Life with IBD
If you have ulcerative colitis (UC) and you're struggling to sleep, you're far from alone. Research estimates that over 75% of IBD patients with active disease report sleep disturbances, and a 2017 study found that people with UC slept only 4.5 hours per night on average. What makes this so frustrating is that the relationship between UC and sleep runs in both directions: your disease disrupts your sleep, and poor sleep makes your disease worse.
How UC Disrupts Sleep
The most obvious culprit is nighttime urgency. Waking up multiple times to use the bathroom fragments your sleep cycles and prevents the deep, restorative stages of sleep your body needs. But urgency is only part of the picture. Abdominal pain, cramping, and bloating can make it difficult to fall asleep or stay asleep. Anxiety about nighttime accidents adds another layer, with many patients reporting that worry about soiling the bed keeps them in a state of heightened alertness even when symptoms are relatively calm.
Medications play a significant role too. Prednisone, one of the most commonly prescribed drugs for UC flares, mimics cortisol and suppresses melatonin production, both of which interfere with your sleep-wake cycle. The higher the dose and the longer you take it, the more pronounced the insomnia tends to be. If you're on prednisone and struggling to sleep, taking it in the morning rather than the evening can help, since this aligns better with your body's natural cortisol rhythm. Talk to your doctor before changing your medication schedule.
The Sleep-Inflammation Cycle
The connection between sleep and UC goes deeper than symptom management. Inflammatory cytokines, including tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and IL-6, directly affect sleep regulation. When UC drives up these inflammatory markers, your sleep quality suffers. At the same time, sleep deprivation activates inflammation at the cellular level, shifting the regulation of genes involved in immune functioning.
A 2024 prospective study published in the Journal of Crohn's and Colitis put numbers to this cycle: patients with chronic poor sleep had a UC relapse rate of 34.5%, compared to just 10.3% in those sleeping well. The researchers identified chronic poor sleep as an independent clinical factor influencing UC relapse, meaning it contributed to flares even after accounting for other variables. Poor sleep quality has also been documented in UC patients who are in remission, suggesting the problem persists beyond active disease.
Sleep Strategies That Account for UC
Generic sleep hygiene advice, while well-intentioned, often misses the specific challenges UC patients face. Here are approaches that factor in the realities of living with this disease.
Meal timing matters more than you think. The Crohn's and Colitis Foundation recommends finishing your last meal at least one to two hours before bed, and avoiding foods that trigger symptoms in the evening, including lactose-containing dairy, high-fiber foods, caffeine, and spicy foods. For many UC patients, eating dinner earlier in the evening significantly reduces nighttime urgency.
Prepare for nighttime bathroom trips. Rather than fighting the reality of nighttime urgency, reduce the disruption it causes. Keep a clear, dimly lit path to the bathroom. Use a small night light instead of overhead lights, since bright light suppresses melatonin and makes it harder to fall back asleep. Have supplies ready so trips are quick and low-stress.
Consider melatonin with your doctor's guidance. Beyond its role as a sleep hormone, melatonin has shown anti-inflammatory properties relevant to UC in both preclinical and clinical studies, including strengthening the intestinal mucosal barrier and modulating the immune response. While more clinical research is needed, some gastroenterologists recommend melatonin for UC patients dealing with insomnia because of this dual benefit.
When Sleep Problems Need Medical Attention
If you're losing sleep during an active flare, that's expected and will often improve as your disease comes under control. But persistent sleep disruption during remission is worth bringing to your gastroenterologist. It may signal subclinical inflammation, or it could be contributing to your next flare. Cognitive Behavioral Therapy for Insomnia (CBT-I) is now considered a first-line treatment for chronic insomnia and has shown effectiveness in IBD patients specifically.
Track your sleep quality alongside your symptoms in Aidy. Many patients discover that sleep disruption is an early warning sign of an incoming flare.