Sleep Impairment: A Trigger for Relapse in IBD?

David A. Johnson, MD


January 23, 2014

In This Article

Meeting the Need for Sleep

We need to consider that patients who are "in remission" may not truly be in remission -- what endoscopists call "deep remission." Patients might be in remission with respect to their disease activity, but not according to their sleep scores. There may be an unmet need here to take a good sleep history and look at ways that we can improve sleep in these patients.

Fatigue is an incredibly common manifestation of sleep deprivation. What about the role of fatigue in IBD? A study from the Manitoba database[6] showed that fatigue is evident in more than 75% of patients with active disease and that even among patients who are "in remission," 30%-40% report daytime fatigue, which is a subtle indicator and very strong predictor of sleep dysfunction.

I suggest that we look at ways to query our patients about sleep. If you are a patient, report to your doctor if you believe that you are experiencing dysfunctional sleep. Medications and patterns of activity may be causing a dysfunctional sleep state.

Some fairly simple approaches, such as taking melatonin, may be very helpful. Animal model data support this strategy, although we don't have good clinical trial data in humans to support it as a "one size fits all" solution for every patient. However, it's a fairly low-cost and low side-effect profile drug to try, at least, in patients.

We need to identify whether there are sleep abnormalities even in patients who are in remission, and to see whether we can proactively remediate these abnormalities and reduce the likelihood for flares in the population with Crohn disease that was reported in the study from the University of North Carolina.

This is a wake-up call for all of us -- not only patients with IBD but also those who provide their care -- that we need to do better.

There are several ways to do this. For example, there are sleep questionnaires, such as the Pittsburgh Sleep Quality Index (PSQI), that can be downloaded and administered to patients with IBD. The PSQI has 19 self-assessment questions for the patient and 5 questions to be answered by the bed partner or roommate, if one is available. It is a very objective and easily scored method of identifying sleep dysfunction.

Much physiologic evidence supports nonpharmacologic approaches to preventing IBD flares or treating those in active disease states. We are likely to find that disordered sleep is important in many other diseases as well, particularly those associated with an upregulation in inflammatory cytokines.

Hopefully, this information is helpful the next time you see a patient with IBD.

I'm Dr. David Johnson. Thanks again for listening, and I hope you have a good night's sleep.


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