More than a third of people with irritable bowel syndrome (IBS) also have a sleep disorder. That's the pooled estimate from 36 studies with 63,620 participants, which put the figure at 37.6%. People with IBS had about 2.6 times the odds of a sleep disorder compared with healthy controls (Wang et al., 2018).
If you've noticed that a rough night sets up a rough gut day, you're not imagining the connection. The harder question is which comes first. Here's what research can and can't tell us so far, and what's worth trying.
A link, not yet a cause
That large analysis shows sleep problems and IBS travel together, but it can't show that one causes the other. The authors themselves called for studies on whether the relationship is causal (Wang et al., 2018).
To get closer to an answer, researchers have tracked people night by night and compared how they slept with how they felt the next day.
Bad nights, harder next days
In a small US study, 24 women aged 18 to 45 with IBS kept sleep and symptom diaries for a full menstrual cycle and wore activity monitors for a week. Poorer self-reported sleep quality predicted more abdominal pain, anxiety and fatigue the next day (Buchanan et al., 2014).
The details matter. Poor sleep didn't significantly predict other gut symptoms the next day, only abdominal pain. And when the researchers looked in the opposite direction, daytime symptoms generally didn't predict worse sleep the following night (Buchanan et al., 2014). In this group, sleep seemed to lead and symptoms followed. With only 24 women, though, the authors describe the study as exploratory.
It may be the waking up that counts
A study at Washington University in St. Louis compared 24 people with IBS and 26 healthy people, 44 of them women, using wrist monitors for 7 days. The IBS group actually slept more hours per day, 7.7 compared with 7.1, yet felt less rested. They also woke more often during the night, about 12 times compared with 9 (Patel et al., 2016).
Those waking episodes predicted worse abdominal pain and gut distress the next day, and more waking was linked with lower quality of life. Part of the effect on pain seemed to run through mood (Patel et al., 2016). So counting hours in bed may miss the point. How broken up those hours are may matter just as much.
Why this matters in midlife
These studies weren't designed around women in their forties and fifties. But if your nights have become choppier in perimenopause, with hot flashes or night sweats waking you, the findings are worth taking personally. If broken sleep can nudge pain and gut distress upward, then sleep deserves a place in your digestive plan, not a separate file.
What actually helps sleep
For chronic insomnia, the American College of Physicians recommends cognitive behavioral therapy for insomnia (CBT-I) as the first treatment for all adults, ahead of sleep medication (Qaseem et al., 2016). CBT-I is a structured program, usually spread over several weeks, that works on sleep timing, habits and the thoughts that keep you awake.
It has been tested in women in midlife, too. In a trial of 106 perimenopausal and postmenopausal women aged 40 to 65 with insomnia and hot flashes, six telephone CBT-I sessions over 8 weeks lowered insomnia severity scores by 9.9 points, compared with 4.7 points in women who received menopause education. At 24 weeks, 84% of the assessed women in the CBT-I group had scores in the no-insomnia range, compared with 43% in the education group (McCurry et al., 2016).
One more interesting finding: the number of hot flashes didn't change, but women in the CBT-I group said the hot flashes interfered less with their lives (McCurry et al., 2016).
Small steps to start this week
Track sleep and symptoms together. Note your bedtime, how often you woke and next-day bloating or pain on a 0 to 10 scale for two weeks.
Keep a steady wake time, even after a bad night. Sleep timing is a core part of CBT-I programs.
Don't lie awake for long. If you can't sleep, get up, do something quiet in dim light and return to bed when sleepy. This is the idea behind stimulus control, one of the techniques used in the CBT-I trial above.
Ask about CBT-I. The midlife trial above delivered it by phone, which can make it easier to fit into a busy schedule.
When to see a doctor
Gut symptoms that wake you from sleep are a reason to get checked rather than something to manage on your own. The same goes for blood in your stool, unexplained weight loss, anemia, or new bloating most days with early fullness, pelvic pain or urinary urgency. And if insomnia has lasted for months, or you snore loudly and wake unrefreshed, talk to your doctor about CBT-I and about whether a sleep disorder such as sleep apnea could be involved.
Sources
Wang B, Duan R, Duan L. Prevalence of sleep disorder in irritable bowel syndrome: a systematic review with meta-analysis. Saudi J Gastroenterol. 2018;24(3):141-150. PMID 29652034
Buchanan DT, Cain K, Heitkemper M, et al. Sleep measures predict next-day symptoms in women with irritable bowel syndrome. J Clin Sleep Med. 2014;10(9):1003-9. PMID 25142761
Patel A, Hasak S, Cassell B, et al. Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44(3):246-58. PMID 27240555
Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125-33. PMID 27136449
McCurry SM, Guthrie KA, Morin CM, et al. Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms: a MsFLASH randomized clinical trial. JAMA Intern Med. 2016;176(7):913-20. PMID 27213646
This article is for general information and isn't medical advice. Talk to your healthcare provider about ongoing sleep problems or digestive symptoms, especially if they wake you at night.
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