DDW 2012 Note: New Insights Into the Sleeping Problems of Individuals With IBS

Sleeping difficulties are a common complaint in the general adult population, but are even more frequently reported by individuals with irritable bowel syndrome. For example, our UNC research team found in a large HMO survey1 of 662 IBS patients several years ago that two-thirds (67%) of them reported having had difficulty sleeping more than once in the past month. This was a significantly higher percentage than found for the healthy comparison subjects (although 49% of those also experienced recurrent sleeping difficulties).

Evidence has been accumulating in research for a couple of decades that the quality of sleep is poorer in IBS patients than in other individuals, and that nights of poor sleep result in worsened bowel symptoms on the days that follow for patients with the disorder2,3. However, those studies have relied on patients’ self-ratings of sleep quality. A study reported by Patel and colleagues on Saturday May 19 at Digestive Disease Week 2012 in San Diego improves on the prior research by using an objective measure of sleep — a wrist-mounted actigraph device that measures body motions and can distinguish between sleeping and waking with high sensitivity.

The researchers measured the sleeping and waking patterns of 20 IBS subjects with the actigraph for a seven-day period, and compared them to those of 23 healthy controls. Subjects also kept daily logs of bowel pain severity and distress, consistency of bowel movements (on the Bristol Stool Scale) and intensity of other bowel symptoms (bloating, gas, urgency, and mucus) during this seven-day test phase.

The results showed that the IBS patients actually slept significantly longer than controls on the average (8.1 vs. 6.9 hours). However, the IBS subjects woke up more times during the night and had shorter average undisturbed sleep periods. Shorter periods of uninterrupted sleep and greater number of awakenings during the night were both found to be statistically associated with more abdominal pain and more GI distress the following day in the IBS patients (but were not associated with other symptoms like bloating or hard or loose stools). The number of awakenings during the night was also associated with worse quality-of-life scores and more gut-focused anxiety in the IBS group.

This study confirms in a more solid way than done before that individuals with IBS do indeed sleep more poorly than other individuals, with more awakenings and shorter spans of uninterrupted sleep on the average, and that this results in significant worsening of their bowel symptoms. But what causes this poor sleep in IBS? Interestingly, the researchers asked the IBS patients why they woke up during the night. Most typically, the patients complained of waking up because of non-gastrointestinal pain (like back pain), or because of needing to urinate. Although it is hard to know how accurately those self-reports reflect the real reasons for awakenings (people probably do not always realize why they find themselves awake at night), it nonetheless suggests the intriguing possibility that non-gastrointestinal somatic symptoms, which are well known from many studies to be unusally prevalent in IBS (symptoms such as muscle pain and frequent need to urinate) are interfering with sleep, which then in turn disturbs gut function and worsens gastrointestinal symptoms.

Presentation:

“Disturbed Sleep Worsens IBS Pain Symptoms: an Effect of Gastrointestinal (GI) Specific Anxiety?” Ami Patel, Benjamin Cassell, Mrudula Kumar, C. Prakash Gyawali, Gregory S. Sayuk. Division of Gastroenterology, Washington University School of Medicine, Saint Louis, MO

Presented at Digestive Disease Week in San Diego, May 19, 2012.

References:

1. Palsson OS, Jones KR, Turner MJ, Drossman DA, Whitehead WE.  Impact of somatization and comorbid medical conditions on health care utilization, disability, and quality of life in irritable bowel syndrome (IBS). Gastroenterology 2002, 122 (Suppl 1): A501-502.

2. Jarrett M, Heitkemper M, Cain KC, Burr RL, Hertig V. Sleep disturbance
influences gastrointestinal symptoms in women with irritable bowel syndrome. Dig
Dis Sci. 2000 May;45(5):952-9. PubMed PMID: 10795760

3. Goldsmith G, Levin JS. Effect of sleep quality on symptoms of irritable bowel
syndrome. Dig Dis Sci. 1993 Oct;38(10):1809-14. PubMed PMID: 8404401

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