How to Sleep Better With Ulcerative Colitis

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If you live with ulcerative colitis (UC), you likely find sleep more difficult than most. Studies have found that poor sleep is far more prevalent among individuals with UC compared with the general population. A 2011 study found that roughly one-half of individuals with inactive inflammatory bowel disease (IBD) and between 72 and 82 percent of those with active IBD experienced poor sleep. But why are sleep disturbances so common among those with UC?


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Reason #1: Flares are disruptive to sleep

During a flare, sleep can be impossible — especially if it occurs at night. A 2018 study published in the International Journal of Behavioral Medicine set out to investigate the link between sleep quality and known symptoms and consequences of UC. Researchers suggested that sleep disruption may be explained by the challenge of returning to a healthy sleep routine after experiencing a severe flare.


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Reason #2: The mental challenge of UC

In an email interview with HealthCentral, Inna Lukyanovsky, PharmD, a Crohn's and colitis expert, recognized this major challenge of UC. “Patients often get depressed, disconnected, and extremely sad,” Dr. Lukyanovsky says. The 2018 study appeared to confirm this, finding that depression predicted overall sleep quality, which led researchers to suggest that psychological health of individuals with UC (rather than the severity of the condition itself) may be the main cause of sleep problems.


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Reason #3: The role of inflammation

“In my experience treating UC, sleep disturbance is much more to do with symptoms of the condition,” Jessica Braid, a trained medical doctor and co-founder of The Natural Doctors, told HealthCentral in an email interview. Inflammation may, therefore, have a role to play since inflammation can disturb sleep. Research has also suggested that UC may be caused by an excessive immune response, and we already know that when our sleep/wake cycle is disrupted, our immune system suffers.


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Reason #4: UC meds

Medications such as corticosteroids can disrupt sleep. This may be because of the effect they have on the body’s adrenal glands, which regulate our fight-or-flight response. “Steroids such as prednisone can keep you up all night and leave you feeling tired in the morning,” according to Dr. Lukyanovsky. Antibiotics can be a problem, too: “Some antibiotics can worsen diarrhea and therefore cause sleep interruptions,” Dr. Lukyanovsky says.


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Suggestion #1: Avoid certain pain meds

When a flare-up strikes, try to relieve abdominal pain with a heating pad or a hot water bottle rather than anti-inflammatory drugs such as aspirin and ibuprofen because they not only irritate the colon, but they can also disrupt sleep. If you feel you need additional help with the pain, acetaminophen (Tylenol) may be a better choice.


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Suggestion #2: Try a different sleeping position

There is no ideal sleeping position when it comes to improving sleep during a UC flare because the pain or discomfort can affect different sides of the colon. So, experiment with what works for you — but it’s probably best to avoid lying on your stomach. “It's usually recommended to sleep on the left side, but many people love to sleep on their stomach, which isn't always helpful,” Dr. Lukyanovsky tells HealthCentral.


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Suggestion #3: Eat differently

You may be able to improve symptoms during a UC flare by eating foods that have lower levels of fiber. If you go this route, make sure you also choose foods that won’t disrupt sleep. Low-fiber options that are can also be beneficial for sleep include lean meat such as chicken and turkey and fruit and vegetables such as spinach and bananas.


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Suggestion #4: Try supplements

“Individuals with UC are more likely to be deficient in magnesium and vitamin B1 and B12,” according to Dr. Braid. She suggests that magnesium and B vitamin supplements can help improve sleep problems in those living with UC. Dr. Lukyanovsky agrees: “B vitamins can make a big difference, and 5-HTP can also help a great deal.”


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Suggestion #5: Exercise

Exercising is probably best reserved for times when you aren’t going through a flare-up — but researchers of the 2018 study mentioned earlier found that sleep disturbances were more common among UC individuals with a higher body mass index (BMI). This led the authors to suggest that weight loss (and assessment for other sleep disorders such as sleep apnea) may be beneficial.


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Suggestion #6: Practice mindfulness techniques

We already know that mindfulness can help improve sleep — but this relaxation technique can be particularly helpful for those living with UC. “Practicing mindfulness daily can help reduce the stress and emotional impact of living with UC and improve sleep,” says Dr. Braid.


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Suggestion #7: Talk about depression and insomnia

“The extra stress of living with UC can disturb sleep and make it difficult to work and form new relationships — and this can lead to social isolation and loneliness,” according to Dr. Braid. The 2018 study confirmed this — it identified depression as a strong predictor of sleep quality — so it’s important to talk to your doctor if you recognize any symptoms of depression (these may be helped with a course of cognitive behavioral therapy for insomnia).


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The bottom line: Don’t ignore sleep issues

A bad night every now and again is normal — but if you are finding it hard to fall asleep or stay asleep at least three nights per week, and this has been going on for at least three months, it’s important to take action. Ongoing sleep disruption can further exacerbate inflammation, and short sleep durations have been found to increase the risk of experiencing an UC flare. You are still capable of sleep, and there are effective alternatives to sleeping pills.