Persistent stomach problems can cause great discomfort in one’s daily life. Indigestion, acid reflux, or even a spell of severe bloating can disrupt a person’s schedule when lasting for a few days, causing a range of symptoms anywhere from irritability to severe pain. As a consequence, one might cancel some activities, see a doctor or even get hospitalized if the situation gets extreme. However, for people who deal with such issues on a regular basis, taking a rain check every day isn’t a realistic option. In attempts to handle responsibilities and the usual stress, these people often ignore their symptoms until matters get much worse and they can no longer manage to meet ends. At this point, what started as a minor gastrointestinal problem might have escalated into a chronic disease and even triggered another health condition.
An estimated number of 60-70 million Americans suffer some sort of digestive issue. For most of these people, sleep ailments aren’t unusual – it’s difficult to fall asleep while you are uncomfortable or in pain. Hence, people with gastrointestinal (GI) issues often experience sleep-related problems like insomnia, sleep apnea, excessive daytime sleepiness, etc.
Vice versa also applies – people who suffer disordered sleep are more likely to develop GI symptoms as well. Sleep deprivation causes the brain to secrete more ghrelin (hunger hormone) which make us crave junk food and overeat. Besides potentially causing weight gain, the increased amount of sugary and high-fat foods further irritates one’s stomach, and the cycle goes on. In obese people with digestive issues, sleep problems are even more frequently reported, with acid reflux, heartburn or nausea regularly waking them up in the middle of the night, or making it a struggle to fall asleep.
Other than the direct impact of lack of sleep on our health, combined with the GI discomfort it also increases our stress level, which, unsurprisingly enough, is another known contributing factor for IBS, heartburn, and insomnia.
As you have discovered by now, the relationship between GI issues and sleep is a complicated one. To attempt and untangle it, continue reading this article.
GERD and sleep
Gastroesophageal reflux disease, or GERD, is a chronic condition that causes one’s stomach acid to go back upwards towards your mouth, causing heartburn, acid-like taste in one’s mouth, nausea, teeth erosion, breathing difficulties, etc. It’s caused by frequent acid reflux that weakens the esophagus (the gateway to your stomach), opening the path for your stomach content to return upwards. GERD affects up to 20% of Americans, the increased risk factors including obesity, pregnancy, connective tissue disorders, and hiatal hernia.
People who suffer this disease often experience some other issues like laryngitis, persistent cough, asthma, and sleep disturbances. 74% of the people with GERD suffer nighttime heartburn, causing them either difficulties with falling asleep or waking them up to cough – ranking insomnia the most common sleep disorder these individuals face.
Other than that, because of the close connection between the stomach-to-mouth pathway and our respiratory system, GERD is linked with sleep-related breathing issues, most commonly obstructive sleep apnea (OSA). OSA is a sleep disorder that causes airway obstruction during one’s sleep, resulting in partial or complete blockage of one’s breathing. The most recommended treatment for OSA is CPAP (Continuous Positive Air Pressure) machine therapy. The way it works is, the CPAP machine draws in air, humidifies and pressurizes it, then delivers it to the patient via a face mask that was set up before sleep. However, for people who also have GERD, this therapy method is not optimal, since the pressurized air sometimes passes through the esophagus and reaches one’s stomach instead of lungs, which could make the esophagus even weaker than it already is, thus worsening the condition.
It is worth mentioning that GERD is frequent in people with Autism Spectrum Disorder (ASD) who also have some sleep issues, as are sleep issues in those with ASD who have GERD; this perfectly displays how closely sleep disturbances and GI run, and how difficult it can be to distinguish cause from consequence when it comes to this combination.
Irritable Bowel Syndrome and Sleep
Irritable bowel syndrome (IBS) is a long-term disorder of the large intestine that manifests through a group of symptoms – usually abdominal pain and a distorted pattern of bowel movements, without evidence of an underlying condition or apparent cause. It is split into four categories based on the most prominent and frequent symptom the patient might display over time:
- IBS-D – diarrhea is common
- IBS-C – constipation is common
- IBS-M – both are common
- IBS-U – neither occurs very often
IBS affects over 21% of the population worldwide, and besides depression and anxiety, the most reported (non-digestive) problems these people face are related to sleep. Both the sleep onset and maintenance insomnias, excessive daytime sleepiness and albeit less commonly, sleep apnea, are all well within a range of the standard experience for people with IBS, disrupting their sleep and lowering their quality of life. While these people might not wake up during the night significantly more often compared to people who don’t have this condition, in the majority of cases, they will have to pass a bowel movement in this time, which may even be painful. This makes it more difficult for people with IBS to continue where they left off when they go back to bed, lowering their sleep quality and resulting in fatigue.
Ulcerative Colitis and Sleep
Ulcerative colitis is a chronic condition that affects the entire large bowel, characterized by the inflammation of the rectum and colon which then develop small ulcers along their walls. Along with Chron’s disease, it belongs to a subgroup called Inflammatory Bowel Disease (IBD – not to be confused with IBS!). Symptoms include abdominal pain, blood or pus with bowel movements, fatigue, fever, and diarrhea. Up to 500 thousand Americans are affected by ulcerative colitis, and it can hit when a person is anywhere between 14 and 40 years old.
This condition can make one’s day a struggle as a consequence of recurring diarrhea and other bowel movement problems, causing a great deal of discomfort and abdominal pain. Dealing with the symptoms and the stress of their frequent recurrence may trigger some sleep issues as well. People who have ulcerative colitis regularly experience fatigue due to a few factors that disrupt their sleep:
- The mental challenge of this disease
- Heightened inflammation in the body, especially if a flare-up happens at night, acting as a fire alarm and preventing sleep.
- Improperly functioning immune system
- Medication for ulcerative colitis (side-effects are often sleep-disruptive)
Besides this, issues with rest have been linked with the onsetting or activating of ulcerative colitis symptoms, making sound sleep a necessary prerequisite of treating and preventing this condition. Research suggests that both those who undersleep and oversleep have a higher risk of ulcerative colitis.
Crohn’s Disease and Sleep
Crohn’s disease is a chronic condition that affects the lining of one’s gastrointestinal system. Much like ulcerative colitis, this disease can be active or inactive – when the symptoms aren’t constant, but rather come and go every couple of weeks or months. Symptoms include diarrhea, abdominal pain, weight loss, fatigue, and even anemia if complications occur.
The exact cause of Crohn’s disease isn’t known, although a combination of environmental, immune and bacterial factors is likely to trigger it in predisposed individuals. Curing it is not possible; treatments are based on alleviating symptoms and maintaining the remission stage of the disease to prevent future flare-ups.
Sleep hygiene is vital at keeping this disease under control. Even while in the inactive state, patients with Crohn’s disease experience fatigue more regularly than the general population; furthermore, people with sleep issues such as insomnia are three times more likely to develop Crohn’s disease, and those who have both Crohn’s disease and a sleep problem double their chances of a flare-up.
Colon Cancer and Sleep
One of the most often diagnosed cancers in both women and men around the globe is colorectal cancer. Caused by a mutation in the cells of the rectum, or rather an error in the mutation, colon cancer encompasses a wide range of symptoms, most dominant being blood in the stool, abdominal pain, and change in bowel movements. When one first notices these symptoms, chances are the cancer has already formed. The sooner they go to a doctor, the bigger their chance of survival, but for this reason, doctors recommend regular screenings of the colon to ensure cancerous cells are discovered in time before they turn malicious.
Treatment for colon cancer is surgery, often accompanied by radiation and chemotherapy. According to the recent studies done on the topic, two of the highest concerns of people with colon cancer are fatigue and sleep disturbances.
These two often go hand in hand, and it isn’t clear which one causes which – patients usually experience them simultaneously. The most frequent sleep disturbances in cancer patients include sleep onset and sleep maintenance insomnia, waking up too early and excessive daytime sleepiness. The cause of these might be a direct consequence of cancer therapy (side-effects like nausea and vomiting), a comorbid condition like depression, stress or some other environmental factor. Patients who experience insomnia often try to make up for the lack of sleep by taking opportunities to nap, which only worsens the disorder and reduces the patient’s overall sleep quality. Up to 50% of all the prescribed pills for patients with cancer are sleep medications, particularly hypnotics.
On the other hand, sleep issues are emerging as risk factors for this type of cancer more and more. Both sleep deprivation and exposure to bright light in the evening have been shown to accelerate the formation of tumors. Shift work and other circadian rhythm abnormalities have been marked as cancer risk contributors, and sleep deprivation was found to increase the risk for colorectal adenomas by 50%. Much of this is still debated among professionals, but we now know that the link between sleep and cancer is of higher significance than previously thought. This is not bad news: treating sleep issues in patients with colon cancer might also ease some of the other difficulties they face, improving the quality of their life and potentially elevating the survival rates for this condition, if only by a little bit.
How to sleep better while experiencing gastrointestinal issues
As long as your condition didn’t reach its dreaded peak, there is something you can do to help yourself. None of the suggestions we listed below can cure all your problems (or harm you, for that matter), but following them is likely to aid in setting the ground for recovery.
- Set up a calming bedroom routine. Something that you will be able to keep up with long-term. For example, it might include taking a shower, brushing your teeth, turning off all electronics, changing your clothes and getting into bed. Before this, to ease stomach issues, you could set out a bit of time beforehand to drink some herbal tea and calm down. All practices that will help you relax are welcome but remember not to make this into a big, tiring list of chores that will annoy rather than aid you.
- Arm yourself to handle potential issues. Prevention is key, but when you know the damage is already done, you will do wise to prepare yourself. Don’t get frustrated when your sleep is disturbed – expect it to happen and focus on how to make the disturbance smaller of an issue. If you frequently wake up during the night and can’t fall back asleep, don’t stay in bed for hours. Leave the room. Indulge in a passive activity like reading, until you are ready to try again. Avoid bright lights and blue screens; your smartphone will only make it harder for you to sleep.
- Keep a log of your symptoms day in and day out. Everything counts: how much you slept, was it enough, what you ate, how stressed you got, etc. Frequent gastrointestinal issues can be a huge annoyance, but if you would just tilt your head and squint, you would realize how to use this to your advantage; the more regular your symptoms are, the faster you will be able to recognize a pattern and learn what your body reacts to. This log will be useful for your doctor and for you to know what to expect of your GI and sleep problems.
- Avoid potential triggers such as spicy, sugary or fried foods, especially in the hours before bedtime. Eating a balanced diet instead will promote good digestion as well as keep your weight in check. This is beneficial as obesity is linked with the worsening of many of the GI and sleep issues, amongst other conditions. Don’t lie down shortly after you have eaten or acid reflux could be triggered. Wear comfortable, loose clothes. Reduce your daily stress as much as possible, as stress has been linked to virtually all of the GI you could have. The same way you feel it in your stomach when you are nervous or excited, you can gather how too much stress on a regular basis could impact your health. Try activities like meditation, yoga, or some relaxing hobby to help keep the stress in check.
- Exercise. Physical activity ticks off quite a few boxes: stress, weight and built-up energy keeping you from sleep are just some aspects of your interest if you have GI issues. Don’t overstrain yourself and shock your body though – if you aren’t sure how much you can realistically handle, discuss it with a doctor. If you have been in a sedentary state for years, simply start with walking. Your body will be grateful for the positive change, however small.
- Switch your sleeping position. Sleeping on your stomach is an all-around bad idea for people with GI issues. In this position, your stomach and esophagus form almost a straight line, which makes it all too easy for stomach acid to make its way towards your mouth. Instead, opt for sleeping on your back or side, preferably left (if it doesn’t hurt). This will ensure your organs are lined orderly and help avoid unnecessary flare-ups.
Co-founder of Counting Sheep and Sleepaholic