Sleep problems plague IBD patients, require more attention

The opinion that inflammatory bowel disease (IBD) is associated with poor sleep is not uncommon among patients with IBD, according to a study. Moreover, these individuals tend to think and behave in manners that worsen sleep and their disease.

“While access to behavioural sleep medicine specialists can be limited, patients are quite receptive to getting sleep information from their IBD providers,” said the researchers, who presented the study at the virtual Crohn’s & Colitis Congress 2022. “To address these patient needs, providers may ask about weekday/weekend sleep differences and what patients do in bed besides sleep.”

IBD providers are aware of the link between poor sleep and IBD, but only a few ask their patients about sleep and provide evidence-based suggestions for management. Hence, the researchers conducted this study to understand patients’ belief about sleep and IBD, their treatment preferences, and offer recommendations to providers on how best to ask about and address such problems in this population.

An anonymous, only survey was carried out on 312 adults (mean age 48.6 years, 66 percent women, 96 percent White) with Crohn’s disease (CD) or ulcerative colitis (UC) who sought treatment at the Dartmouth-Hitchcock IBD Center in the US. Participants were asked about their sleep patterns, thoughts and behaviours related to sleep, as well as open-ended questions about sleep and IBD.

Of the patients, 61 percent had CD and 39 percent had UC (mean symptom duration, 20.7 years). Majority of the respondents (81 percent) supported some interaction between sleep and IBD. Thematic analysis revealed the belief that sleep was worse during flares and that sleeping poorly exacerbated IBD symptoms, while good sleep was protective. [Inflamm Bowel Dis 2022;28(Suppl 1):S93]

Pain, night-time bowel movements, and general and IBD-specific anxiety all contributed to poorer sleep quality. Participants with poor sleep showed more dysfunctional beliefs about sleep (d, 1.6; p<0.001) and were more likely to engage in behaviours that can worsen sleep, including taking daytime naps (d, 1.16; p=0.03), lying in bed while in pain during the day (d, 1.19; p<0.001), and worrying/planning in bed (d, 0.99; p<0.001).

Seventy percent of participants shared the belief that IBD providers must ask about sleep during visits. In addition, 67 percent of those with poor sleep thought that these providers should offer sleep recommendations, while 83 percent expressed interest in sleep treatment and/or information, provided it was not time intensive.

Major barriers to seeking treatment among IBD patients were as follows: access to treatment, cost, availability, lack of knowledge about treatment options, and disinterest in medication.

“Patients should be encouraged to maintain consistent sleep/wake times, not take naps (or nap for 20-30 minutes before lunch), use their beds only for sleep and sex, and not spend time in bed when they are not sleeping (eg, if resting when fatigued or in pain),” the researchers said.

“Poor sleep occurs in 75 percent of people with IBD and is prospectively associated with increased risk for disease flare, hospitalization, surgery, and reduced quality of life,” they noted.