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P458 Sleep problems in inflammatory bowel disease; When bed becomes a battleground

Green A.*1, Beale A.2, Fraser A.3, Potokar J.3, Durrant C.1, Barnes M.1

1University of Bristol, Department of Social Medicine, Bristol, United Kingdom 2Bristol Royal Infirmary, Gastroenterology, Bristol, United Kingdom 3Bristol Royal Infirmary, Bristol, United Kingdom

Background

Sleep disturbance in patients with Inflammatory Bowel Disease is prevalent (49%), increasing during relapse (70–80%) (1). Sleep problems contribute to reduced quality of life and may increase risk of flare (2). Cognitive behavioural therapy for insomnia can improve sleep problems in other chronic conditions (3) A qualitative study was undertaken to explore the sleep disturbances of patients with IBD and assess the acceptability of psychological input to address this

Methods

Using convenience sampling, 15 adult patients with sleep disturbance were recruited from IBD clinics and interviewed by a single experienced sleep researcher. A semi structured interview technique was used, followed by three questionnaires: the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale and the Hospital Anxiety and Depression (HAD) Scales.

The 7 male and 8 female participants had a mean age of 48 years (range 24–71). Eight had ulcerative colitis and seven Crohns disease, 3 had a stoma. The mean time since diagnosis was 12 years (range 4 month to 30 years). 10 were employed, 1 participant was not working and 4 had retired.

Results

All patients reported that their sleep had deteriorated since their diagnosis.

Table 1

Anxiety and Depression Score (HADS)Sleepiness score (Epworth)Sleep Quality Index (Pittsburgh)
Score range (normal)0–21 (<10)0–24 (<10)0–21 (<6)
Study subjects score (mean)151413

Seven participants described problems in falling asleep, 12 experienced problems waking during the night. The mean amount of sleep each night was 4.5 hours. Sleep questionnaires indicated highly disturbed sleep. Patients tended to normalise their difficulties as part of their IBD.

Three distinct themes emerged: factors related to physical symptoms and treatments for IBD, psychological factors, such as stress and hypervigilance, and also poor sleep “hygiene” such as watching TV in bed.

Of the 7 who had sought help each had been prescribed night sedation, but only one had found this useful. None had heard of psychological intervention for sleep, 11 were keen to try it. A CBT like intervention was perceived as useful, especially for adults of working age. The mechanism by which such intervention could be delivered was discussed with no single preferred option

Conclusion

For these IBD patients bed is a battleground, not a place of rest. This study highlights the complexity of the problem, its impact and the limited understanding of it. An IBD specific CBT- like intervention could empower patients to manage their own sleep in the longterm and improve quality of life

References:

[1] Graff LA, Vincent N, Walker JR, Clara I, Ediger J et al. (2011), A population-based study of fatigue and sleep difficulties in inflammatory bowel disease, Inflammatory Bowel Disease, 1882–9, 17(9)

[2] Ranjbaran Z, Keefer L, Farhadi A, Stepanski E, Sedghi S and Kesharavarzian A., (2007), Impact of sleep disturbances in inflammatory bowel disease, Journal of gastroenterology and hepatology, 1748–53, 22(11)

[3] Espie CA, Fleming L, Cassidy J, Samuel L, Taylor LM, White CA et al, (2008), Randomized controlled clinical effectiveness trial of cognitive behavioural therapy compared with treatment as usual for persistent insomnia in patients with cancer, Journal of Clinical Oncology, 4651–8, 26(28)