Circadian Rhythms, Melatonin, and IBS: A Sleep Connection

Published on Thursday, August 24, 2023 by Alexander Koch

Better Sleep for IBS Management: The Intricate Link Between Melatonin, Circadian Rhythms, and IBS Symptoms

Foodguides.com was founded to help people living with IBS (as well as GERD and Acid Reflux) better manage their condition. As the root cause of any patient’s IBS is typically unknown, medical management of IBS involves treating symptoms with medication and a Low FODMAP diet.

Obtaining adequate amounts of high-quality sleep may present another key and often overlooked element to reducing the burden of IBS. Research backs a relationship between sleep disturbances and bowel function. Specifically, IBS patients are more than twice as likely than average to present with a sleep disorder. A robust field of research seeks to understand the mechanisms behind this relationship.

Circadian Rhythms

Our circadian rhythms govern the natural wake-during-day and sleep-at-night pattern most of us follow. These circadian rhythms are a cyclic pattern of behavior and metabolism governed by our autonomic nervous system. While circadian rhythms are internally set, they are influenced by our external environment, most notably exposure to light and dark.

Further, there is evidence that the gut microbiome is under circadian control and that disturbances in circadian rhythms can lead to increases in intestinal permeability and imbalances in gut microflora, both of which would potentially disrupt gut function.

Melatonin is a key hormone involved in regulating circadian rhythms and maintaining gastric motility. Nighttime secretion of melatonin (specifically, the melatonin/tryptophan ratio) has been found to be significantly lower in IBS patients (particularly those with diarrhea vs. constipation) than in healthy controls, suggesting an alteration in the metabolism of melatonin may be a root cause for both IBS and sleep disturbances.

Psychological stressors are often associated with sleep disorders, but sleep disturbances in IBS patients have been found to be independent of psychological distress, possibly strengthening the notion that mechanisms such as impaired melatonin production are responsible for sleep impairment.

What can I do to get better sleep?

Obtaining more and better-quality sleep is healthful in and of itself. The fact that it may also help reduce the burden of IBS is a very nice bonus. So what can one do?

Melatonin supplementation is easily available. As discussed above, emerging evidence suggests that melatonin metabolism may be the common link between IBS and sleep disturbances. A few clinical trials have demonstrated that supplementing melatonin can produce both better sleep and IBS symptom relief, particularly for IBS-C patients. Discuss this with your medical provider before starting any over-the-counter supplements.

Avoid late eating. Late feeding can alter circadian rhythms, potentially exacerbating IBS symptoms. Adopting a consistent eating pattern and avoiding food intake for at least three hours before sleep may enhance sleep quality and reduce IBS symptoms.

Avoid late exercise. There is some evidence that exercise later in the day can reduce melatonin secretion relative to when exercise is performed in the morning. So if you are having difficulty sleeping, you might benefit more from morning exercise sessions.

Avoid high levels of light exposure before sleep. Recommendations from experts in a 2022 PLoS Biology article outline an evening-time light exposure of ≤10 lux, which is the equivalent of total starlight, for at least 3 hours before bedtime. For comparison, average evening lighting in residences tends to be ~30 lux, so their recommendation is a substantial reduction – though well-founded on the light levels that would best improve melatonin production.

_{Baniasadi, N., Dehesh, M. M., Mohebbi, E., Hayatbakhsh Abbasi, M., & Oghabian, Z. (2017). ASSESSING THE SLEEP QUALITY AND DEPRESSION-ANXIETY-STRESS IN IRRITABLE BOWEL SYNDROME PATIENTS. Arquivos de gastroenterologia, 54(2), 163–166. https://doi.org/10.1590/S0004-2803.201700000-08}
_{Brown, T. M., Brainard, G. C., Cajochen, C., Czeisler, C. A., Hanifin, J. P., Lockley, S. W., Lucas, R. J., Münch, M., O'Hagan, J. B., Peirson, S. N., Price, L. L. A., Roenneberg, T., Schlangen, L. J. M., Skene, D. J., Spitschan, M., Vetter, C., Zee, P. C., & Wright, K. P., Jr (2022). Recommendations for daytime, evening, and nighttime indoor light exposure to best support physiology, sleep, and wakefulness in healthy adults. PLoS biology, 20(3), e3001571. https://doi.org/10.1371/journal.pbio.3001571}
_{Carlson, L. A., Pobocik, K. M., Lawrence, M. A., Brazeau, D. A., & Koch, A. J. (2019). Influence of Exercise Time of Day on Salivary Melatonin Responses. International journal of sports physiology and performance, 14(3), 351–353. https://doi.org/10.1123/ijspp.2018-0073}
_{Chojnacki, C., Walecka-Kapica, E., Lokieć, K., Pawłowicz, M., Winczyk, K., Chojnacki, J., & Klupińska, G. (2013). Influence of melatonin on symptoms of irritable bowel syndrome in postmenopausal women. Endokrynologia Polska, 64(2), 114–120.}
_{Damiola, F., Le Minh, N., Preitner, N., Kornmann, B., Fleury-Olela, F., & Schibler, U. (2000). Restricted feeding uncouples circadian oscillators in peripheral tissues from the central pacemaker in the suprachiasmatic nucleus. Genes & development, 14(23), 2950–2961. https://doi.org/10.1101/gad.183500}
_{Fowler, S., Hoedt, E. C., Talley, N. J., Keely, S., & Burns, G. L. (2022). Circadian Rhythms and Melatonin Metabolism in Patients With Disorders of Gut-Brain Interactions. Frontiers in neuroscience, 16, 825246. https://doi.org/10.3389/fnins.2022.825246}
_{Heitkemper, M. M., Han, C. J., Jarrett, M. E., Gu, H., Djukovic, D., Shulman, R. J., Raftery, D., Henderson, W. A., & Cain, K. C. (2016). Serum Tryptophan Metabolite Levels During Sleep in Patients With and Without Irritable Bowel Syndrome (IBS). Biological research for nursing, 18(2), 193–198. https://doi.org/10.1177/1099800415594251}
_{Kim, Y. M., Snijders, A. M., Brislawn, C. J., Stratton, K. G., Zink, E. M., Fansler, S. J., Metz, T. O., Mao, J. H., & Jansson, J. K. (2019). Light-Stress Influences the Composition of the Murine Gut Microbiome, Memory Function, and Plasma Metabolome. Frontiers in molecular biosciences, 6, 108. https://doi.org/10.3389/fmolb.2019.00108}
_{Koloski, N. A., Jones, M., Walker, M. M., Keely, S., Holtmann, G., & Talley, N. J. (2021). Sleep disturbances in the irritable bowel syndrome and functional dyspepsia are independent of psychological distress: a population-based study of 1322 Australians. Alimentary pharmacology & therapeutics, 54(5), 627–636. https://doi.org/10.1111/apt.16500}
_{Lacy, B. E., Pimentel, M., Brenner, D. M., Chey, W. D., Keefer, L. A., Long, M. D., & Moshiree, B. (2021). ACG Clinical Guideline: Management of Irritable Bowel Syndrome. The American journal of gastroenterology, 116(1), 17–44. https://doi.org/10.14309/ajg.0000000000001036}
_{Summa, K. C., Voigt, R. M., Forsyth, C. B., Shaikh, M., Cavanaugh, K., Tang, Y., Vitaterna, M. H., Song, S., Turek, F. W., & Keshavarzian, A. (2013). Disruption of the Circadian Clock in Mice Increases Intestinal Permeability and Promotes Alcohol-Induced Hepatic Pathology and Inflammation. PloS one, 8(6), e67102. https://doi.org/10.1371/journal.pone.0067102}
_{Wang, B., Duan, R., & Duan, L. (2018). Prevalence of sleep disorder in irritable bowel syndrome: A systematic review with meta-analysis. Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association, 24(3), 141–150. https://doi.org/10.4103/sjg.SJG_603_17}