Managing insomnia and other sleep disorders in IBD must first start with raising awareness of the IBD-sleep connection among clinicians and patients.
“Previously, researchers have shown that poor sleep predicts adverse outcomes for patients with Crohn’s disease and ulcerative colitis,” Jessica K. Salwen-Deremer, PhD, notes. “While cognitive behavioral therapy for insomnia, or CBT-I, is the gold standard treatment for chronic insomnia disorder, we weren’t sure if it was the best course of action for IBD, as waking up during the night for a bowel movement is not a typical sleep-related behavior or occurrence. We wanted to determine if this was an appropriate patient population for CBT-I and if there were thought and behavior patterns that we could intervene in.”
The researchers also aimed to determine “whether there was an appetite for CBT-I among patients with IBD,” she says. The study, which was published in Digestive Diseases and Sciences, administered an anonymous online survey to inquire about sleep-related patterns, thoughts, and behaviors, treatment preferences, and barriers to treatment among patients with IBD.
Most Patients Want to Talk About Sleep
The study included 312 participants (66.3% female; mean age, 48.62), more than half of whom (60.9%) had Crohn’s disease. Half of the study population (N=156) reached the clinical threshold for a diagnosis of insomnia.
Individuals with insomnia reported a significantly higher level of concern about the negative effects of sleep loss and greater helplessness about sleep. These patients were also more likely to engage in behaviors known to perpetuate insomnia, such as spending time in bed in pain (P≤0.001), than those without insomnia.
“One of the biggest findings to stress is that 70.3% of participants expressed interest in discussing sleep with their gastroenterologists,” Dr. Salwen-Deremer says.
Additionally, 63.5% of participants expressed interest in receiving suggestions from their gastroenterologist about how to improve sleep or who to see about sleep issues. Most patients with insomnia (84.6%) were also interested in participating in sleep treatments, such as meeting with a sleep specialist (Figure).
Raising Awareness of Sleep Issues in IBD
Dr. Salwen-Deremer acknowledges that, for gastroenterologists, inquiring about sleep and behavioral health can be “really difficult, especially in a 20-minute clinical encounter where you’re also talking about health maintenance, medication changes, and procedures, such as colonoscopies.”
However, she notes that mental healthcare providers are becoming increasingly involved in the care of patients with IBD. “I’m lucky that I work in an institution where there is a great multidisciplinary team that includes myself, other mental healthcare providers, specialty pharmacists, and dietitians. Access to evidence-based Web-based tools is increasing, too, and providers may be able to recommend these programs to patients. Examples include Mindfulness Coach and Insomnia Coach, both of which are put out by the US Department of Veterans Affairs.”
Treating insomnia and other sleep problems in patients with IBD must start with increasing awareness of the issue among both healthcare professionals and patients, Dr. Salwen-Deremer says.
“Clinicians should know that nonpharmacological treatments for insomnia not only exist, but are really excellent,” she notes. “That’s a key point.”
Further, the survey results indicated that not all patients realize insomnia can be a part of IBD.
“For example, a patient might say: ‘I have Crohn’s disease, so of course I should be fatigued and not sleeping well,’” Dr. Salwen-Deremer explains. “Certain patients may need education on what they can expect when their treatments are working optimally. If you get up for a bowel movement and are back in bed and asleep in 10 minutes, that’s IBD, but if you’re up for 30 minutes or more, or if you’re waking up without urgency, that’s likely insomnia.”
