The Sleep, Crohn's, and Ulcerative Colitis Connection

by Martin Reed Patient Advocate

Compared to healthy individuals, those with inflammatory bowel disease (IBD):

  • Wake more frequently

  • Use more sleeping pills

  • Take longer to fall asleep

  • Have higher levels of tiredness

  • Have lower daytime energy levels

  • Suffer from poorer overall sleep quality

IBD may even be linked to sleep apnea; one study found that 13 percent of patients with IBD had obstructive sleep apnea.

Is Poor Sleep Linked to Crohn's Disease and Ulcerative Colitis?

A study published in Clinical Gastroenterology and Hepatology set out to identify the association between sleep and risk of incident Crohn's disease and ulcerative colitis.

The prospective study involved female registered nurses who filled out a health questionnaire every other year.

In each routine questionnaire, participants were asked to self-report if they had been diagnosed with Crohn's disease (CD) or ulcerative colitis (UC). Those who responded with a positive diagnosis for CD or UC were later sent a detailed questionnaire requesting additional information on:

  • Type of IBD

  • Treatment

  • Date of diagnosis

  • Disease behavior and complications

Participants who reported CD or UC were also asked to give permission for two board-certified gastroenterologists to review their medical records to confirm their diagnosis.

Routine questionnaires also asked participants how much sleep they got over the previous 24 hours. Those who responded were later asked to keep a sleep diary for one week.

The Link to Ulcerative Colitis

Researchers found that women who slept for six hours or less were one-and-a-half times more likely to have UC compared to women who got between seven and eight hours of sleep.

Interestingly, women with sleep durations of nine or more hours were twice as likely to have UC compared to those who slept for between seven and eight hours.

Results remained similar even after adjusting for smoking, physical activity, dietary fiber intake, and BMI.

Sleep duration did not appear to influence the risk of developing CD.

The Link Between Sleep and IBD

The Clinical Gastroenterology and Hepatology study found that _s_leep health is closely linked to immune system health. Sleep deprivation has been found to reduce levels of interleukin-2, a signaling molecule that regulates the activities of white blood cells as part of the body's immune response.

T helper cells are another part of the body's immune system. Type 1 helper (Th1) cells are triggered by interleukin-2. Reduced levels of interleukin-2 can favor Type 2 helper (Th2) cells which have a more dominant role in the development of UC.

Finally, interleukin 6 regulates inflammation as part of the immune response. Studies have found that even short-term sleep deprivation can increase levels of interleukin 6, and this may influence intestinal permeability.

The Importance of Sleep

So it appears that sleep issues can affect our risk of developing IBD, and this may be down to the influence sleep has on the body's inflammatory immune response.

However, IBD flares can also affect sleep; one study found that 82 percent of those with active IBD had poor sleep quality compared to 51 percent of those with inactive IBD.

Poor Sleep May Exacerbate IBD Symptoms

One study found that those in clinical remission for CD were twice as likely to suffer a relapse at the six-month mark if they experienced impaired sleep.

Another study published in the American Journal of Gastroenterology found that shorter sleep duration increased the medium and long-term risk for an UC flare.

Another, involving mice, found that acute and chronic intermittent sleep deprivation increased colonic inflammation.

How to Improve Sleep When Suffering From IBD

Melatonin supplements may help. Although human studies are hard to find, an experiment on mice with induced colitis found that melatonin reduced the inflammatory effects of sleep deprivation.

This finding prompted the authors of that research to suggest that melatonin may help patients with inflammatory bowel disease, particularly if suffering from sleep deprivation.

A separate study may back this up. It found that one in four patients with inflammatory bowel syndrome had an abnormal melatonin secretion profile.

Changing your career may help, too. One study of German employees from 1990 found that those who worked long or irregular hours were more likely to suffer from IBD compared to those who worked regular hours.

As stated by the authors of a 2013 study, it’s not current standard clinical practice to evaluate sleep disturbances in those with IBD. This should change because, as the authors of that study argued, addressing sleep issues can help keep IBD in remission and even alter disease outcomes.

Martin Reed
Meet Our Writer
Martin Reed

Martin is the creator of Insomnia Coach, an eight-week course that combines online sleep education with individual sleep coaching. His course helps clients improve their sleep so they can enjoy a better life with more energy and start each day feeling happy, healthy, rested, and refreshed. Martin also runs a free sleep training course that has helped over 5,000 insomniacs. He holds a master’s degree in health and wellness education and studied clinical sleep health at the University of Delaware.