Can Irritable Bowel Syndrome Cause Insomnia?

People with irritable bowel syndrome (IBS) are much more likely to develop a sleep disorder than those without the digestive disorder.

However, the cause of this might surprise you a bit.

Current research clearly shows that poor sleep predicts the severity and frequency of next-day IBS symptoms (1,2).

However, the reverse is not necessarily true. In other words, IBS does not cause sleep problems itself in the short term for most people.

There are some exceptions to that, and it can sound confusing at first.

So let’s dig into the research a bit to clear things up...

The Link Between IBS and Sleep Disorders

A systematic review of 36 studies looked at the relationship between IBS and sleep disorders (3).

The authors calculated that people with IBS are approximately 2.6 times more likely to develop a sleep disorder than the general population.

Unlike other topics, nearly every study found a consistent elevated risk for sleep disorders, as you can see in the chart below (every event rate mean for each study was greater than 0).

Does IBS Cause Insomnia, or Does Insomnia Trigger IBS?

If people with IBS are more likely to get insomnia, that doesn’t mean that IBS is causing the insomnia.

As I mentioned earlier, research actually shows that low quality sleep primarily drives IBS symptoms (1,2). The researchers behind the first of those referenced studies sums it up nicely:

This finding is mostly consistent with our earlier study with a different sample of IBS subjects, which also showed that irritable bowel syndrome symptoms did not predict that night's sleep quality...

In the short-term at least, IBS does not cause insomnia (for the average person at least, there could be exceptions) or a measurable increase in sleep disturbance frequency.

However, there’s one big caveat:

IBS affects mood and wellbeing, which leads to stress and anxiety, 2 of the most common causes of insomnia.

In other words, a few nights of bad sleep can trigger IBS symptoms, which then make sleep issues worse, and so on. In that sense, IBS can absolutely lead to long-term sleep issues like insomnia.

An online questionnaire of 1950 university students found that IBS symptom severity is significantly associated with insomnia complaints (4). The more severe the symptoms are, the more anxiety and stress IBS is likely to cause, which leads to more common insomnia.

If not addressed quickly, acute sleep issues can easily develop into chronic insomnia.

SummaryWhile IBS may not be the initial trigger for sleep issues, evidence shows that people with IBS are much more likely to develop insomnia, suggesting that IBS symptoms contribute to poor sleep.

IBS and Depression

The other most probable explanation for people with IBS being at high risk of developing a sleep disorder is that IBS is linked with depression. Depression is one of the major risk factors of insomnia.

A study analyzed 3429 individuals, of which 11% had an IBS diagnosis. They found that not only were people with IBS more likely to develop depression, IBS severity worsened as depressive symptoms worsened (5).

I should note that this is also likely a similar mechanism that we looked at above.

The same research mentioned earlier found no direct link between IBS causing mood disorders like depression in the short-term, but again, the anxiety from IBS can lead to a negative cycle with depression.

Depression, anxiety, and insomnia are all so interconnected that it can be hard to determine which one is in particular causes the others.

SummaryDepression has a bidirectional link with insomnia (meaning that either one can lead to each other), and IBS may exacerbate depressive symptoms. This may contribute to the increased risk of insomnia that individuals with IBS have.

How Are Sleep Issues In People With IBS Treated?

IBS still isn’t fully understood, and is IBS patients are typically directly treated with diet modification currently.

But since sleep disturbances is the driver of IBS symptom flare-up, it needs to be treated directly.

Not too much research has been done on this specific population, but it appears that you treat sleep issues like insomnia in people with IBS the same as you would in the general population.

One study found that brief behavioral therapy for insomnia (BBT-I), a shortened version of cognitive behavioral therapy, was effective in patients with IBS (6). After 4 weeks:

At follow-up, there were significant differences between groups in measures of sleep quality and insomnia severity...40% of the BBT-I sample reported clinically meaningful drop in symptoms compared to 17% of the control group.

As expected, irritable bowel syndrome symptoms like abdominal pain also decreased in those that experienced an improvement in sleep.

SummaryJust as in the general population, insomnia in those with IBS should be treated with a comprehensive plan made by a medical professional. It will likely include some sort of cognitive behavioral therapy, and may include sleep medication if appropriate.

Can Stomach Pain Cause Insomnia?

Earlier on I mentioned that research shows that irritable bowel syndrome doesn’t cause sleep disturbances directly in “most” cases.

But severe IBS symptoms at night that include stomach pain can absolutely cause difficulty falling asleep.

Research has also shown that hunger pains can make it harder to sleep if they are severe enough.

Why Does IBS Trigger At Night?

Some people with IBS find that their symptoms typically are worse at night, while most find that they are worse during the day.

IBS symptoms are often related to digesting food, so people that eat later in the day tend to have irritable bowel syndrome symptoms at night.

In addition, if you have excess sleep anxiety, that can make irritable bowel syndrome symptoms even worse.

If someone finds themselves with bad IBS flare ups at night, they can test eating earlier and eating less. If the issues remain, it rules out food-related causes.

How to Calm an IBS Flare Up At Night?

Long-term treatments like dietary modification and behavioral therapy for IBS are still being studied to determine the best solutions (7).

If you have a flare up at night, more helpful short-term solutions to alleviate some discomfort and reduce the chance of a sleep disturbance include:

• Relaxation techniques - These have some evidence behind them for helping manage IBS symptoms. Relaxation techniques typically refer to meditation and yoga, which can also improve sleep quality.
• Heat - Applying a heat pad over the intestinal area can relieve some discomfort and even encourage digestion if needed.
• Exercise - Light to moderate exercise can improve sleep and even certain IBS symptoms (even if it sounds counterintuitive). Intense exercise at night can lead to difficulty falling asleep, but you likely can’t do that while experiencing irritable bowel syndrome symptoms regardless.
• Tea - There’s limited evidence that tea may improve IBS symptoms. Additionally, there’s some research showing that some types of tea may improve insomnia (8).
• Melatonin supplements - While it's not a cure-all, research does show that melatonin makes it easier to fall asleep for a large portion of people. Melatonin supplements are not related to IBS at all, they're just generally useful and typically well-tolerated for addressing sleep complaints.

For the last 2 options, it's important not to overdo them. Exercise that is too intense, or tea with lots of caffeine can delay sleep onset.

Too much tea can also lead to difficulty maintaining sleep if you need to wake up to urinate frequently.

What’s the Best Sleeping Position For IBS Symptoms

Like other functional gastrointestinal disorders that can interrupt sleep (e.g. acid reflux), the best sleeping position for IBS is usually on the left side.

Due to the orientation of the stomach, lying on the left side of your body is generally best for digestion and causes the least stress on your body.

Sleeping on your back can also be helpful, especially if you are slightly elevated with pillows.

Summary: IBS and Insomnia

People with irritable bowel syndrome are much more likely to develop sleep disorders like insomnia.

Initially, it appears that poor sleep quality causes irritable bowel syndrome symptoms, and not the other way around (although bowel movements at night could disrupt sleep).

However, due to the effect of IBS on mental health, it can lead to long term sleep problems if the sleep issues aren’t addressed quickly.

People with IBS and insomnia will likely need to adjust their diet and improve their approach to sleeping under the guidance of a doctor.

References

1. Sleep Measures Predict Next-Day Symptoms in Women with Irritable Bowel Syndrome
2. Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome
3. Prevalence of sleep disorder in irritable bowel syndrome: A systematic review with meta-analysis
4. The Association of Insomnia, Perceived Immune Functioning, and Irritable Bowel Syndrome Complaints
5. The association between irritable bowel syndrome and the coexistence of depression and insomnia
6. Brief Behavioral Therapy for Insomnia in Patients with Irritable Bowel Syndrome
7. Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine
8. Treatment of Irritable Bowel Syndrome with a Combination of Curcumin, Green Tea