Sleep Apnea and IBS: When You Don’t Get Enough ZZZZ’s
Which comes first? IBS symptoms or a bad night’s sleep?
The relationship between IBS and sleep can seem like the classic chicken-and-egg scenario: For some people, symptoms like gas, abdominal pain and frequent bathroom visits occasionally wreck any chance of peaceful slumber. Other people find that if they don’t sleep well, no matter what the reason, it triggers their IBS symptoms the next day.
I’m in the first group. Over the years, I’ve found that symptoms occasionally keep me from falling asleep or bother me during the night – making me feel run-down the next day. Recently, though, I learned that there may be more to it.
Sleep apnea diagnosis and treatment
Several years ago, I was diagnosed with a mild-ish case of obstructive sleep apnea (OSA). In case you haven’t heard of it: WebMD describes OSA as a potentially serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated OSA stop breathing repeatedly during sleep, sometimes hundreds of times a night. (Luckily, mine is NOT that bad!) This means the brain and body may not get enough oxygen. Left untreated, the disorder can cause serious health problems, including high blood pressure, stroke, heart failure, diabetes and depression.1
Day-to-day, OSA can leave you feeling unrested, sleepy, irritated—really affecting your quality of life. Much like a bad flare-up with IBS.
After using an oral appliance for several years, I’ve now “graduated” to using Continuous Positive Airway Pressure (CPAP) machine. It holds the airway in my throat open, keeping my breathing from being interrupted. Initially, I had a little trouble with gas in the morning from swallowing air overnight. That’s a common issue. But the last thing I need is MORE abdominal bloating! So, I jumped online to do some troubleshooting and learned a lot.
Complex relationship between IBS and sleep disorders
Scientists are already keenly aware of the complex relationship between sleep disorders and gastrointestinal health. People with IBS (and irritable bowel disease) have reported suffering from insomnia, fragmented sleep, greater use of sleep medication, lower energy levels when awake and increased fatigue than other have “healthy” people.5 (Quote marks are mine—I still consider myself a healthy person, just aging!)
It’s well established that one of the risk factors associated with OSA is gastroesophageal reflux, or GERD.5 Luckily, GERD has never been part of my IBS-M symptom profile. But a lot of studies over the past 20 years have also found an association between OSA and IBS, with OSA triggering or even escalating IBS symptoms.2-4
How that happens biologically is pretty complex (the immune system is involved), and I’m not a scientist. But my takeaway from it all is this: It’s not a chicken-OR-egg scenario for me. It’s a chicken-AND-egg scenario. I already have a solid IBS regimen in place. But now I also understand that I have to be really compliant with the CPAP treatment. If I’m not, it could put me at risk for an IBS flare-up—plus leave me tired and grumpy all day. (Could that be called IBS-ZZZZZ?)
Tips for good sleep
Some researchers found that 2 weeks of treatment with the sleep aid melatonin significantly reduced reported symptoms in people with OSA and IBS.3 That’s interesting, and I will add it to my list of potential short-term remedies. Essentially, though, the bottom line is to do what it takes to sleep well. Even people without OSA could benefit from good sleep hygiene. Some of these suggestions from the National Sleep Foundation6 sound like sensible IBS care, too:
- Avoiding stimulants such as caffeine and nicotine close to bedtime
- Steering clear of food that can be disruptive right before sleep, such as those that could cause heartburn
- Establishing a regular relaxing bedtime routine
- Making sure that the sleep environment is pleasant
- Exercising to promote good quality sleep
Are these steps you can take to preserve your ZZZs?
Do you live with any sleep disorders (eg. insomnia, RLS, sleep apnea) in addition to IBS?