The chicken or the egg — which one came first? Just like this dilemma of deciding which started and which followed, the relationship between sleep and inflammatory bowel disease (IBD) is a cyclical one. The two are deeply connected and related; one leading to the other.
Why is sleep important for IBD?
We require adequate sleep to allow our brains and bodies to rest and for cells to rejuvenate. Even for someone who is healthy and not compromised by a disease such as IBD, sleep is essential for mental health, physical health, quality of life, and safety.
The National Heart, Lung, and Blood Institute states that if you’re sleep deficient, you may have trouble making decisions, solving problems, controlling emotions and behavior, and coping with change. It can even impair driving as if you’ve drank alcohol. Lack of sleep overtime is linked to depression, suicide, and risk-taking behavior. Put simply, poor sleep sets up your body for scarce functioning.
Getting adequate sleep is particularly important for IBD, in which your body is under constant damage and battling low immunity. Sleep disturbances activate pro-inflammatory cytokines, signaling molecules that come from immune cells. If you continuously curtail your sleep, your body will overuse the stress response, leading to inflammation and eventually immunodeficiency – less effective at fighting off illnesses.
How sleep affects IBD
IBD symptoms such as pain and diarrhea disrupt sleep especially when they occur at night. Inflammation from damage and flare-ups produce cytokines that directly alter sleep patterns and can disrupt the stages of sleep. Some cytokines can actually induce sleep while others can cause insomnia. Reasons including lack of sleep, pain, bloating, needing to use the toilet, need to drink water, and anxiety.
In one study, IBD patients reported only 4.5 hours of sleep when most adults need 7 to 9 hours per night.
How to get a good sleep with IBD
The Crohn’s and Colitis foundation put together steps you can take to get a better sleep, depending on your symptoms. Try out different methods that can help improve sleep and find which works best for you:
Talk to your physician about adjusting any medication that may be interfering with your sleep such as steroids. These can make it difficult to fall and stay asleep. Taking them earlier in the day may prevent this.
Night sweats can be uncomfortable and disturb sleep. Try wearing lightweight, breathable pajamas. Consider taking a cool or warm shower or bath before bedtime to help you cool off and relax. Ask your physician if symptoms might be related to the medication you’re taking.
Eating at Night
Digestion works the best earlier in the day so try to eat larger meals, earlier. Aim to give yourself at least an hour between eating and going to bed unless you haven’t eaten enough during the day. If you need a snack before bed, aim for easily digestible foods and avoid fried, spicy, or heavy meals especially before bed.
Some painkillers (per your physician recommendation) that don’t cause digestive upset may help you feel better therefore improve sleep. It may be beneficial for relaxation and digestive comfort to have some calming decaf teas like chamomile or lavender before bed. A bath before bed or body pillow may also provide extra relief and ease.
Gastric reflux is common with IBD. It can be worse if you drink alcohol, or eat right before bed. This is because when you lay flat, stomach acid makes it way back up into the food pipe. Aim to avoid eating a heavy meal right before bed and ask your physician if they recommend over-the-counter medications.
If you use the bathroom frequently at night, an anti-diarrhea medication may be right for you. It also may help if you visit the bathroom right before bed so you don’t wake up in the middle of the night. Avoid irritating foods (spicy, fatty, or flare-up causing) in general but particularly during the second half of the day.
Try relaxation techniques
If you’re anxious or stressed before bed, it’s only going to make matters worse — both for your IBD and sleep disruptions. Try relaxation techniques such as deep breathing. Meditation is one of the best ways to wind down after a busy day. It doesn’t have to be the typical sense of meditation, it can be anything that helps you quiet your mind. It can be as simple as taking 10 deep breaths or listening to relaxing music.
Monitor caffeine intake as it can both irritate IBD symptoms and prevent sleep. Some people are more sensitive to caffeine than others. You know yourself best. In general, aim for less than 400mg per day — the equivalent of about 3-4 cups of coffee and avoid having caffeine about 6 hours before bedtime.
Smoking is a stimulant, making it difficult to fall asleep. It also makes heartburn worse, which can interrupt sleep. Many studies have shown that people who smoke are more likely to develop Crohn’s Disease, and research suggests that smoking increases the severity of the disease.
Get more exercise
Exercise or move daily. Staying active throughout the day tires your body out and gets you ready to rest. Just aim to do it at least 3 hours before bedtime because it can give you a boost of energy, making it difficult to sleep.
Avoid alcohol, especially if you’re using it to fall asleep. It can actually cause you to wake up throughout the night and early in the morning. Avoid drinking in excess and try not to drink a few hours before bedtime.
Don’t take long naps. A short power nap can be extremely rejuvenating and help you relax, reduce fatigue, and increase mental alertness. But if you sleep much longer than 30 minutes, it can make you feel groggy and difficult for you to fall asleep when bedtime comes.
Same as how artificial and blue light can impact your sleep, getting outside and accessing natural light during the day programs your body to keep its natural circadian rhythm. In fact, one study found that people who work in offices with windows sleep an average 45 minutes longer than people without artificial light.
Get fresh air
When it’s too hot, your sleep will be disrupted. Try keeping the windows open before or during bedtime to get fresh air as well as controlling the temperature of your bedroom. If you don’t have AC or a fan, try taking a cool shower before bed.
Stop screen time
Try to make it a routine to wind down on a nightly basis. Cut down on screen time (phones, TV, computer) as much as possible before bed. The blue light from your phone can suppress the production of melatonin, the hormone that regulates the circadian rhythm or sleep cycle. Same goes for artificial lights so dim them if possible.
Having regular conversations and getting support from a chatbot coach like Nori will help you discover and change lifestyle factors that impact your sleep.
This article has been written by Lisa Booth, registered dietician and nutritionist, and co-founder of Nori Health. Content is based on her professional knowledge, and our collection of 100+ scientific research study papers.