Red flags for sleep and mental health

3 minute read

An Australian study shows significant rates of insomnia, anxiety and depression associated with inflammatory gut disorders.

More than 60% of patients with chronic gut health disturbance experience clinically significant insomnia, with a large portion also experiencing depression and anxiety, an Australian research team has concluded. 

A cohort of 670 online respondents with IBD were assessed for abdominal pain, mental health, and insomnia. Findings were reported in the journal Intestinal Research. 

Clinically significant depression (based on a score of greater than 9 on the Patient Health Questionnaire) was seen in 18% of the cohort, and 29% had clinically significant anxiety (greater than 10 on the Generalized Anxiety Disorder 7-Item). 

An Insomnia Severity Index (ISI) score greater than 10, indicating clinically significant insomnia, was seen in 62% of the cohort and over a third of the cohort had at least moderate insomnia. The authors noted that the chronic insomnia rates seen in the general population is between six and 20%. 

Nearly three quarters of the cohort were female, and the median age was 41. Almost 60% had Crohn’s disease, half were on biologics, and 30% had undergone surgery for IBD. 

Assessment was based on self-reporting, using a variety of validated questionnaires such as the Insomnia Severity Index (ISI), the Harvey Bradshaw Index (HBI), the Simple Clinical Colitis Activity Index (SCCAI) and the IBD-disability index self-report (IBD-DI-SR).  

Physical activity, abdominal pain, nocturnal diarrhea, anxiety and depression were also assessed using validated self-reporting methods, and data on relevant factors such as obesity, smoking status, medications and previous surgeries were also attained. 

The research undertaken jointly between the University of Adelaide, Southern Adelaide Local Health Network (SALHN), Central Adelaide Local Health Network (CALHN), and Flinders University also found that increased severity of insomnia was associated with a worse disability score. 

Higher ISI scores, indicating worse insomnia, were often found in those who reported opioid usage to manage chronic pain. Frank blood was also associated with also associated with a higher mean ISI score. 

Gastroenterologist Professor Jane Andrews and co-author of the paper, told Gut Republic that the study was robust and representative, showing a genuine perceived issue for people living with IBD.  

She said the study also showed which factors were independently related to likelihood of insomnia. 

“And they are ones we can recognise and treat in routine care, so a great opportunity to improve quality of life for people living with IBD,” she said. 

She said screening tools should be utilised at every visit to enable clinicians to routinely find out if patients have clinically active disease, abdominal pain, and relevant MHIs.  

The authors noted that given the established association between sleep deprivation and hyperalgesia, insomnia may worsen abdominal pain. Gastrointestinal symptoms such as diarrhea have also been linked with sleep disturbances.  

They referred to CBTi, a form of cognitive behavioural therapy targeted at insomnia which has shown some benefit in improving pain, as a potential avenue of treatment.  

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