Patients with inflammatory bowel disease (IBD) who have trouble sleeping often believe that there is a link between their sleep and IBD. These patients may have thought and behavior habits which worsen their sleep and, likely, their IBD, according to a study presented at Digestive Disease Week 2022, on May 22, in San Diego, California.

About 75% of patients with IBD experience poor sleep, which can increase the risk for disease flair, hospitalization, and surgery, and can reduce a patient’s quality of life. This study aimed to “probe patients’ beliefs about their sleep and IBD, to understand the patient perspective on this topic, to explore their treatment preferences and barriers, to see if this topic matters to patients, and then to arm providers with recommendations on how to address sleep problems,” said Jessica Salwen-Deremer, PhD.

Dr Salwen-Deremer is an assistant professor of psychiatry and medicine at the Geisel School of Medicine at Dartmouth University in Dartmouth, New Hampshire.

The study included 312 adults with Crohn disease (CD) or ulcerative colitis being treated at the Dartmouth-Hitchcock IBD Center. Via the online patient portal, an anonymous survey was conducted, asking patients about sleep patterns, thoughts, and behaviors related to sleep, as well as open-ended questions about sleep and IBD. Dr Salwen-Deremer reported that about 70% of their participants had poor sleep and added, “Importantly, about a third or so met criteria for 2 or more sleep disorders.”

While there are many IBD-related sleep disruptions that are common in patients experiencing poor sleep, Dr. Salwen-Deremer explained that they found, “it’s really not those usual suspects — bowel movements at night…that’s not significantly significant when controlled. The same for IBD-specific pain and medications.” What this study found to be statistically significant were “more diffuse symptoms,” such as generally feeling unwell, and worrying about incontinence.

A total of 81% of the participants indicated an interaction between sleep and IBD. These patients were most concerned about losing control of their sleep, as well as the effects of poor sleep. “They’re concerned about what happens to their physical and mental health long term when they’re not sleeping well,” Dr Salwen-Deremer stated. Participants also thought that their sleep was worse during flares, and that poor sleep led to worse IBD symptoms while good sleep was protective.

Those patients who experience poor sleep also had more dysfunctional beliefs about sleep, and were more likely to engage in behaviors that can worsen sleep. Dr Salwen-Deremer divided those behaviors into 2 categories: sleep hygiene (variability in bedtime, lying in bed awake, worrying/planning in bed) and pain-specific behaviors (using pain medications primarily as a sleep aid, resting in bed when in pain). She also pointed out that the pain-related behaviors are “worse in folks with CD, and worse in those with active disease.”

When it came to a clinician’s role in patient’s sleep behaviors, 70% of the participants thought that IBD providers should ask about sleep during visits. Of the patients with poor sleep, 67% thought their IBD providers should provide sleep recommendations, and 83% were interested in sleep treatment, and/or some information, if it was not time-intensive. Top treatment preferences for these patients, Dr Salwen-Deremer reported, were a vitamin or supplement, meeting with a sleep specialist over telehealth, and mobile-based apps. “Fourth on the list is taking a nightly pill,” she stated. “People think that they need medication, but it’s not their top way of getting treatment. And that’s important.” Major barriers to seeking treatment for patients included access to treatment, availability, cost, lack of knowledge about treatment options, and lack of interest in medication.

“The first thing to do is to ask about sleep,” Dr Salwen-Deremer recommended, with a simple yes/no question: Are you having any problems with sleep or fatigue? From there, clinicians can ask specific questions about the patient’s sleep schedules, and what patients do in bed other than sleeping. Then recommendations can be made: maintaining consistent sleep/wake times; not napping, or only napping for 20-30 minutes before lunchtime; only using their beds for sleep or intimacy; and not spending time in bed when fatigued or in pain.

“The other thing you should do is to educate your patients about their options,” Dr Salwen-Deremer stressed, by letting them know that there are nonpharmacologic treatments and free, app-based approaches available. For patients with chronic insomnia, it is also important to explain that sleep hygiene recommendations will not be sufficient. “Once the sleep problems become chronic those will not work, and patients will often feel like failures,” Dr Salwen-Deremer stated. Providers should also be aware of how to refer patients to a sleep medicine clinic, or cognitive behavioral therapy for insomnia.

“Overall, poor sleep matters to patients,” Dr Salwen-Deremer concluded, “and they want help from their IBD providers.”

—Allison Casey

Reference:
Salwen-Deremer JK, Jagielski CH, Smith MT, Siegal CA. People with IBD want to talk about sleep: Recommendations on what to ask and how to respond to sleep complaints. Abstract presented at: Digestive Disease Week; May 22, 2022. San Diego, California.