Poor Sleep and IBD: Are They Linked?

You are not imagining things. That poor night's sleep may have made your inflammatory bowel disease (IBD) worse. Poor sleep can increase the risk of IBD relapses and flares. And IBD may also disturb your shut-eye.¹

Learning more about the close relationship between IBD and sleep may help you manage your symptoms.

Who is at risk for sleep problems with IBD?

Research shows that poor sleep is much more common in people with both active and inactive IBD compared with people who do not have IBD. A 2020 study of 166 people with IBD found roughly 2 out of 3 felt they slept poorly. The people with IBD who were most likely to report unsatisfying sleep also had:^2,3

• Anxiety
• Depression
• Lower quality of life
• IBD-related conditions outside the intestines, affecting the eyes, skin, or joints

The same study found no links between sleep quality and IBD disease activity or subtype. But it did find that some of the sleep disturbances in those with IBD could be tied to the drugs they were taking.³

Crohn's disease, ulcerative colitis, and sleep problems

IBD is a family of conditions that includes Crohn's disease and ulcerative colitis (UC). People with both Crohn's and UC report a high rate of sleep problems.^2-4

One study found that 3 out of 4 people with Crohn's disease who slept poorly had a higher risk of:⁴

• Symptom relapse
• Surgery
• Hospitalization

People with Crohn's in this study reported waking up more often due to pain or needing to go to the bathroom. They also were more likely to use benzodiazepine and psychiatric medicines and to have tissue markers that point to inflammation.⁴

A 2018 study found that when UC is not controlled, it can increase the risk of depression. Depression often affects sleep. When combined, UC symptoms, depression, and poor sleep create a vicious cycle that can lower overall quality of life.²

What is the sleep-IBD connection?

Several studies show a 2-way street between sleep and immune diseases, including Crohn's and UC. Even when IBD is not present, researchers have found many links between sleep and the immune system. For instance, good sleep helps the body fight infection.¹

On the other hand, sleep deprivation has led to a weakened immune system in animal studies. Sleep deprivation negatively affects T-cells into the following day. T-cells are part of the immune system that help protect the body from infection.¹

Sleep deprivation is also linked to an increase in cytokines. Cytokines are proteins involved in the immune system's inflammation response.¹

Doctors do not yet fully understand the reasons why poor sleep affects IBD. Some think poor sleep causes changes in cells that cause inflammation or leads to more immune attack cells. Another theory is that poor sleep could lead to a breakdown in tissues in the gastrointestinal tract that then leads to UC or Crohn's.⁵

Getting better sleep with IBD

You do not have to wait for health researchers to figure it all out. You can take steps now to improve your sleep. Talk to your doctor about whether you should be screened for insomnia or sleep apnea, or see a sleep specialist.⁵

The most commonly reported sleep problem with IBD is insomnia. Cognitive behavioral therapy (CBT) is a well-regarded treatment for insomnia. Using CBT for insomnia can help people with IBD reduce pain, depression, and inflammation.⁵

CBT for insomnia involves working with a therapist to:⁵

• Find a sleep routine that works for you
• Stop or reduce naps
• Improve your environment to promote sleep
• Learn what you can do when you wake at night

If you think your sleep habits may be affecting your IBD, or vice versa, talk to your doctor.