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Can’t Sleep? Could Be Your Digestion

Posted Nov 16 2009 10:00pm

Can’t Sleep? Could Be Your Digestion
Studies link digestive problems with restless nights.
By Linda Carroll; republished with permission from
You’re tired of feeling tired. But no matter how early you get to bed, you never feel well-rested in the morning. You’ve tried adjusting the room temperature, replacing the mattress and fluffing the pillows. Nothing seems to work.

You may be looking in the wrong place for a cure. It could be that your digestive system is sabotaging your sleep.

Increasingly, scientists are linking digestive disorders with a host of nocturnal problems ranging from insomnia to restless nights that lead to exhaustion during the day.

For example, a small pilot study published in November in Alimentary Pharmacology & Therapeutics showed that heartburn treatments may lead to a more restful night’s sleep in people suffering from gastroesophageal reflux syndrome (GERD). And a study published in Mayo Clinic Proceedings in December found that irritable bowel syndrome may be linked with insomnia.

Reflux redux

The connection between damaged sleep and heartburn is “the real deal,” says Dr. David Metz, a professor of medicine in the division of gastroenterology, director of the acid peptic disorders program and co-director of the GI physiology laboratory, all at the University of Pennsylvania in Philadelphia.

And many people don’t even know that reflux is the source of their daytime fatigue. “They don’t know why they feel tired all the time and their quality of work suffers,” Metz says. “They think they’re sleeping through the night and they’re not.”

In desperation, some patients turn to sleeping pills. That’s a bad idea for people with GERD, Metz says, because the stomach acid that has leaked into the throat stays there longer and does more damage to the esophagus. If you wake up—even briefly—you will swallow and clear the acid from your esophagus, he says.

The heartburn study followed for 8 weeks 18 patients who had been diagnosed with GERD. Researchers asked the patients to fill out two questionnaires—one designed to determine the severity of GERD symptoms and the other designed to uncover sleep problems.

At the beginning of the study, only 11 percent of patients had normal sleep, says Dr. David A. Johnson, a professor of medicine and chief of gastroenterology at Eastern Virginia Medical School. After four weeks of taking a proton pump inhibitor for heartburn, half the patients were getting a restful night’s sleep.

“What we think happens is that the GERD bumps you out of the pattern of progression to restful sleep,” Johnson says. “People get up in morning and don’t feel good and they don’t know why.”

The study does have limitations, Johnson allows. In particular, the study was small, and researchers didn’t have a control group to compare to the patients who received GERD therapy.

The next step is a large placebo-controlled study, Johnson says.

IBS and sleep

The association between irritable bowel syndrome and insomnia turned up in a survey of 2,269 people chosen at random from Olmsted County, Minn. The Olmstead residents were asked both about digestive symptoms and sleep problems.

The most common digestive problem linked with insomnia was IBS, but patients with sensitive stomachs also had problems getting to sleep.

What isn’t clear is whether the digestive ills cause insomnia or poor sleep leads to stomach and bowel problems, says study co-author Dr. Nick Talley, a professor of medicine and gastroenterology at the Mayo Clinic College of Medicine in Rochester, Minn. It’s also possible that some other problem is causing both the digestive ills and the sleep disturbance, Talley says.

“There could be an abnormality in the brain centers that regulate sleep and bowel function,” he adds. “We do know from imaging studies that blood flow in the brain is altered in IBS. Sleep disturbance could be a reflection of this.”

The study may help researchers figure out causes for both problems, says co-author Dr. G. Richard Locke, an associate professor of medicine at Mayo.

It could be as simple as a single neurotransmitter out of whack, Locke and Talley say. “For instance, we know that serotonin, a chemical released in the bowel, is very important for proper functioning,” Talley says. Serotonin is also involved in sleep, he adds.

Locke says the researchers originally got the idea for the study because so many IBS patients coming to their clinic mentioned they have problems sleeping.

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