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Sleep Disorders

Please Advise!

12/10/2009

Question:

I had an outbreak from my ibs 3 weeks ago which was pretty bad. I am pretty much ok right now with the ibs issue, except for some discomfort to some food and some stomach issue but not that bad.

My issue is the possible other effects that have occured from the ibs. I have a very hard time sleeping because I wake up with a rapid heart beat, a horrible shaky feeling in my neck and upper back, a bad headache, dry mouth, and major faitgue. I never have this issue unless I get an ibs attack.

I have only had two ibs attacks in my life and both time they have cause all these other issues. These issue seem to last for weeks or months and I can not function. The weird thing is, some days I feel pretty beter, but everytime I seem to decline and go back to not sleeping and not being able to function.

I am lost. Do you think this is a sleep issue that is causing the problems? Can ibs throw off the whole body and cause all these issues?

I have had high blood pressure in the past. I have also been taking a bunch of natural supplement to try and help my stomach, my head, and my sleep. The sleep supps seem to either help for a few hours or not at all, which is crazy to me.

Please advise if you can. I do not have insurance so going to doctor last option.

thanks you brent

Answer:

It sounds as though your problems are quite bothersome and you are right to seek help. Unfortunately, without further information and a physical examination, my comments can only be general in nature and may not get you the answer you need. You likely will need to see a physician to sort out the cause of your symptoms and how best to approach these.

Irritable Bowel Syndrome (IBS) as it relates to sleep has been studied and limited data suggests that individuals with IBS are more likely to report insomnia and nonrestorative sleep. These complaints appear to be linked mostly to the gastrointestinal symptoms occurring at night and the psychological stress and anxiety related to the condition. In addition, when objective sleep testing has been reported, most patients do not appear to have a significant underlying sleep disorder. So it’s possible that your sleep problems may be the result of the IBS and the treatment should focus on the IBS.

Your symptoms could also suggest a primary sleep disorder that is fragmenting or interrupting sleep leading to your current symptoms. This would more likely be the case if you had sleep problems persisting at times that you were not having problems with your IBS. Some of the more common sleep problems that could lead to your symptoms include obstructive sleep apnea (OSA) or sleep-related gastroesophageal reflux (heartburn). OSA is quite common in modern society, affecting up to 5% of middle aged adults in America. It is due to the recurrent complete or partial closure of the airway during sleep. When one of these breathing disturbances occurs during sleep, a brief arousal usually results in order to establish normal breathing again. As a result, individuals with OSA suffer from fragmented sleep and tend to feel unrefreshed upon awakening as well as sleepy and tired during the daytime. The main risk factors for the development of sleep apnea include being overweight and having specific anatomic abnormalities (such as large tonsils) that may narrow the airway. Aside from unrefreshing sleep and daytime sleepiness, individuals with sleep apnea often complain of loud snoring, headaches upon awakening, a poor sense of well-being, decreased ability to concentrate and reduced alertness.

Aside from the conditions mentioned above, numerous other factors may influence the quality of your sleep. These can range from the environment you sleep in (i.e. too warm, too loud) to medications you may taking.

In general, practicing good sleep habits, regular exercise, and avoiding nicotine use close to bedtime are helpful. Some simple steps you can take to improve your sleep include the following:

1) Maintain a regular wake time, even on days off work and on weekends.
2) Try to go bed only when you are drowsy.
3) Keep a regular schedule. Regular times for meals, medications, chores and other activities help keep the inner clock running smoothly.
4) Avoid napping during the daytime. If you do nap, try to do so at the same time every day and for no more than one hour. Mid-afternoon (no later than 3 PM) is best for most people.
5) Do not spend excessive amounts of time in bed. Use your bed only for sleep, intimacy, and times of illness.
6) A relaxing pre-sleep ritual such as a warm bath, light bedtime snack, or 10 minutes of reading may help. Avoid heavy meals before bedtime.
7) Try to exercise regularly. Vigorous exercise should be limited to earlier in the day, at least six hours before bedtime. Mild exercise should be done no more than 4 hours before bedtime.
8) Avoid ingestion of caffeine within 6 hours per day. "Reasonable" caffeine consumption is considered to be the equivalent of about 1-2 cups of coffee per day.
9) Do not drink alcohol when sleepy. Even a small dose of alcohol can have a significant effect when combined with tiredness and alcohol tends to cause sleep disruption after the first few hours of sleep. Do not drink alcohol while taking sleeping pills or other medications.
10) Avoid the use of nicotine close to bedtime or during the night.

To determine if there is sleep-related cause for your problems, a thorough history and physical examination are needed. A referral to a Sleep Specialist by your primary care physician should be considered to help sort out whether further testing is needed. Once a history and physical examination have been performed, the Sleep Specialist will decide if further evaluation is necessary.

To learn more about sleep and sleep disorders, please visit the American Academy of Sleep Medicine's website at www.aasmnet.org. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you.

Good luck and here's to better sleep!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University