In an article published in Everyday Health, Robert Rosenberg, DO, points out the relationship between disruption of sleep and the modification of the immune system, which can ultimately influence the course of inflammatory bowel diseases (IBDs), such as Crohn’s disease and ulcerative colitis.
A 2013 study completed at the Massachusetts General Hospital and published in the journal Clinical Gastroenterology and Hepatology, analyzed the sleeping disorders of 3,173 patients with IDB. The study showed that, among the 1,291 patients with Crohn’s disease in remission, those with impaired sleep were twice as likely to have a flare-up of active disease when followed for six months. This study in particular did not show a similar relationship between sleep to ulcerative colitis, but others have.
Sleep disorders are very common in the United States, Rosenberg writes, adding that the National Institutes of Health studies have estimated that 50–70 million Americans currently suffer from sleep disorders, and intermittent sleep disorders can adversely affect people’s health.
According to Rosenberg, the link between poor sleep and IDB may be the disease’s waxing and waning characteristic, which includes diarrhea, abdominal pain, and weight loss. Sleep loss is associated with an increase in inflammatory cytokines such as TNF-alpha, IL-6, and elevated C-reactive protein, all of which have been implicated in the inflammatory process characteristic of IBD.
These inflammatory mediators can also severely disrupt sleep, and, consequently, a vicious cycle can arise with the chronic inflammation of IBD worsening sleep, and decreased sleep increasing the production of the very mediators of inflammation that exacerbate IBD.
Melatonin, the hormone that drives circadian rhythms, also plays an interesting role, says Rosenberg. This hormone is present in the gastrointestinal tract in amounts 400 times higher than in the gland that produces it, the pineal gland. Melatonin is a powerful antioxidant and free radical scavenger that, in animal experiments, has been found to be capable of preventing experimentally induced colitis. As a result, there are experts in the field calling for studies to determine whether melatonin supplementation might be effective in treating IBD.
For Rosenberg, it is becoming clear that disordered sleep can have a major impact on colitis, as it appears that both insufficient sleep and possibly abnormal melatonin production might play a significant role in increasing the activity of the inflammatory system. Much more attention needs to be paid to underlying sleep disturbances in those with IBD. It would appear that, as in heart disease, diabetes, and stroke, the importance of sleep can never be underestimated.