Poor sleep has been reported by the majority of patients with irritable bowel syndrome (IBS), non-ulcer dyspepsia (NUD) and fibromyalgia. We have previously evaluated 505 patients with functional bowel symptoms and found that 58% of patients overall complain of sleep problems: 68% of patients with NUD, 71.2% of patients with NUD and IBS, 50.2% of patients with IBS and 55.1% of healthy individuals reported sleep disturbances. Patients with NUD but not IBS reported sleep disturbances more frequently than healthy subjects. We also found that upper abdominal symptoms, perceived severity of symptoms and presence of co-morbid psychological disorders increased the likelihood of sleep disturbances. The majority of patients with NUD experienced abdominal pain at night that awoke them from sleep.

Sleep studies have identified abnormal sleep wave patterns in patients with IBS, NUD and fibromyalgia. Patients with fibromyalgia have abnormalities in the non-rapid eye movement (nREM) stage IV sleep. This abnormality consists of a rapid (alpha wave) rhythm intruding into the usual slow (delta wave) rhythm of stage IV sleep. Patients with this sleep abnormality complain of awakening tired and unrefreshed in the morning. Even after patients awake from what they describe as a “sound sleep,” they report a general feeling of tiredness and fatigue. The sleep pattern is reported to occur in almost all patients with fibromyalgia and by the majority of IBS patients. This alpha EEG sleep anomaly has also ben reported in patients with chronic pain. Fibromyalgia patients commonly associate the onset of their sleep disturbance, musculoskeletal and mood symptoms with a major stressful event.

Increased REM (rapid eye movement) sleep has been reported in patients with IBS and NUD. REM sleep is a sleep phase characterized by arousal, altered activity of the autonomic nervous system and altered colon (large intestine) function. REM sleep is reduced by low dose amitryptiline treatment which has shown to be effective in treating IBS, NUD and fibromyalgia. The sleep disturbance is likely to play an important role in the chronicity of symptoms by setting up a vicious cycle: pain, fatigue and emotional distress alter the body’s arousal systems during sleep. In turn, the poor sleep quality increases sensitivity to bowel and somatic (skin and muscle) stimuli leading to more pain and distress.

We are currently planning to test the effect of alosetron (serotonin antagonist which has been found to be effective in treating IBS, please see Serotonin section) on sleep and colon motility (function). If you are interested in learning more about this study or would like to participate, please contact us at (310) 312-9381.