Sleep & IBD disease activity

Sleep & IBD disease activity

You may notice that as stress increases in your life, so does your disease activity, or vice-versa: an increase in disease activity can lead to more stress.

By Leslie Ann Berg, MSPH 

We’ve found that in order to make actionable, lasting behavioral change, knowing the scientific explanation for how and why something is occurring can be a potent stimulus for action. So, let’s dig into the research.

Following strong anecdotal evidence in IBD patients, scientists began conducting research to see if there was actually an association between psychological stress levels and IBD disease activity. Studies based on symptom reporting revealed that mood disorders (namely depression and anxiety) can lead to increased inflammation and a heightened risk for IBD, as well as worsening disease activity in those who already have the disease.

While the brain can affect the gut, scientists have also uncovered ways that the gut affects the brain. Researchers have identified gut-brain signaling that proves inflammation in the intestines alters brain function, and in turn, negatively influences behavior – disrupting circadian rhythm, uncovering mood disorders, and altering appetite. Studies also show that psychological symptoms and IBD symptoms go hand in hand – as one increases in severity, so does the other.

It’s evident that not only can depression and other mood/behavior disorders lead to an increase in IBD disease activity, but also the opposite is true – IBD can lead to an increase in mood disorder symptoms. But how? The mechanism is through the gut-brain axis. The gut-brain axis describes the bidirectional relationship between the gut and the brain – the two organs communicate constantly with each other, sharing neurological, hormonal, and immune signaling. This relationship is strong and very real and explains why gut disorders affect the brain (as well as brain-related functions like mood, appetite, sleep, and behavior) and why things going on in the brain can affect the gut. If you’re looking to get your IBD under control and into long-term remission, one of the most helpful tactics is to manage your psychological stress. Managing your psychological stress means – in a very direct way – managing your IBD.

But how do I do this, you might ask? Because, as most of us know, managing stress isn’t so easy.

2020 review looked at studies investigating the strong link between psychological stress and IBD and concluded that a holistic approach to managing IBD is vital for patients to keep their psychological stress in check. Researchers who conducted the review study recommended implementing lifestyle interventions focusing on three main areas:

  1. Avoiding sleep deprivation
  2. Optimizing nutrition
  3. Monitoring and managing mood disorders

We couldn’t agree more. Modifying your lifestyle to improve your disease is the best way to encourage long term remission. While optimizing nutrition and managing your existing psychological health are important points and areas we’ll spend a lot of time talking about on this site, sleep is an under-addressed issue that we think needs a lot more attention. In fact, a study published this year in Current Gastroenterology Reports reviewed what we know about sleep in the IBD adult population and concluded that poor sleep is an unrecognized but incredibly important “extra-intestinal manifestation” of IBD. A study presented at Digestive Disease Week 2020 found that within the first 6 months of diagnosis, approximately 26% of IBD patients developed “new onset fatigue”, and fatigue was strongly linked to a prior diagnosis of depression, anxiety, and sleep disorders. Additional studies have found the following relationships between IBD and sleep:

The relationship between IBD and sleep is bidirectional – sleep impacts disease activity and disease activity impacts sleep – so coming up with strategies to improve sleep quality and realign the circadian rhythm is paramount for achieving psychological health and long-term remission.

TAKE ACTION! As you work to manage psychological stress in your daily life, make sleep a #1 priority. Let nothing (in your power, of course) get between you and a good night’s sleep. To help get you there, we recommend the following:

Lastly, remind yourself that not every night will be a good night’s sleep, especially if you’re experiencing a flare-up. But the more you implement the above steps day in and day out, the more likely you are to get good sleep most nights, which will improve your psychological, immune and gut health, and have a positive impact on your IBD.

Read Sleep & IBD Disease Activity.