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Irritable Bowel Syndrome And Sleep

SCOFA-IBS-Sleep-1

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 
What’s the Link Between IBS and the Brain? | What’s the Link Between Sleep Disorders and IBS? | How Can IBS Disrupt Your Sleep?

 

Overview

Irritable bowel syndrome (IBS) is a common gastrointestinal disease that can cause symptoms such as stomach pain and irregular bowel movements. But could it also be affecting your sleep?

Research has found that sleep disturbances, such as insomnia and hypersomnia, are highly prevalent among IBS patients. So, how does IBS disrupt your sleep?

Pain, chronic stress, dysbiosis, pro-inflammatory cytokine changes, anxiety, and depression related to IBS can all contribute to developing sleeping difficulties.

Continue reading to learn more about the relationship between IBS and your brain, the link between IBS and sleep disorders, and how your IBS may cause poor sleep.

 

What’s the Link Between IBS and the Brain?

Irritable bowel syndrome (IBS) is a common condition that affects the large intestines and can lead to the following symptoms:[1]

  • Constipation
  • Diarrhea 
  • Bloating 
  • Gas
  • Stomach cramps 
  • Abdominal pain 

Around 11 percent of people worldwide live with irritable bowel syndrome making it one of the most common gut-brain interaction disorders.[2]

A gut-brain connection means that the brain can directly affect the stomach, intestines, and vice versa – your gut also affects your brain.[3] Thus, there’s bidirectional communication between your gut and your brain.

When you think of eating, your brain signals your stomach to start releasing the digestion juices even before the food gets there. Similarly, the microbiota (microorganisms) in your gut can send signals to the brain.[3]

Therefore, intestinal distress, like the one caused by IBS, can either cause or result from depression, stress, anxiety, and other psychiatric disorders.[4]

 

What’s the Link Between Sleep Disorders and IBS?

Several studies have investigated the relationship between gastrointestinal (GI) diseases, including IBS, and sleep disturbances.[5] 

Poor quality sleep was often found in patients with gastrointestinal diseases. Conversely, many GI diseases can affect the sleep-wake cycle and lead to sleep disorders.[5]

A systematic review was done in 2018 that studied the association between sleeping troubles and irritable bowel syndrome. The review concluded that sleep disorders were common in IBS – 37.6 percent of people with IBS also had a sleeping problem.[6]

On the other hand, a study was done in 2014 that investigated how poor sleep can affect pain from IBS. The study showed that women were more likely to have IBS abdominal pain if they reported sleep disturbances the night before.[7] This finding indicates that sleep quality can affect subsequent IBS symptoms.

Although these studies suggest a bidirectional link between IBS and sleep disorders, they did not investigate how often specific sleep disorders appeared in people with irritable bowel syndrome. 

A study published in 2021 found that people with IBS were more likely to have the following sleeping disorders:[8]

 

  •     Insomnia: Patients with IBS were more than three times more likely to have symptoms related to insomnia
  •     Hypersomnia: Patients with IBS were more than four times more likely to have symptoms related to hypersomnia 
  •     Both insomnia and hypersomnia: Patients with IBS were more than five times more likely to have both insomnia and hypersomnia-related symptoms 

 

Consequently, irritable bowel syndrome may contribute to developing sleeping trouble, such as excessive daytime sleepiness (hypersomnia) and difficulty falling or staying asleep (insomnia).[8] 

SCOFA-IBS-Sleep-2

 

How Can IBS Disrupt Your Sleep? 

As mentioned, there’s an established bidirectional communication between the brain and the gut through the gut-brain axis (GBA).[3] But how can irritable bowel syndrome cause poor sleep? 

 

1) Pain

IBS is defined by the presence of abdominal pain and a change in bowel habits.[1]

According to one study, 63 percent of patients with IBS reported chronic pain, and 48 percent reported headaches.[8]

It can be challenging to fall asleep or get a good night’s sleep if you’re feeling constant IBS pain. In 2018, researchers investigated the association between experiencing pain from IBS and insomnia. They concluded that IBS pain could cause:

  • Difficulty falling asleep
  • Difficulty maintaining sleep
  • Poor sleep quality 

Moreover, diarrhea and constipation from IBS can also affect your ability to sleep well.

When you’re in pain, the sympathetic nervous system in your brain becomes activated, consequently increasing your heart rate.[9] As a result, your brain signals your body to stay alert and awake, which can lead to sleeping difficulties. 

 

2) Chronic Stress 

People with IBS have an increased sensitivity to stress and significantly higher levels of perceived stress.[10]

Studies have shown that stress can impair normal sleep functions and cause sleeping disturbances such as insomnia.[11] Therefore, IBS-induced stress can disturb your sleep or make it less restful.

 

3) Anxiety and Depression

One study conducted in 2017 investigated the prevalence of anxiety and depression in patients with irritable bowel syndrome. The study found that 37.1 percent of patients with IBS also had anxiety, and 84 percent had depression.[12]

Researchers also found that anxiety and depression have a bidirectional relationship with insomnia and poor sleep quality.[13] As a result, anxiety and depression caused by IBS can lead to disturbed sleeping patterns. 

 

4) Dysbiosis

Dysbiosis is an imbalance in your gut’s microbiota (microorganisms in your gastrointestinal system),[14] which can interfere with the functioning of your bowels and plays a vital role in the pathogenesis of IBS.[15]  

Research shows that disturbance in the gut microbiota can affect your sleep quality and circadian rhythm,[16] which can cause you to have trouble falling or staying asleep. 

Consequently, having irritable bowel syndrome can contribute to you not getting enough sleep through dysbiosis. 

 

5) Pro-inflammatory Cytokines

People with IBS have elevated levels of pro-inflammatory cytokines, such as tumor necrosis factor ɑ (TNFɑ) in their guts.[17]

Animal studies showed that changes in TNFɑ levels could affect your sleep schedule and interfere with your sleeping patterns.[18] Hence, the rise in pro-inflammatory agents associated with IBS can throw off your sleep schedule. 

 

What’s the Takeaway? 

There’s an apparent two-way relationship between your sleep and your gut health. In the same way, disturbed sleep can contribute to gastrointestinal problems; gut diseases can also impact your sleep. 

Irritable bowel syndrome can disrupt your sleep. The lack of good sleep can worsen your IBS resulting in a vicious cycle of IBS-Bad sleep-worse IBS. 

Thus, if your IBS is causing you sleeping trouble, consult with your doctor or a healthcare professional. Improving your sleep can help you manage your IBS symptoms, which would help you sleep better. 

 

References: 

  1. Patel N, Shackelford K. Irritable Bowel Syndrome. StatPearls Publishing; 2022. Accessed August 9, 2022. https://www.ncbi.nlm.nih.gov/books/NBK534810/
  2. Black CJ, Ford AC. Global burden of irritable bowel syndrome: trends, predictions and risk factors. Nat Rev Gastroenterol Hepatol. 2020;17(8):473-486. doi:10.1038/s41575-020-0286-8
  3. Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol Q Publ Hell Soc Gastroenterol. 2015;28(2):203-209.
  4. Fadgyas-Stanculete M, Buga AM, Popa-Wagner A, Dumitrascu DL. The relationship between irritable bowel syndrome and psychiatric disorders: from molecular changes to clinical manifestations. J Mol Psychiatry. 2014;2(1):4. doi:10.1186/2049-9256-2-4
  5. Khanijow V, Prakash P, Emsellem HA, Borum ML, Doman DB. Sleep Dysfunction and Gastrointestinal Diseases. Gastroenterol Hepatol. 2015;11(12):817.
  6. Wang B, Duan R, Duan L. Prevalence of sleep disorder in irritable bowel syndrome: A systematic review with meta-analysis. Saudi J Gastroenterol Off J Saudi Gastroenterol Assoc. 2018;24(3):141-150. doi:10.4103/sjg.SJG_603_17
  7. Buchanan DT, Cain K, Heitkemper M, et al. Sleep Measures Predict Next-Day Symptoms in Women with Irritable Bowel Syndrome. J Clin Sleep Med. Published online September 15, 2014. doi:10.5664/jcsm.4038
  8. Grover M, Kolla BP, Pamarthy R, et al. Psychological, physical, and sleep comorbidities and functional impairment in irritable bowel syndrome: Results from a national survey of U.S. adults. PLOS ONE. 2021;16(1):e0245323. doi:10.1371/journal.pone.0245323
  9. Hamunen K, Kontinen V, Hakala E, Talke P, Paloheimo M, Kalso E. Effect of pain on autonomic nervous system indices derived from photoplethysmography in healthy volunteers. BJA Br J Anaesth. 2012;108(5):838-844. doi:10.1093/bja/aes001
  10. Weaver KR, Melkus GD, Fletcher J, Henderson WA. Perceived Stress, Its Physiological Correlates, and Quality of Life in Patients With Irritable Bowel Syndrome. Biol Res Nurs. 2018;20(3):312-320. doi:10.1177/1099800418756733
  11. Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018;27(6):e12710. doi:10.1111/jsr.12710
  12. Banerjee A, Sarkhel S, Sarkar R, Dhali GK. Anxiety and Depression in Irritable Bowel Syndrome. Indian J Psychol Med. 2017;39(6):741-745. doi:10.4103/IJPSYM.IJPSYM_46_17
  13. Oh CM, Kim HY, Na HK, Cho KH, Chu MK. The Effect of Anxiety and Depression on Sleep Quality of Individuals With High Risk for Insomnia: A Population-Based Study. Front Neurol. 2019;10:849. doi:10.3389/fneur.2019.00849
  14. Dysbiosis – an overview | ScienceDirect Topics. Accessed August 9, 2022. https://www.sciencedirect.com/topics/medicine-and-dentistry/dysbiosis
  15. Wang L, Alammar N, Singh R, et al. Gut Microbial Dysbiosis in the Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Case-Control Studies. J Acad Nutr Diet. 2020;120(4):565-586. doi:10.1016/j.jand.2019.05.015
  16. Neroni B, Evangelisti M, Radocchia G, et al. Relationship between sleep disorders and gut dysbiosis: what affects what? Sleep Med. 2021;87:1-7. doi:10.1016/j.sleep.2021.08.003
  17. Balikji S, Mackus M, Brookhuis KA, et al. The Association of Insomnia, Perceived Immune Functioning, and Irritable Bowel Syndrome Complaints. J Clin Med. 2018;7(9):238. doi:10.3390/jcm7090238
  18. Rockstrom M, Chen L, Taishi P, et al. Tumor Necrosis Factor Alpha in Sleep Regulation. Sleep Med Rev. 2018;40:69-78. doi:10.1016/j.smrv.2017.10.005
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