Focus on Sleep, Stress, And Exercise in IBS

OB/GYN News, June 15, 2001 by Timothy F. Kirn

SACRAMENTO -- Think SSEX--sleep, stress management, and exercise--in the treatment of irritable bowel syndrome, Dr. Michael Lawson said at a gastroenterology update sponsored by the University of California, Davis.

"These are the three things that you want to work on"--diet and drugs have been relegated to a secondary role in treatment, said Dr. Lawson, a Sacramento gastroenterologist at Kaiser Permanente.

Patients with irritable bowel syndrome (IBS) are hypersensitive to visceral stimuli, recent research has shown. An inability to moderate pain signals from the gastrointestinal tract may lie at the root of IBS. This new theory has superseded theories that IBS is primarily the result of a defect in gastric motility, he explained.

Of 11 studies that have evaluated the efficacy of stress management in patients with IBS, 7 showed a positive effect, Dr. Lawson said.

Two techniques of stress management that have yielded a good response are breathing techniques and focused visual imagery, Dr. Lawson said. At Kaiser, IBS patients are now referred to participate in an 8-week stress management course that has reduced the number of physician appointments and emergency department visits for these patients.

Sleep disturbance is common among IBS patients, Dr. Lawson said. The majority of patients report feeling tired and run down, and 80% of IBS patients also have fibromyalgia. IBS patients may spend twice as much time in REM sleep as the average person, probably as a consequence of having discomfort and continually being awoken at night.

"Sleep patterns are very important," Dr. Lawson said. "Correcting that REM activity can be very useful in treating irritable bowel syndrome."

Low-dose tricyclic antidepressants may benefit patients who report sleep disturbance, Dr. Lawson said. Not only are they sedating, but tricyclic antidepressants relieve pain by depleting norepinephrine, which makes nerve endings less reactive.