sleep Among Women with Irritable Bowel Syndrome. Digestive Diseases and Sciences. 53:694-703. doi:10.1007/s10620-007-9943-9.
