What is IBS?
IBS stands for irritable bowel syndrome. It is a common disorder of the digestive system that affects the large intestine (colon). IBS causes symptoms like abdominal cramping, bloating, gas, diarrhea and/or constipation. These symptoms can vary from mild to severe and often come and go over time. IBS does not cause permanent damage to the digestive system, but it can significantly impact quality of life. It is estimated that 10-15% of people globally suffer from IBS.
What causes IBS?
The exact cause of IBS is unknown, but several factors are thought to play a role:
Brain-gut connection
There is constant communication between the brain and the gut that allows them to work together smoothly. With IBS, this communication becomes disrupted, leading to abnormal muscle contractions and pain/discomfort. Stress can exacerbate these effects.
Inflammation
Some research shows there may be inflammation in the digestive system of those with IBS. This can make the intestines more sensitive and reactive.
Changes in gut bacteria
People with IBS seem to have different balances of good and bad bacteria in their intestines compared to healthy individuals. This imbalance could contribute to digestive issues.
Food sensitivities
Those with IBS often have more difficulty digesting certain foods like dairy, eggs, wheat, citrus fruits, beans, cabbage, and broccoli. These foods can trigger symptoms.
Intestinal motility issues
Some people with IBS have slower movement of food and waste through the intestines, leading to constipation. Others have faster motility, resulting in loose stools/diarrhea.
How does IBS disrupt sleep?
IBS can negatively impact sleep in several ways:
Abdominal pain and cramps
Stomach pain and cramping from IBS often gets worse at night. This can make it very difficult to fall asleep and stay asleep. Pain can also wake you up in the middle of the night.
Urgency to use the bathroom
The sudden urge to have a bowel movement is common with IBS. This can wake you up frequently to use the bathroom, interrupting your sleep.
Diarrhea
IBS diarrhea often occurs at night. Having to get up repeatedly to use the bathroom can greatly fragment sleep.
Constipation
Constipation can also disrupt sleep, as straining to pass stools is painful. The discomfort and bloating of constipation can prevent restful sleep.
Gas and bloating
Intestinal gas gets trapped during sleep, as nighttime breathing patterns promote more shallow breathing. This can lead to painful gas buildup and make sleep uncomfortable.
Anxiety and depression
Many IBS patients also have mood disorders like anxiety and depression. These conditions commonly disrupt sleep on their own.
Medication side effects
Some medications used to treat IBS symptoms, like antispasmodics and laxatives, can interfere with sleep as side effects.
How does poor sleep affect IBS?
Lack of quality sleep doesn’t just result from IBS symptoms. It can also make IBS worse in many ways:
Increased pain sensitivity
Sleep deprivation lowers the threshold for abdominal and visceral pain, making IBS cramping feel more intense.
Gut motility changes
Insufficient sleep can alter gut motility patterns. This can increase constipation or diarrhea symptoms of IBS.
Higher stress hormones
Reduced sleep leads to increased levels of stress hormones like cortisol. This stimulates the brain-gut axis, exacerbating IBS symptoms.
Weakened immune function
Sleep is vital for a properly functioning immune system. With disrupted sleep, inflammation is increased throughout the body, including the digestive system. This worsens IBS.
Poor food choices
Being tired from poor sleep makes people more likely to eat convenient, processed foods. These foods often amplify IBS issues.
Less exercise
Exhaustion and fatigue from inadequate sleep usually leads to less physical activity. Exercise helps relieve constipation and reduce stress that triggers IBS.
Tips to improve sleep with IBS
Making certain lifestyle changes can help promote better sleep for those suffering from IBS:
Avoid trigger foods at dinner
Eat early, at least 2-3 hours before bedtime, and avoid foods known to trigger your IBS symptoms. This prevents an exacerbation of symptoms at night.
Limit caffeine and alcohol
Caffeine and alcohol can overstimulate the gut and worsen diarrhea. They also interfere with sleep. Avoid them in the afternoon and evening.
Take medications correctly
Take medications that cause drowsiness in the evening. Time laxatives and antidiarrheals so they provide relief overnight without waking you up.
Practice relaxation techniques
Stress makes IBS worse. Do relaxing practices like meditation, yoga, deep breathing, or listening to calming music before bed.
Use heat therapy
A heating pad or warm bath can soothe abdominal pain and muscle spasms before sleep.
Get moderate exercise daily
Light exercise during the day, like walking, improves gut motility and sleep. However, avoid exercise close to bedtime.
Establish a nighttime bathroom routine
Use the toilet right before bed to help your body relax and empty your bowels. This reduces bathroom runs at night.
Keep a symptom diary
Recording daily IBS symptoms and sleep patterns helps you identify triggers to avoid at night. Share this diary with your doctor.
Medical treatments for sleep issues with IBS
Several medical approaches may also help when lifestyle measures aren’t enough:
Prescription medication
Drugs like low-dose antidepressants, antispasmodics, and antidiarrheals can sometimes provide relief, allowing better sleep.
OTC medication
Over-the-counter options like Peppermint capsules, probiotics, fiber supplements, and laxatives/anti-diarrheals may also be helpful.
Cognitive behavioral therapy (CBT)
CBT from a psychologist helps improve coping skills for chronic illnesses like IBS. This can reduce anxiety that interferes with sleep.
Medicinal cannabinoids
Cannabidiol (CBD) oil and medical marijuana may help relieve IBS pain. More research is still needed on their risks and benefits.
Acupuncture
Some studies indicate acupuncture can reduce IBS symptoms. Acupressure may also improve sleep. More research is needed.
Gut-directed hypnotherapy
This centers on hypnosis techniques that relieve anxiety, visceral hypersensitivity, and abnormal gut activity that triggers IBS.
Conclusion
IBS and poor sleep unfortunately have a very bidirectional relationship – lack of sleep exacerbates IBS, and IBS often profoundly disrupts normal sleep. Making targeted lifestyle modifications is essential. When this is not enough, a variety of medical and complementary approaches may provide additional relief. Consulting both your primary care physician and a gastroenterologist allows development of an integrative treatment plan to improve both your IBS disease control and your sleep quality. With time and consistency utilizing the right interventions for your particular symptoms, restful nights are possible even when living with IBS.
