Sleep and IBS
Sleep is important to every aspect of overall health, but it often gets overlooked in the context of gut health and as an IBS management strategy. The connection actually goes both ways, because sleep can have an impact on your digestion and IBS symptoms and gut health and IBS can influence your sleep-wake cycle and sleep quality.
Find out how sleep can affect your IBS symptoms and get some tips...
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Sleep and Gut Health
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Sleep allows your body to rest, repair and restore itself. If you don't get enough, digestive processes that occur only during sleep can be disrupted and your gut can't fix damage done while you are awake or stockpile energy to be used throughout the day for digestion.
Sleep and your gut are also both connected to many other systems in your body, including the nervous system, immune system, endocrine system (hormones) and the gut microbiome. Through the interplay of all of these systems, sleep can affect your gut and what happens in your gut can affect your sleep.
What are Circadian Rhythms?
You have probably heard the term circadian rhythm, which is used to describe changes in your body and behaviour that follow a roughly 24-hour cycle. The cycle is regulated by a natural timing device called a biological clock. But did you know that you actually have more than one biological clock and many different natural rhythms?
You have one central clock in the hypothalamus region of your brain that controls your sleep-wake cycle. This master clock is affected by light/dark cues and regulates melatonin production, a hormone involved in sleep.
Your central clock communicates with smaller clocks, found in other tissues and organs, to keep your body functioning on a 24-hour cycle and carrying out its different functions at the best time of the day.
Circadian Rhythms and Digestion
There are a number of these smaller clocks in your gut that control different functions of digestion.
The gut/brain axis, the two-way communication system between your gut and your brain, includes feedback loops between your central clock and the smaller clocks in your gut. In this way your circadian rhythms, sleep and digestion can all have an impact on each other.
In fact, there is now a field of study known as chrononutrition, that looks at links between circadian rhythms, eating times and metabolic health.
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Sleep and IBS
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Research shows that about 40% of people with IBS also have sleeping issues. These include insomnia, waking up multiple times in the night, feeling less rested after a full night's sleep and sleep apnea.
The relationship between sleep and IBS is bidirectional. It appears that poor sleep can negatively affect drivers of IBS symptoms and IBS can interfere with sleep. There are several theories about how IBS and poor sleep can influence each other.
If you're already keeping a food and mood journal to investigate your IBS symptoms, consider adding a sleep record to the mix.
Gut/Brain Interaction
IBS is a disorder of gut/brain interaction (DGBI). The gut/brain axis is a complex communication system that involves, among other things, the nervous system, the gut microbiome, hormones and the immune system. Problems in the gut can disrupt signals being sent to the brain to control sleep. Through this communication network, poor sleep can also affect the gut.
Go to The Gut/Brain Axis in the About IBS section for more info.
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Circadian Rhythm Issues
Your circadian rhythm regulates digestion through communication between the central clock in your brain that controls the sleep/wake process and the smaller clocks in your gut. But your central clock and smaller clocks can get out of sync with each other and with the outside world.
Poor quality sleep or sleeping at odd times can disrupt your rhythm, leading to issues like problems with motility, increased gas and even inflammation in the gut lining. This timing disruption could also cause changes to your microbiome, which could in turn have an impact on IBS symptoms.
Your body generally breaks down and processes food better during the daytime. If you eat at odd times or late at night, this could also disrupt your rhythms and affect your sleep. Out of whack circadian rhythms is one reason why shift work or jet lag can make IBS symptoms worse.
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Melatonin
Melatonin is a hormone that is responsible for falling and staying asleep. But the greatest source of melatonin in the body is found in the gut and it can also influence the gut microbiome, movement in the GI tract (motility) and the health of your gut walls. The bacteria in your gut can affect your supply of melatonin, because they help your body to make it.
So sleep and the health of your gut are also connected through the gut/brain/microbiome axis.
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The Gut Microbiome
Although there is still much more to learn about sleep and the gut microbiome, research is suggesting that a diverse microbiome is connected with better sleep. Poor sleep could also change the balance of bacteria in your gut, reducing good gut bacteria and increasing harmful bacteria, leading to issues like bloating, irregular bowel movements, and worsened IBS symptoms.
Since IBS is often associated with less microbial diversity and an altered gut microbiome, this means that poor sleep could be affecting your IBS symptoms and your IBS could be affecting your sleep.
Go to About the Gut Microbiome for more info.
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Inflammation
Research is showing that chronic, low-grade inflammation of the inner lining of the intestines is involved in the disease process of IBS. Inflammation can interfere with the body's natural sleep-wake cycle and circadian rhythm. But the reverse is also true and sleep disturbances can increase levels of inflammation.
Go to the Inflammation section to find out more about its impact on IBS.
Stress
Sleep deprivation is a form of chronic stress. Stress is a huge driver of IBS symptoms and being stressed out can make it more difficult to sleep. One study showed that patients with IBS had more sympathetic nervous system activity (fight or flight) while they were awake and during REM sleep than the control group.
IBS symptoms, combined with poor sleep, can lead to chronic fatigue. This adds to the cycle of stress, leaving you mentally and physically burned out.
Go to About Stress and IBS to find out more about its impact on IBS.
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Mood Disorders
The mood disorders of anxiety and depression are commonly linked with IBS and trouble sleeping. Sleep disorders, like insomnia or disrupted sleep patterns, can increase stress, anxiety, and depression and the opposite is also true. Mood disorders can impact sleep. These mood disorders likely play an important role in the link between sleep and IBS.
Thoughts and feelings can be very powerful. One interesting IBS study showed that participants who felt they had slept badly had an increase in IBS symptoms and mood disturbances, even though the quality of their sleep was shown to be the same as others who reported less symptoms and felt they had slept well.
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Pain in the Gut
Disturbed sleep, especially waking up through the night, can cause greater abdominal pain the next day in people with IBS. Sleep enhances your brain’s ability to manage pain. There is evidence that poor sleep increases visceral hypersensitivity (VH), which causes your gut to be overly sensitive and overreact to the normal processes of digestion. Pain could keep you from sleeping.
Go to Visceral Hypersensitivity in the About IBS section for more info.
Diarrhea and Constipation
Sleep impacts digestion and lack of sleep has been linked to more severe diarrhea symptoms in IBS-D or constipation in IBS-C. Running to the bathroom with diarrhea or the discomfort of constipation could affect the quality of your sleep, although studies show that most people with IBS don't feel their symptoms are disturbing their sleep.
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Tips for Better Sleep with IBS
Poor sleep and worsening IBS symptoms have the potential to become a vicious negative feedback loop, but there's lots of ways you can turn that loop around with some lifestyle changes.
Check out other IBS management strategies on this site to better control symptoms for a better night's rest and scroll down for lots of sleep tips. Find the ones that work for you.
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Stick to a Sleep Schedule
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Do your best to go bed and wake up at the same time every day.
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Limit naps to 30 minutes during the day.
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Create a Comfy Sleep Space
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Invest in comfortable bedding and make your sleep space inviting to you.
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Try blackout curtains and white noise machines or soothing music to block outside distractions.
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Meal Timing
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Try to eat during the daytime
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Avoid eating very early in the morning or late at night
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Relaxing Bedtime Routine
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Dedicate 30–60 minutes before bed to unwinding.
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Consider reading, meditating, taking a hot bath or other strategies to relax your mind and body.
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Try not to look at any screens for an hour before sleepy time.
Go to Meditation for soothing music and guided meditations for sleep.
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Avoid Stimulants Before Bed
- Avoid caffeine, nicotine, and alcohol for a few hours before bed.
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Avoid eating large meals or trigger foods before sleeping.
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Manage Stress and Anxiety
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Use stress management techniques throughout the day and especially before bedtime.
Go to Stress Management
Go to Psychosocial Therapy for more info on CBT and other therapeutic options.
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Move Your Body
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Improves sleep quality and helps to maintain a healthy circadian rhythm.
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Try for at least 20 minutes a day and not too close to bedtime.
Go to Get Moving for IBS for more info and online exercise classes.
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Light and Dark
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Light exposure helps to regulate circadian rhythm and keep natural sleep-wake cycle in sync.
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Bright, natural light helps you wake up and dim, dark environments help you to sleep.
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Get some natural light during the day, first thing when you wake is best, and get off your screens and dim the lights as you prep for sleep!
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Get Professional Help
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If you think you have a sleep disorder, like insomnia or sleep apnea, or a mood disorder, speak to your doctor about possible treatments.
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Your doctor may not ask, so make sure you mention any sleep issues in connection with your IBS.
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Melatonin Supplements
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Study of IBS patients showed 3mg before bed decreased abdominal pain, but did not improve sleep.
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Your body probably makes enough melatonin, but evidence suggests that melatonin supplements may help you sleep and are safe for short-term use.
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Treat melatonin as you would any sleeping pill and use it under your doctor's supervision.