Ep.59 – How to get better sleep when you have IBS
26 Jun, 2024

Episode Intro

Have you ever noticed your digestive symptoms are worse when you're really tired? Unfortunately, there are some links between IBS and SIBO and how you sleep. We've all had those times when you just don't sleep well and life feels so much harder. But what about if it goes on for months? In this episode of the Inside Knowledge podcast for people with IBS, I'll cover how sleep and your gut health interact, I'll talk about some sleep hygiene tips so you can try and get the best night's rest possible, as well as covering diet and eating patterns to help you get better sleep.

Podcast transcript

Sleep and IBS

Hello, welcome to episode 59 of the Inside Knowledge. I’m Anna Mapson. The reason for picking sleep as a topic for a podcast is that a lot of my clients really struggle with sleep. It can be down to things like waking up because your symptoms are waking you up. So you’re waking up with gas and pain.

That’s the probably the most common, but also it can be because IBS and sleep issues often go hand in hand. IBS is often linked with, anxiety and mood disorders and we know that they also play into sleep problems a lot. So feeling well rested and energetic really helps you make better choices for your food.

It helps your ability to concentrate at work and perform and your desire to want to move your body as well. Like it’s very hard to Want to go and exercise when you just haven’t slept well for weeks and weeks. So sleep is really important for our overall health and it also massively impacts on our immune system.

So when people are very tired and sleep deprived, they often feel run down and be more susceptible to getting infections. You already know all of this, I’m sure, that sleep is important. However, what we want to try and work on is how to make it easier or how you can improve your sleep to sleep for longer and sleep better.

Because sometimes when you are struggling with sleep, knowing all these things about how important sleep is, and how you’re going to wake up feeling even more tired, can be a bit counterproductive with people going on and on about how terrible it is to be sleep deprived. It is also very common that people don’t sleep enough.

I found some data saying that men in the UK get around six and a quarter hour sleep a night and females get around six hours And the one of the most sleep deprived age groups is the age 35 to 44 getting less than six hours on average and this was in one study, But I think it just goes to show that When you’ve got a lot of worries and obviously that sort of midlife can be quite stressful. They sometimes call it the sandwich generation.

You’ve got children or other caring responsibilities and then maybe parents who are aging and responsibilities plus work and then on top of that you’ve got your health concerns. There’s a lot of things that could be disrupting your sleep and knowing that. Sleep is important isn’t really enough.

So I’m going to focus a bit more on how we can get over it. I thought it might be helpful to talk a little bit about how we fall asleep as well Just so that you understand there’s two Triggers for us falling asleep and getting a good night’s sleep. The first is our cycle of the sleep hormone. Melatonin is one of the hormones that really drives our sleep and this does have a kind of rhythm to it. It tends to be really low in the middle of the day Obviously, that’s when we’re wide awake and then as the night It starts to fall, the light becomes darker and also throughout our day we change our pattern, we start to slow down and then melatonin will increase and it tends to peak just after midnight, like the early hours of the morning.

And then it decreases again as we start to wake up. The other way that we sleep is something called sleep pressure. So throughout the day all our cells are burning energy. We’re moving around doing things. And there is a byproduct called adenosine. So there are adenosine receptors in the brain and there is this kind of build up of pressure, this adenosine, that’s getting stronger and stronger and that is also triggering the need to sleep.

Now adenosine is blocked by caffeine. When we have a cup of tea and coffee, that will stop your brain receiving the messages about adenosine, which will reduce your sleep pressure. Also if you have a nap, that also reduces the pressure to sleep. You’ve probably already noticed that when you’re more stressed, you feel more anxious and therefore sleep becomes even harder.

We know when we’re overtired, we might feel more anxious and that can be really hard to switch off. It’s basically your brain putting your body into a kind of danger mode, thinking, okay, I haven’t slept because there must be something going on. I’ve got to be on high alert all the time.

And always looking for danger and something that could go wrong,. So you’re always looking out to anticipate the worst case scenarios, and then this can further drive anxiety levels. So, We also know when we’re in that fight or flight state, we don’t digest food as well.

And this can end up leading to higher levels of bloating and gas and pain that then can wake you up. So it can become this really vicious cycle that is actually quite hard to get out of. We also know that sleep can change your gut microbiota, which is really interesting. I found this study where some young and normal healthy men, and they sleep deprived them for two nights. And they tested their gut microbes before and after the experiment and in just two nights of four hours sleep, so they had half the recommended time rather than eight hours, they saw changes in their gut microbes and these Microbes were more associated with metabolic disruption, so think about things like blood sugar regulation, increased weight gain.

Also, The men had worse insulin responses, meaning they were less able to pack away glucose from their food, they got a big insulin rise. If that was to go on over time, it can potentially lead to metabolic conditions like diabetes and that sort of thing.

They’ve also done experiments taking sleep deprived mice, that, sort of mimics a jet lag experience, and they noticed this sort of insulin changes in these mice., when they gave the bacteria from the jet lagged mice to other mice, they also saw the insulin responses., we also know that there might be a immune response as well, as some inflammatory markers are increased by sleep deprivation. These are interleukin 6, TNF alpha, sometimes nuclear factor kappa beta, B. These are increased when people are really sleep deprived chronically and in the short term as well in studies.

Then the other thing is when we’re tired, we tend to make different food choices. We choose foods that are energy dense . We crave sweet things that are going to give us a hit and that is because When we’re really tired, your brain is just desperate for some energy and the quickest release carbohydrates would be like simple sugars, simple carbohydrates, because you know that those are going to give you that energy hit to get through the next stage of the day until you can sleep again.

Now, I’m going to move on to what you can do to improve your sleep now, but I wanted to just labour that point a little bit that it is important and it does affect your digestion, so lack of sleep is not something to ignore when we’re looking at how to improve your digestion. Some people are surprised about that and don’t give sleep the priority that it deserves.

One of the key things that I see with some clients as well is you’re not giving yourself eight hours opportunity for sleep. You’re not going to bed in enough time, basically. A lot of people will go to bed at 11, 12 o’clock and then be needing to get up quite early or they’re waking up quite early, and so they’re just not getting enough sleep.

even eight hours in bed, let alone eight hours asleep. So one of the first things that you can do to try and improve your sleep is to just give yourself an opportunity to get that eight hours sleep. Now when we talk about eight hours that is the magic number, but we know probably from studies that some people will do better on a little bit less, some people will do better on a little bit more, and there’s no exact science to it.

It’s what We also know some people are more of a early morning, like Lark chronotype. So somebody who prefers to get up early and go to bed early. And then there’s the night owls who prefer to wake up late and go to bed early. late. Now the problem is for the night owls that our society is very much geared to people who get up early. And school and work mostly all require people to be up dressed out of the house early in the morning and not sleeping in, and this is a real problem for teenagers who have a late chronotype as they sort of get to 14, 15, 16. It’s natural for them to want to sleep in later and wake up later. However, school and everything normally, Means that they have to get up early, which means that they then are sleep deprived if they’re staying up late.

So although they hate it, going to bed early for teenagers is some of the best things they can do to maintain all those things I was just talking about. The blood glucose, the better insulin response, the healthy immune system, and also ability, obviously to concentrate. So that is one of the first things we’ve got to get.

you having enough sleep and enough time in bed. Now, if you are someone who has got ability to change your schedule to meet your needs and you’re someone who can start work whenever you want, you’d prefer to start work at 11 in the morning and you sleep through, that is okay. Although, there is some sort of research that says people who are the earlier chronotype tend to be healthier and tend to have healthier weight.

But it might be more skewed because of the way society treats people who like to sleep in. Often you can’t juggle your schedule around to meet that. But if you can and it works for you, that’s okay. If you’re well rested, you’re getting your eight hours sleep a night, but you’re just waking up at ten o’clock in the morning and then going off to work, that is fine if it works for you.

As I mentioned at the beginning, one of the biggest disruptors for sleep is, our Intrusive thoughts, repetitive thoughts, anxious worries, basically feeling stressed, feeling anxious. So, during the daytime, we’ve got to try to find an outlet for these emotions. It can be things like journaling, which is really helpful for writing down all the thoughts that are in your head, getting stuff out of your brain.

Maybe it’s chatting to your friends more frequently. But, another really good approach if you are struggling with sleep is to have therapy and go for some counselling if that is financially available to you. If not, you might be able to get something through your doctor, although there are massively long waiting lists out there.

But finding a way to be able to talk about your emotions, talk about your thoughts, is really, really helpful to getting better sleep, because those are the times when the worries come cascading round your brain. The other thing you need to start doing is practicing relaxation, and not only doing it when you’re stressed, is practicing some of those deep breathing techniques.

Listen to episode 48 for a run through of different breathing techniques and things that you can do for IBS. Practicing those regularly so that you can call on them when you need them. If you only practice them when you’re feeling really stressed or you’re having a period of insomnia, then that is not going to be as effective because you have to be able to call on these practices in tough times. And so you have to get the practice in when you’re feeling a little bit better.

The other things you can do to improve your sleep is a short nap but only in the middle of the day. So I would not advise having a nap firstly for longer than about 20 or 30 minutes in the daytime and then secondly later than about 2, 2.

  1. And that is because you’re going to impact on your sleep pressure and It makes it harder to go to sleep the following night. Most of the advice around sleep is also trying to stick to a bit of a schedule, even at the weekends, so that you are trying to get up early at the weekends if you get up early during the week.

So you keep the same routine, and that is about stabilising that production of the melatonin and your sleep cycle, and trying to keep it consistent. Because, um, Sometimes it’s called social jet lag, where you sleep in at the weekends, particularly if it’s like a long weekend and you have three nights of sleeping in late.

When you try and get up on Monday morning, it’s like your body clock has shifted to the weekend pattern. And then on Monday you’ve got to try and get back to your work pattern and you can feel really tired. You can feel like you’re jet lagged because your body has been used to waking up at 10am but suddenly you’ve got to wake up at 6.

30 and get to work. So trying to keep a stable pattern even at the weekends is really beneficial for getting good quality deep sleep. Other things that help improve your sleep include activity during the daytime. Exercising ideally for about 30 minutes a day preferably outside, because then you are also getting exposure to daylight.

And you might have heard me talk about this before, but when we see daylight in the morning, that helps to suppress the melatonin. When your eyes are exposed to the bright sunlight and this does not help by getting a bright light and inside the house it just won’t work there’s a very different sort of light that comes from the sun. The best thing to do is just to go outside even on a cloudy day you will be exposed to higher lux that’s how they call it Calculate the light.

I don’t actually know what it stands for. Ha ha. Lux. And that is gonna be higher and it also stops the production of melatonin in the morning which then kicks it off again at night. So when you stop it in the morning, it comes back stronger at night. And that is what we want to regulate your sleep and wake cycle.

In babies that sleep and wake cycle is not established. When first come out of the womb and there is all over the place and that’s why babies wake up a lot during the first year of their life and possibly more but it takes a long time for this wake sleep cycle to regulate itself. Exercising during the day, um, ideally at least 30 minutes. And it doesn’t have to be full on exercise, just a nice walk with your dog or popping around to the shops, you know, that’s okay. Um, but just getting a bit of movement in because that also helps your body realize what you’re doing.

We’re awake and active in the day. We’re better to sleep and be calm at night. So exercising, but not too near bedtime. For people who exercise within two to three hours of bed, sometimes you might still have raised cortisol levels. So when we do engage in exercise, that um, you know, really stresses your heart out and you pumps your blood round and you’re really getting going.

That is fantastic for your health but it can also raise up your cortisol levels a little bit and then you might find it’s harder for those cortisol levels to fade away to allow you to go to sleep on time. So if possible try to get your exercise a bit earlier in the day., , and if possible in the morning I would say but obviously it doesn’t work for everyone’s schedule.

Now sleep hygiene. It’s also very important. This is about making sure your room is dark, so if possible blocking out all your street lamps, turn off any electric lights, make sure that your eyes are not exposed to daylight. When the room is not properly dark, your body May still be noticing light coming through your eyelids and to the retina the back of your eye and Still sending some messages to the brain that there is something going on It’s not time to sleep.

So having it as dark as you can really really helps. And try to have the room as cool as you can like around 18 degrees Apparently is a good temperature So whether you have the window open if you need to wear earplugs as well to make it quiet or an eye mask to make it dark.

That’s helpful for some people and I know at the moment right now we’re in the middle of the British summer and it’s light by about four o’clock in the morning and at the moment we haven’t got our blackout blinds up and I’m having to put an eye mask on as soon as I wake up and realize it’s 4am and I want to go back to sleep.

Put my eye mask on and try to go back to sleep. Try not to keep checking on the clock as well, or looking at the phone, because partly the light wakes you up a little bit, but also it can make you feel really anxious if you wake up a lot through the night. Try, if possible, to just go back to sleep and don’t worry about what time it is.

If we think about eating and what you can do in terms of diet to improve your sleep, one of the first things I would say is think about your caffeine intake. When you’re very tired, obviously you may want to rely on caffeine to wake yourself up in the morning. There is some advice as well that says, try not to have coffee or tea first thing, like if you can wait for an hour or so, then you are actually maximising your usefulness of the caffeine hitting your brain.

So when you first wake up, your body may be quite high in melatonin. And that’s the sleep hormone. You might feel quite groggy and you need that to clear. So one of the best things you can do is go outside and get that daylight, as I was mentioning. That helps you. And then also, any kind of movement that you can do in the morning, it helps to wake your body up.

Have a drink of water, do a little bit of movement, a bit of exercise. Just in your pyjamas in the kitchen is fine, it doesn’t have to be going for a run or anything. That helps to wake you up without the caffeine. Then, if you have your caffeine a bit later on, you’re probably not going to need as much caffeine throughout the day, whereas if you have one as soon as you wake up, probably by mid morning, you’re going to need another one as that caffeine will have worn off.

 Try and keep your caffeine to before lunchtime if you can. So if you do drink tea, coffee, green tea, and also things like coke and pepsi that have, caffeine in them, or energy drinks, then try to keep those in the morning. Because caffeine has a very long half life, that means the time it takes to leave our body through the liver processing it is around six hours and then if you have a cup of coffee at 12 o’clock at six o’clock at night you’ve still got half the amount of caffeine there on average some people will be much faster metabolizers of caffeine than others however that is still a lot of caffeine to have in your body now if you push that back a few hours again and we’re talking about four o’clock you have a cup of coffee then at 10 o’clock at night you’ve still got half that Caffeine sloshing around your blood may be interfering with your sleep.

Now, even if you’re someone who says, I can drink coffee at tea time and I still go to sleep alright. Some people can because they are, like I said, very fast metabolizers of caffeine. However, you may find you don’t get a good quality sleep. So that caffeine is still there in your body and you might, the sleep pressure allows you to fall asleep, but it could disrupt your sleep wake cycle.

Also in the evenings you want to try to avoid alcohol, that can be a sedative, so it may help you fall asleep quite quickly but then you probably will wake up early hours of the morning, maybe feeling a bit dehydrated, maybe with a blood sugar dip, so alcohol feels like it’s relaxing and soothing but actually can probably impact on your sleep.

You may also find your liver is working a little bit over time and you wake up very hot about three or four o’clock in the morning, I know that definitely happens to me . Now I spoke about when to ignore my IBS advice in episode 56.

One of the things I mentioned is having a night snack if you’re someone who wakes up . So this is good advice, and you do not need to always follow the recommendation to fast overnight if you’re someone who wakes up a lot. So if you find yourself regularly waking up early, maybe you’re not eating enough during the day.

So I would definitely consider upping your protein to The minimum, which is 0. 8 grams of protein for every kilo of body weight that you have. You can work it out depending on your body size. Go and listen to the episode on protein, episode 46, which goes through all the calculations and it’s got all the information on there.

Ideally, you want to try and allow about three hours before bed to digest your food, to allow the food to go down so that when you lie down, there’s no chance of additional reflux issues because the food is starting to move out through your stomach and into your small intestine. If you go to bed after a big meal, You may find you’re getting some heartburn, maybe even more nausea, and also sometimes people feel they don’t sleep as well when their food is still in their stomach.

Everything sort of slows down when you sleep including digestion, so you’re not going to get that processing of nutrients as effectively and it’s just kind of sitting in your gut for longer. Some people find taking a magnesium supplement may be helpful, particularly the form of magnesium, glycinate or bis glycinate.

This is very relaxing on the nervous system and can be helpful before bed. Check with your health provider whether that is suitable for you. If you have low blood pressure, I would, consider whether that is suitable because magnesium can lower your blood pressure, but it also may interact with other things.

You don’t want to take a lot of magnesium if you’ve got kidney issues, for example, or, on certain types of medication. So do check, but it can be very relaxing and people find they get a better, deeper sleep, through taking magnesium at night. That was a little whistle stop tour through some ideas for better sleep, but not all of them will be applicable to you. If you want individual personalised help with your diet and your IBS, then please get in touch for details on how to apply to my 3 month gut reset programme. That is where I work with people on a 1 to 1 basis over 3 months with lots of 1 to 1 coaching time and support to improve your diet.

So if you’re interested in that, please email me or get in touch via my website. The email address is info@goodnessme-nutrition.com thanks for listening to this episode of the Inside Knowledge. Better digestion for everyone.

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