Sleep issues in folks with Crohn’s may be brought by anxiety or depression, chronic pain, or psychological trauma. Determining and treating any disease-related causes of pain or discomfort have to be a top priority. Cognitive-behavioral therapy, hypnosis, and meditation can all help you get healthier sleep.
Getting a restful night of sleep can be difficult for everyone. But when you have Crohn’s disease, the prospect of sleeping well can be even more daunting and hard. Even if you’re not having an active flare of the disease, you might have anxiety related to your condition that hinders your ability to sleep. Or you may have ache that isn’t caused by active disease, but still has a very disruptive effect.
It’s not just a one-way relationship between inflammatory bowel disease (IBD) and sleep problems. According to an article published in April 2015 in The American Journal of Gastroenterology, there’s proof that sleep dysfunction and disruption may play a role in the onset of IBD flares in many people. And an earlier study pointed out that people with insomnia have 3 times the risk of developing a bowel disorder.
Difficulty sleeping can also lead to issues that aren’t directly related to IBD symptoms. A study of adolescents with IBD, published in May 2014 in the journal Sleep Disorders, found that poor sleep was connected with anxiety and depression, aggressive behaviour, and attention problems.
Finding a successful way to improve your sleep depends, first and foremost, on what’s causing your disruption in the first place. But whether your issues are mostly psychological or physical in nature, there are ways that can help you achieve relaxation when you need it most.
Identifying Sleep Problems Related to Crohn’s
While there might be more than one reason why you’re having trouble sleeping, it’s vital to identify those reasons rather than just trying to sleep better, says Eva Szigethy, MD, PhD, a psychiatrist who serves as director of the Visceral Inflammation & Pain (VIP) Center at the University of Pittsburgh Medical Center. Dr. Szigethy specializes in the brain–gut connection and behavioral problems in people with IBD.
“We obviously want to make sure that we aren’t missing a treatable … organic problem,” says Szigethy, meaning something directly related to Crohn’s disease activity. After active flares of the disease, finding and treating any bowel obstructions is at the top of this list, she says.
Joel B. Levine, MD, a gastroenterologist and professor of medicine at the University of Connecticut, confirms this concern about finding obstructions. “You would be surprised how many people with Crohn’s receive anti-inflammation drugs for their pain when, in fact, they have evolved to a more scarred intestine,” Dr. Levine says. The remedy for an obstruction, he notes, is surgery to stretch, remove, or open up the scarred area of the intestine.
If you’re being woken by diarrhea at night, says Levine, that may indicate a higher likelihood that it’s related to a disease flare than the same issue during the daytime. “As a soft rule of thumb, many functional causes of diarrhea — such as diet and stress — are only during the day,” he says.
Once all of these potential causes of sleep disturbance are ruled out, says Szigethy, 3 main causes remain: anxiety or depression, chronic functional pain (ache that isn’t directly tied to disease activity), and post-traumatic stress disorder (PTSD), which may be connected to violence or childhood trauma, or simply to the trauma caused by Crohn’s disease itself.
Consider Medications for Crohn’s Pain to Get a Good Night’s Sleep
Szigethy notes that the options available for abdominal pain relief include much more than traditional opioid painkillers — in fact, unless your pain is caused by the aftermath or surgery, opioids likely pose a greater risk than benefit for patients long term.
“We have psychotropic medications that can help GI [gastrointestinal] symptoms,” she says, adding that certain tricyclic antidepressants have been shown not just to reduce pain and improve mood, but also to help treat diarrhea.
It’s important that your doctor knows about all symptoms associated with your pain — such as diarrhea, constipation, nausea, or vomiting — because some drugs for pain may improve certain symptoms, while others can make them worse.
“You have to understand the pain in the context of other GI symptoms,” says Szigethy.
Establish a Routine for a Better Night’s Sleep
The National Sleep Foundation recommends that most adults get 7 to 9 hours of sleep every night. Two essential steps to make yourself more tired at night, says Szigethy, are regular moderate exercise and sticking to a regular bedtime and waking schedule. Also important, she says, is “making sure that you’re in an environment that is conducive to sleep,” without distracting sounds or light. Others steps to improving sleep include:
- Reserve your bed for sleep only (no tablets or TV time in bed).
- Keep a sleep journal
- Talk to a support group or loved one about stress triggers
Retrain Your Brain to Get Sound Sleep
To change the way your brain approaches sleep more significantly, Szigethy says there’s strong evidence supporting the effectiveness of cognitive-behavioral therapy and hypnosis, as well as meditation. “All of these techniques teach you to either distract yourself from the pain signal or take your mind offline,” she says.
If you can’t or don’t want to see a trained therapist for these techniques, Szigethy suggests checking out mobile apps like Lantern (cognitive-behavioral therapy for anxiety and stress), Headspace (meditation), and Sleepio (just for sleep). Many apps like these feature audio-guided mental exercises that can help you calm down.
Remember that your own mind can be as powerful as any drug, says Szigethy. “I think that there’s nothing more chemically powerful than the chemicals in our own human brain.”