Why Crohn's Disease Harms Sleep (and What to Do About It)
If you live with Crohn’s disease, it’s likely that you’re already very familiar with one of the most common symptoms of the condition — a bad night of sleep. Crohn’s flares are commonly associated with an increase in nighttime awakenings. So, what can be done to improve sleep quality when living with Crohn’s disease?
How Crohn’s causes sleep problems
A 2013 study that analyzed data from over 3,000 individuals who participated in the Crohn’s and Colitis Foundation of America Partners study found that during a flare, sleep is often disrupted due to the need to use the bathroom and symptoms such as abdominal pain.
Researchers also determined that medications such as corticosteroids may also be responsible for sleep disruption and suggested that other symptoms associated with Crohn’s — such as higher levels of anxiety and depression — can also impair sleep.
Interestingly, the study found that sleep was also disrupted for roughly half of those who were in clinical remission. This suggests that sleep is not being affected exclusively by the symptoms of a Crohn’s flare-up.
The role of inflammation
Individuals with Crohn’s tend to have higher markers associated with inflammatory activity — and research has found that inflammatory messengers such as Interleukin 1 (IL-1) and Tumor Necrosis Factor Alpha (TNF-α) may suppress REM sleep and alter sleep patterns.
As the authors of the 2013 study pointed out, administration of Interleukin 6 (IL-6) — a messenger that acts as both a pro-inflammatory cytokine and an anti-inflammatory myokine — can increase non-rapid eye movement (NREM) sleep and reduce slow wave sleep during the first half of the sleep cycle.
This suggests that even when you’re in remission, a higher level of inflammatory messengers circulating around the body may contribute to sleep disturbances.
The relationship between sleep and Crohn’s disease
Although the symptoms associated with Crohn’s can disturb sleep, research also suggests that poor sleep can also increase the risk of a flare. In fact, the 2013 study found that those who were struggling with their sleep — even when in remission — were nearly twice as likely to experience a flare-up within six months compared with good sleepers.
Once again, this could be down to inflammation — one study found that mice subjected to 24 hours of sleep deprivation and intermittent sleep deprivation over 10 days were more susceptible to colon inflammation.
Finally, since TNF-α plays a role when it comes to regulating the circadian rhythm (our internal body clock), abnormal levels may influence the regulation of intestinal permeability.
How to sleep better when living with Crohn’s
When you live with Crohn’s, you may be more likely to experience regular bouts of fatigue — and this can make it tempting to spend more time in bed and to avoid exercise and other activities in a bid to conserve energy. Unfortunately, both of these strategies can make your sleep worse.
When we spend too much time in bed, we create a learned association that the bed is a place for wakefulness rather than sleep. Over time, this can actually make sleep even more difficult. Research has also consistently shown that exercise and social interaction are not only beneficial for sleep, but they can reduce the risk of depression.
If specific symptoms are interrupting your sleep, you can try tackling them on an individual basis. For example, if you wake feeling hot and sweaty, it can be helpful to lower the thermostat at night and try sleeping with lighter pajamas (you can keep a blanket or two next to the bed should you get cold at night).
If pain and discomfort is keeping you awake at night, try changing your sleeping position (side sleeping may be helpful) and ensure that any pain medication you take isn’t affecting your sleep. Some pain medications contain caffeine while others may irritate the colon — generally speaking, Tylenol (acetaminophen) is often a good choice for those with Crohn’s.
It can also be helpful to avoid eating late at night so the digestive tract isn’t hard at work when you want to be sleeping (and to reduce the frequency of those nighttime trips to the bathroom).
Finally, if you find yourself worried or anxious about sleep or your overall health, breathing exercises, mindfulness routines, progressive muscle relaxation, and cognitive behavioral therapy for insomnia may be helpful.
If your sleep problems continue, don’t ignore them. Your doctor may be able to offer an alternative medication that could reduce the impact on your sleep or offer further advice or guidance.
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