Crohn’s Disease And Sleep

What is Crohn’s disease?

Crohn’s disease is an autoimmune disease related to the inflammation of a person's bowels. It occurs when there is inflammation within the gastrointestinal tract, which is the passage of the digestive system that begins at the mouth and ends at the anus.¹ Inflammation most commonly occurs in the small and large intestines and can spread through the walls of the intestines, causing damage to multiple tissue layers.² This inflammation produces several painful symptoms. 

The exact cause of Crohn’s disease has not yet been established. It is thought to be an autoimmune disease, where the immune system mistakes the healthy bacteria in the gastrointestinal tract for parasitic bacteria.³ It is also suggested that genetics may be a cause of the disease, as a person is more likely to be diagnosed with Crohn’s disease if close family members have the condition.

Symptoms

The symptoms can vary in intensity and be recurrent in their presence. It can be mild, or severe when the disease is active (during a flare-up). Symptoms include diarrhoea, blood in faeces, and stomach aches and cramps.⁴  Blood in your faeces is a key indicator of the disease; if you experience blood in your faeces, you must visit your GP immediately for a proper diagnosis and treatment. Reduced appetite can lead to weight loss.⁵ You can also experience mouth sores due to nutritional deficiencies. There can also be a pain in the anal region due to local inflammation. Fatigue is also a common symptom which affects sleep patterns.

Can Crohn’s disease affect sleep?

Crohn’s disease has the potential to affect sleep in some individuals. Severe symptoms such as stomach cramps and diarrhoea affect sleep as the patient is likely to not be able to get to sleep due to the pain or having to often go to the bathroom. The painful symptoms can also wake a person up in the middle of the night, interrupting their sleep cycle.

A 2019 study investigated the relationship between sleep and inflammatory bowel disease, and it was found that those with inflammatory bowel disease experience more sleep disturbances than those without the disease.⁶ 

Fatigue is a common Crohn’s disease symptom

Fatigue arises due to sleep disturbances as a result of the disease. It is a key symptom which is often overlooked and can lead to other serious health problems. 

Can lack of sleep make Crohn’s disease worse?

There is evidence to suggest that lack of sleep can worsen Crohn’s disease. The research investigated the link between sleep and Crohn’s disease symptoms. It is that known that sleep is indispensable to many aspects of human health, including the immune system. Sleep scientists have found there is a bi-directional relationship between sleep and the immune system.⁷ This means that when the immune system is not working at full capacity, there is a significant negative impact on sleep. Moreover, good sleeping habits help to improve immune function and response. 

Lack of sleep can worsen inflammation

Inflammation is the cause of Crohn’s disease symptoms, there a vicious cycle exists where the disease affects sleep, which in turn affects inflammation, making the disease worse. This is a very complex relationship, and there are several mechanisms that cause this cycle to occur. One study showed that with poor sleep during one night, levels of a protein called NF-kB increased, which stimulates inflammatory pathways throughout the body, causing the symptoms of the disease to worsen.⁸  

How to stay hydrated when living with Crohn’s disease?

It is essential to stay hydrated if you have Crohn’s disease, as dehydration can worsen the symptoms and also lead to more health complications such as constipation, muscle cramps, and fatigue. Water or electrolyte-containing fluids are the recommended fluids, with an average of around 2 litres a day, depending on the person's weight.⁹ It is also beneficial to eat foods high in potassium, such as bananas, spinach, and salmon. Another recommendation to manage Crohn's is to limit one's alcohol and sugar consumption as much as possible, as this only leads to further fluid loss. 

Conclusion

The link between Crohn’s disease and sleep remains one of the lesser-known symptoms but certainly one of the most critical points for targeting treatment. There is active research on medications that are linked to sleep improvement, which may prove to be very effective for this disease. People with Crohn’s disease are also recommended to take lifestyle measures to improve their sleep, such as maintaining a balanced diet, sufficient physical activity, and following a proper sleep schedule which consists of going to bed early and having 6-8 hours of sleep.