ulcerative colitis, crohn's diseaseIf you are not getting the recommended 7 to 8 hours of sleep at night, you may be at an increased risk of developing ulcerative colitis according to a new study in Clinical Gastroenterology and Hepatology.

Ulcerative colitis is a chronic autoimmune disease of the large intestine in which the gastrointestinal lining becomes inflamed and develops ulcers. This is caused by an abnormal response by the body’s immune system. In patients with inflammatory bowel diseases, the immune system mistakens food, bacteria, and other substances in the intestine as foreign or invading substances. Ulcerative colitis affects only the large intestine wheres as Crohn’s disease can affect any part of the gastrointestional tract. In addition, Crohn’s disease can affect all layers of the intestinal wall in contrast to ulcerative colitis only affecting the lining of the colon.

“Both short and long durations of sleep have important health implications and are associated with increased overall mortality, cardiovascular disease and cancer,” said Ashwin N. Ananthakrishnan, MD, MPH, Massachusetts General Hospital. “Our findings indicate that ulcerative colitis may potentially be added to this list. We found that less than six hours of sleep per day and more than nine hours of sleep per day are each associated with an increased risk of ulcerative colitis.”

Researchers conducted a prospective study of women who were enrolled in the Nurses’ Health Study (NHS) I since 1976 and NHS II since 1989 and followed through detailed biennial questionnaires with greater than 90 percent follow-up. The large size of the groups, prospective design and continued duration of follow-up provide a unique opportunity to examine the correlation between sleep duration and the disease incidence.

The results showed a “U-shaped” relationship between sleep duration and the risk of ulcerative colitis, with both short and long duration of sleep being associated with an increased risk of disease. These observed associations were independent of other known environmental risk factors.

In a previous study, also published in Clinical Gastroenterology and Hepatology last year, researchers reported that poor sleep quality even while in remission, resulted in a two fold increase in the risk of Crohn’s disease exacerbations at six months. All this combined data supports sleep disruption and its impact on the immune system. It is essential that healthcare providers treating patients with gastrointestinal and autoimmune diseases regularly inquire about the quality and duration of sleep.

It is important that people go to sleep around the same time every night. When the timing of your sleep is shifted even if the duration of sleep is the same, it’s not going to be as restorative. In addition, avoid watching TV before bed. This also includes using your computer in the evening. Computer screens (smartphones and laptops) emit light in the blue part of the spectrum. This doesn’t cause a problem during the daytime, but at night, this blue light limits the production of melatonin. As a result, it disturbs your sleep-wake cycle. There are free apps you can install on your computer if you are one of those people that need to be on your computer at night that adjusts colors in a way that it reduces the stimulating effects of blue light at night. Caffeine and other stimulants can keep you up and interfere with sleep. It is best to avoid these four to six hours before bedtime. Finally, try to get your workout in earlier in the day. Exercise increases cortisol and can make hard trying to fall asleep.

Environmental triggers are what healthcare providers investigate in functional medicine. These can be food triggers such as food sensitivities or gluten that can trigger inflammation as well as anything coming in with the food such as toxins or molds. In addition, the nutrient status of the person. This can be antioxidant status, vitamins, essential fatty acids, vitamin D, etc. Also, gut health which includes “leaky gut” and dysbiosis. Finally, there are toxins that can be affect the status of the immune system. These are heavy metals, xenobiotics, as well as the total toxic burden in the body. What appears to happen with most autoimmune conditions is there are multiple triggers chronically stimulating the immune system over a long period of time in multiple ways and our immune system gets into overloaded, overwhelmed state and loses its ability to function.

Ananthakrishnan, A. N., Sleep Duration Affects Risk for Ulcerative Colitis: A Prospective Cohort Study. Clinical Gastroenterology and Hepatology 2014: 12(11): 1879-1886

Ananthakrishnan, A. N., Sleep Disturbance and Risk of Active Disease In Patients With Crohn’s Disease and Ulcerative Colitis. Clinical Gastroenterology and Hepatology 2013: 11(8): 965-971

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