Digestive Diseases and Sciences

, Volume 63, Issue 11, pp 2983–2991 | Cite as

Sleep Disturbances Are Commonly Reported Among Patients Presenting to a Gastroenterology Clinic

  • Sarah Ballou
  • Eaman Alhassan
  • Elise Hon
  • Cara Lembo
  • Vikram Rangan
  • Prashant Singh
  • William Hirsch
  • Thomas Sommers
  • Johanna Iturrino
  • Judy Nee
  • Anthony LemboEmail author
Original Article



Poor sleep quality is common among patients with gastrointestinal (GI) disorders. However, few studies have assessed the presence of insomnia or reported circadian preferences and none have directly compared sleep between common GI conditions.


To compare clinical sleep characteristics in patients presenting to a tertiary care GI clinic for irritable bowel syndrome (IBS), functional dyspepsia (FD), inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), and celiac disease (CD).


Validated sleep measures were administered to consecutive patients if they were diagnosed with IBS, IBD in clinical remission, CD, FD, or GERD. Healthy Controls (HCs) with no reported GI diagnoses or symptoms were also recruited.


A total of 212 eligible respondents completed this survey, 161 GI clinic patients (IBS (n = 48), GERD (n = 29), IBD in clinical remission (n = 44), CD (n = 40)), and 41 HCs. Only, 10 respondents had a diagnosis of FD, and these were excluded. The IBS group had the highest frequency of poor sleep (72%) followed by CD (61%), GERD (60%), IBD (54%), and HC (39%). IBS patients also had the highest frequency of clinical insomnia (51%), followed by GERD (37%), CD (35%), IBD (27%), and HC (18%). 40% of IBS patients reported taking sleep medications at least once per week, compared to 32% of GERD, 23% IBD, 13% CD, and 15% HC.


Patients presenting to a tertiary care GI clinic report poorer sleep than healthy controls. In general, patients with IBS report the highest rates of sleep difficulties compared to patients with other diagnoses.


Gastrointestinal diseases Sleep Irritable bowel syndrome Inflammatory bowel disease Gastroesophageal reflux disease Celiac disease 



This research was supported in part by NIH/NIDDK Grant # T32DK007760.

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflicts of interest.


  1. 1.
    Fass R, Fullerton S, Tung S, Mayer EA. Sleep disturbances in clinic patients with functional bowel disorders. Am J Gastroenterol. 2000;95:1195–2000.CrossRefGoogle Scholar
  2. 2.
    Heitkemper M, Jarrett M, Burr R, et al. Subjective and objective sleep indices in women with irritable bowel syndrome. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. 2005;17:523–530.CrossRefGoogle Scholar
  3. 3.
    Keefer L, Stepanski EJ, Ranjbaran Z, Benson LM, Keshavarzian A. An initial report of sleep disturbance in inactive inflammatory bowel disease. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 2006;2:409–416.Google Scholar
  4. 4.
    Iwakura N, Fujiwara Y, Shiba M, et al. Characteristics of sleep disturbances in patients with gastroesophageal reflux disease. Intern Med Tokyo Jpn. 2016;55:1511–1517.CrossRefGoogle Scholar
  5. 5.
    Mody R, Bolge SC, Kannan H, Fass R. Effects of gastroesophageal reflux disease on sleep and outcomes. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2009;7:953–959.Google Scholar
  6. 6.
    Graff LA, Vincent N, Walker JR, et al. A population-based study of fatigue and sleep difficulties in inflammatory bowel disease. Inflamm Bowel Dis. 2011;17:1882–1889.CrossRefGoogle Scholar
  7. 7.
    Lackner JM, Gudleski GD, Dimuro J, Keefer L, Brenner DM. Psychosocial predictors of self-reported fatigue in patients with moderate to severe irritable bowel syndrome. Behav Res Ther. 2013;51:323–331.CrossRefGoogle Scholar
  8. 8.
    Bellini M, Gemignani A, Gambaccini D, et al. Evaluation of latent links between irritable bowel syndrome and sleep quality. World J Gastroenterol. 2011;17:5089–5096.CrossRefGoogle Scholar
  9. 9.
    Thompson JJ, Elsenbruch S, Harnish MJ, Orr WC. Autonomic functioning during REM sleep differentiates IBS symptom subgroups. Am J Gastroenterol. 2002;97:3147–3153.CrossRefGoogle Scholar
  10. 10.
    Zingone F, Siniscalchi M, Capone P, et al. The quality of sleep in patients with coeliac disease. Aliment Pharmacol Ther. 2010;32:1031–1036.CrossRefGoogle Scholar
  11. 11.
    Mårild K, Morgenthaler TI, Somers VK, Kotagal S, Murray JA, Ludvigsson JF. Increased use of hypnotics in individuals with celiac disease: a nationwide case-control study. BMC Gastroenterol. 2015;15:10.CrossRefGoogle Scholar
  12. 12.
    Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.CrossRefGoogle Scholar
  13. 13.
    Nojkov B, Rubenstein JH, Chey WD, Hoogerwerf WA. The impact of rotating shift work on the prevalence of irritable bowel syndrome in nurses. Am J Gastroenterol. 2010;105:842–847.CrossRefGoogle Scholar
  14. 14.
    Caruso CC, Lusk SL, Gillespie BW. Relationship of work schedules to gastrointestinal diagnoses, symptoms, and medication use in auto factory workers. Am J Ind Med. 2004;46:586–598.CrossRefGoogle Scholar
  15. 15.
    Kim HI, Jung S-A, Choi JY, et al. Impact of shiftwork on irritable bowel syndrome and functional dyspepsia. J Korean Med Sci. 2013;28:431–437.CrossRefGoogle Scholar
  16. 16.
    Zhen LuW, Ann Gwee K, Yu Ho K. Functional bowel disorders in rotating shift nurses may be related to sleep disturbances. Eur J Gastroenterol Hepatol. 2006;18:623–627.CrossRefGoogle Scholar
  17. 17.
    Basnet S, Merikanto I, Lahti T, et al. Associations of common noncommunicable medical conditions and chronic diseases with chronotype in a population-based health examination study. Chronobiol Int. 2017;34:462–470.CrossRefGoogle Scholar
  18. 18.
    Merikanto I, Englund A, Kronholm E, et al. Evening chronotypes have the increased odds for bronchial asthma and nocturnal asthma. Chronobiol Int. 2014;31:95–101.CrossRefGoogle Scholar
  19. 19.
    Chrobak AA, Nowakowski J, Zwolińska-Wcisło M, Cibor D, Przybylska-Feluś M, Ochyra K, et al. Associations between chronotype, sleep disturbances and seasonality with fatigue and inflammatory bowel disease symptoms. Chronobiol Int 2018;1–11.Google Scholar
  20. 20.
    Rotem AY, Sperber AD, Krugliak P, Freidman B, Tal A, Tarasiuk A. Polysomnographic and actigraphic evidence of sleep fragmentation in patients with irritable bowel syndrome. Sleep. 2003;26:747–752.CrossRefGoogle Scholar
  21. 21.
    Elsenbruch S, Harnish MJ, Orr WC. Subjective and objective sleep quality in irritable bowel syndrome. Am J Gastroenterol. 1999;94:2447–2452.CrossRefGoogle Scholar
  22. 22.
    Artom M, Czuber-Dochan W, Sturt J, Murrells T, Norton C. The contribution of clinical and psychosocial factors to fatigue in 182 patients with inflammatory bowel disease: a cross-sectional study. Aliment Pharmacol Ther. 2017;45:403–416.CrossRefGoogle Scholar
  23. 23.
    Patel A, Hasak S, Cassell B, et al. Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44:246–258.CrossRefGoogle Scholar
  24. 24.
    Buchanan DT, Cain K, Heitkemper M, et al. Sleep measures predict next-day symptoms in women with irritable bowel syndrome. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 2014;10:1003–1009.Google Scholar
  25. 25.
    Fine L. Sleep: important considerations in management of pain. Phys Med Rehabil Clin N Am. 2015;26:301–308.CrossRefGoogle Scholar
  26. 26.
    Haack M, Lee E, Cohen DA, Mullington JM. Activation of the prostaglandin system in response to sleep loss in healthy humans: potential mediator of increased spontaneous pain. Pain. 2009;145:136–141.CrossRefGoogle Scholar
  27. 27.
    Haack M, Sanchez E, Mullington JM. Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy volunteers. Sleep. 2007;30:1145–1152.CrossRefGoogle Scholar
  28. 28.
    Haack M, Scott-Sutherland J, Santangelo G, Simpson NS, Sethna N, Mullington JM. Pain sensitivity and modulation in primary insomnia. Eur J Pain Lond Engl. 2012;16:522–533.CrossRefGoogle Scholar
  29. 29.
    Tang Y, Preuss F, Turek FW, Jakate S, Keshavarzian A. Sleep deprivation worsens inflammation and delays recovery in a mouse model of colitis. Sleep Med. 2009;10:597–603.CrossRefGoogle Scholar
  30. 30.
    Swanson GR, Burgess HJ, Keshavarzian A. Sleep disturbances and inflammatory bowel disease: a potential trigger for disease flare? Expert Rev Clin Immunol. 2011;7:29–36.CrossRefGoogle Scholar
  31. 31.
    Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2:297–307.CrossRefGoogle Scholar
  32. 32.
    Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: Psychometric Indicators to Detect Insomnia Cases and Evaluate Treatment Response. Sleep. 2011;34:601–608.CrossRefGoogle Scholar
  33. 33.
    Gagnon C, Bélanger L, Ivers H, Morin CM. Validation of the Insomnia Severity Index in primary care. J Am Board Fam Med JABFM. 2013;26:701–710.CrossRefGoogle Scholar
  34. 34.
    Adan A, Almirall H. Horne & Östberg morningness-eveningness questionnaire: A reduced scale. Personal Individ Differ. 1991;12:241–253.CrossRefGoogle Scholar
  35. 35.
    Yi C-H, Hu C-T, Chen C-L. Sleep dysfunction in patients with GERD: erosive versus nonerosive reflux disease. Am J Med Sci. 2007;334:168–170.CrossRefGoogle Scholar
  36. 36.
    Black TP, Manolakis CS, Di Palma JA. “Red flag” evaluation yield in irritable bowel syndrome. J Gastrointest Liver Dis JGLD. 2012;21:153–156.Google Scholar
  37. 37.
    Ranjbaran Z, Keefer L, Farhadi A, Stepanski E, Sedghi S, Keshavarzian A. Impact of sleep disturbances in inflammatory bowel disease. J Gastroenterol Hepatol. 2007;22:1748–1753.CrossRefGoogle Scholar
  38. 38.
    Paine S-J, Gander PH, Travier N. The epidemiology of morningness/eveningness: influence of age, gender, ethnicity, and socioeconomic factors in adults (30–49 years). J Biol Rhythms. 2006;21:68–76.CrossRefGoogle Scholar
  39. 39.
    Gingold-Belfer R, Peled N, Levy S, et al. Impaired sleep quality in Crohn’s disease depends on disease activity. Dig Dis Sci. 2014;59:146–151. CrossRefGoogle Scholar
  40. 40.
    Wu Y-L, Chang L-Y, Lee H-C, Fang S-C, Tsai P-S. Sleep disturbances in fibromyalgia: A meta-analysis of case-control studies. J Psychosom Res. 2017;96:89–97.CrossRefGoogle Scholar
  41. 41.
    Abad VC, Sarinas PSA, Guilleminault C. Sleep and rheumatologic disorders. Sleep Med Rev. 2008;12:211–228.CrossRefGoogle Scholar
  42. 42.
    Telford O, Diamantidis CJ, Bosworth HB, Patel UD, Davenport CA, Oakes MM, et al.: The relationship between Pittsburgh Sleep Quality Index subscales and diabetes control. Chronic Illn 2018;1742395318759587.Google Scholar
  43. 43.
    Roehrs T, Hyde M, Blaisdell B, Greenwald M, Roth T. Sleep loss and REM sleep loss are hyperalgesic. Sleep. 2006;29:145–151.CrossRefGoogle Scholar
  44. 44.
    Schey R, Dickman R, Parthasarathy S, et al. Sleep deprivation is hyperalgesic in patients with gastroesophageal reflux disease. Gastroenterology. 2007;133:1787–1795.CrossRefGoogle Scholar
  45. 45.
    National Institutes of Health. National Institutes of Health State of the Science Conference statement on Manifestations and Management of Chronic Insomnia in Adults, June 13–15, 2005. Sleep. 2005;28:1049–1057.CrossRefGoogle Scholar
  46. 46.
    Kim J, Cho S-J, Kim W-J, Yang KI, Yun C-H, Chu MK. Insomnia in tension-type headache: a population-based study. J Headache Pain. 2017;18:95.CrossRefGoogle Scholar
  47. 47.
    Hinz A, Glaesmer H, Brähler E, et al. Sleep quality in the general population: psychometric properties of the Pittsburgh Sleep Quality Index, derived from a German community sample of 9284 people. Sleep Med. 2017;30:57–63.CrossRefGoogle Scholar
  48. 48.
    Zeitlhofer J, Schmeiser-Rieder A, Tribl G, et al. Sleep and quality of life in the Austrian population. Acta Neurol Scand. 2000;102:249–257.CrossRefGoogle Scholar
  49. 49.
    Wong WS, Fielding R. Prevalence of insomnia among Chinese adults in Hong Kong: a population-based study. J Sleep Res. 2011;20:117–126.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sarah Ballou
    • 1
  • Eaman Alhassan
    • 1
  • Elise Hon
    • 1
  • Cara Lembo
    • 1
  • Vikram Rangan
    • 1
  • Prashant Singh
    • 1
  • William Hirsch
    • 1
  • Thomas Sommers
    • 1
  • Johanna Iturrino
    • 1
  • Judy Nee
    • 1
  • Anthony Lembo
    • 1
    Email author
  1. 1.Department of Medicine, Division of GastroenterologyBeth Israel Deaconess Medical CenterBostonUSA

Personalised recommendations