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GI Issues and Sleep

Anyone who’s living with IBD, GERD, or even the occasional bout of indigestion or heartburn knows that a poor night’s sleep only makes you feel worse.

In fact, GI issues and sleep are so interconnected that scientists have literally referred to the relationship as a chicken-and-egg problem.

Why stomach problems cause sleep problems, and vice versa

It’s hard to sleep when you’re uncomfortable. Conditions like indigestion, constipation, heartburn, and nausea are all extremely uncomfortable, and even painful at times. If GI issues strike at night, it makes it difficult to sleep. Unfortunately, when we don’t get enough sleep, our stomach problems often persist into the next day and often get worse.

While we sleep, our body keeps working – restoring and repairing our muscles so they can do their job the next day. Our body requires a remarkable amount of energy to function properly. One of those major functions is our digestive process – eating, chewing and processing food before eliminating what we don’t need. Without sufficient sleep, we don’t have enough energy to perform that process as smoothly and as painlessly as we should.

The problems don’t stop there. When we’re sleep deprived, our appetite increases, and we actually begin to crave the kinds of junk food that trigger GI problems. Tired brains release more ghrelin (the hunger hormone), while well-rested minds release more leptin (an appetite suppressant). The more sugary, fatty food we eat, the more we feel it in our waistline – as well as our digestive and bowel movements.

When you’re overweight, GI symptoms worsen. Obese people are much likelier to report waking up from sleep due to chest pain or acid reflux, and experience lower quality sleep overall.

It’s not just the hunger hormone working against us. It’s faulty logic, too. When we’re tired, we’ll do anything for a quick energy boost. As a result, we often turn to caffeine and sugar. Both of these are bad for our digestion and our sleep.

With all this discomfort and lack of sleep, it’s no surprise we end up feeling stressed. Unfortunately, stress itself contributes to insomnia, IBS, and heartburn.

GERD, heartburn and sleep

Gastroesophageal reflux disease (GERD) is a chronic condition affecting 10 to 20% of Americans, making it the third most common GI disorder in the U.S. Common symptoms include heartburn and acid reflux.

As many as 74% of sufferers experience nighttime heartburn, contributing to sleep-onset insomnia (difficulty falling asleep). When acid flows back into the esophagus from the stomach, individuals start choking or coughing, either waking them up or keeping them from falling asleep in the first place.

heartburn and disturbed sleep

The same proinflammatory cytokines present with GI diseases like GERD also show up with sleep disorders. When you’re sleep deprived, those cytokine levels increase, worsening GERD symptoms.

GERD is often comorbid in children with autism spectrum disorder (ASD), and their risk increases if sleep issues are also present. Children with autism and sleep problems are twice as likely to experience frequent constipation and heartburn. Subsequent research says the relationship works both ways – autistic children with sleep issues are just as likely to have GI problems as autistic children with GI issues are to have sleep problems.

Children with ASD are also at high-risk for obstructive sleep apnea (OSA). OSA is a form of sleep-disordered breathing where the individual stops breathing during sleep due to a blockage of their airways. Even without autism, people with OSA are more likely to have GI tract conditions like gastric reflux and hiatal hernia, which stem from the spot in your diaphragm where your esophagus meets your stomach.

Although CPAP therapy is extremely effective for treating sleep apnea, there is one side effect that’s especially problematic for people with GERD. Occasionally air enters the esophagus and stomach instead of the lungs, which can worsen GERD symptoms.

IBS and sleep

Irritable bowel syndrome (IBS) is a chronic disorder of the large intestine that affects between 7 to 21% of the global population, with a disproportionate amount of sufferers in the US and south Asia.

Sleep problems are one of the biggest non-intestinal complaints of IBS sufferers. Difficulty falling asleep, disturbed sleep, and daytime fatigue are commonly reported. Research has also confirmed a positive association between IBS and sleep apnea.

While people with IBS are just as likely to wake up during the night as someone without IBS, they’re more likely to require a bowel movement rather than urinate, and that bowel movement is often accompanied by abdominal pain. This discomfort makes it tougher to fall back asleep.

People with IBS also often have fibromyalgia, which is tied to sleep problems of its own.

Ulcerative colitis and sleep

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) that affects the colon and rectum of 250,000 to 500,000 Americans. Onset typically occurs in adults between ages 15 and 40.

People living with ulcerative colitis deal with abdominal pain, diarrhea and bowel issues on a daily basis, along with the fatigue and stress that comes part and parcel with managing such recurring discomfort.

Recent research suggests that adequate, quality sleep is important for managing UC symptoms as well as preventing the disease in the first place. One study observed that both chronic oversleeping and sleep deprivation seem to be risk factors for ulcerative colitis. Participants who consistently slept fewer than 6 hours per day or more than 9 were much likelier to also have ulcerative colitis.

Crohn's disease and sleep

Over 2 million Americans have some form of IBD, whether it’s ulcerative colitis or Crohn’s disease. Crohn’s disease (CD) affects the lining of the digestive tract, with symptoms ranging from abdominal pain and diarrhea to anemia and fatigue. For many people with CD, fatigue persists when the disease is inactive as well.

People with insomnia have a three-fold increased risk of developing a bowel disorder like CD or UC. And, according to a study of over 1,200 patients, disturbed sleep and/or inadequate sleep doubles the risk of flare-ups for those living with Crohn’s disease.

Improving sleep is important not just for managing symptoms of Crohn’s disease, but also for preventing relapse during remission. A study of individuals in remission from Crohn’s disease found that the ones with sleep problems doubled their risk of it becoming active again.

How to sleep better when you have IBD, IBS, or heartburn

While most GI issues stem from chronic conditions, getting better quality sleep can alleviate the intensity of your symptoms. Try these behavioral strategies for improving sleep despite heartburn or IBD.

1. Follow a bedtime routine.

Develop a bedtime routine that calms your mind, body, and stomach. Take a warm bath or do some calming yoga poses.

Drink a nice cup of herbal tea. Chamomile, lemon balm, and passionflower have all been shown to promote sleep, reduce anxiety, and soothe indigestion.

Melatonin can also be an effective way to induce drowsiness. In one study, it reduced sleep latency (the amount of time it takes to fall asleep), and increased the overall total sleep time for individuals with IBS. Melatonin’s anti-inflammatory properties may also be helpful for sleep-deprived individuals living with colitis, according to another study.

2. Prepare for nighttime disruptions.

If you’re living with chronic heartburn, abdominal pain, or digestive issues, recognize now that you will expect some nighttime awakenings throughout your life. However, rather than getting frustrated, accept that these will happen and take steps to relax yourself back to sleep afterwards.

If you find yourself lying awake in bed for more than 20 minutes, get up and leave your room. Go do something calm somewhere else, like reading a book by a soft lamp, until you feel tired again. You don’t want your brain to come to associate your bed with sleeplessness.

Also clear your bedroom of electronics, especially clocks which build frustration as you watch the hours tick by.

3. Pay attention to your diet.

People with IBD and GERD are used to getting diet advice, so it’s no surprise that we’re including it as a tip here. Avoid heavy meals and spicy or sugary trigger foods late at night, at least 2 hours before bed.

Managing your diet will help keep your weight in check, too, minimizing your risk of heartburn. Never lay down after you eat, and wear clothes that are comfortable and loose, especially when going to bed. Too-tight clothing increases pressure on your stomach, leading to heartburn and GI issues.

Take care during the day to keep your blood sugar balanced, so as to avoid nocturnal hypoglycemia. Your blood sugar already lowers naturally while you sleep, but people with GI issues are more at risk. To keep your blood sugar steady, avoid overly sugary foods all day long, not just before bed. Instead, eat smaller meals throughout the day to stay in balance.

4. Change up your sleep position.

Stomach sleeping is terrible for acid reflux, since it places your esophagus in line with your stomach. Instead, sleep on your side or your back.

If you lie on your side, opt for your left side to reduce the pressure on your heart and other organs. If you sleep on your back, use a wedge pillow or raise the head of your bed with 6-inch risers to keep your esophagus above your stomach and reduce acid reflux.

Those with ulcerative colitis should lie on their back. If you’re more comfortable sleeping on your side, choose the side opposite to the side of your colon that gives you the most trouble. If you’re still feeling pain, avoid painkillers and use a heating pad instead. Painkillers like ibuprofen can actually irritate your colon, making you feel worse.

5. Reduce stress.

Stress builds anxiety and the kind of spiraling thoughts that keep insomniacs up at night, just as it makes your stomach feel like a spiral of its own.

To reduce stress, try incorporating one or more of the following into your life: yoga, meditation, or aromatherapy. Practice deep breathing or relaxation exercises before bed. If you can’t get the worries to stop, write them down in a journal to free them from your mind.

Additional resources

Studies and research

Advocacy groups and organizations

  • The CDC’s portal on inflammatory bowel disease (IBD) provides up-to-date research and demographic analysis on Americans living with ulcerative colitis or Crohn’s disease.
  • The International Foundation for Functional Gastrointestinal Disorders is a non-profit focused on raising awareness, funding research, and providing helpful resources and treatment advice for people suffering from gastrointestinal and motility disorders.
  • The Crohn’s & Colitis Foundation provides educational resources online, and helps patients and caregivers find local support groups, doctors and other healthcare providers near them.

Blogs and social media

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