Skip to main content

Sleep Disturbance Influences Gastrointestinal Symptoms in Women with Irritable Bowel Syndrome


This analysis evaluated the association between sleep disturbance and gastrointestinal symptoms in women with and without irritable bowel syndrome (IBS), and examined the role of psychological distress in this relationship. Women with IBS (N = 82) reported considerably higher levels of sleep disturbance compared to controls (N = 35), using both retrospective seven-day recall and daily diary recall for two menstrual cycles (P < 0.05 on 8 of 10 measures). We used daily diary data to estimate the association between sleep disturbance and gastrointestinal symptoms, both across women (ie, whether women with high average sleep disturbance have higher average gastrointestinal symptoms) and within woman (ie, whether poorer than average sleep on one night is associated with higher than average gastrointestinal symptoms the following day). The regression coefficients for the across-women effect are large and highly significant in both groups (IBS, β ± se = 0.46 ± 0.08, P < 0.001; controls, 0.57 ± 0.13, P < 0.001). The regression coefficients for the within-woman effect are considerably smaller and statistically significant only in the IBS group (IBS, 0.06 ± 0.02, P = 0.006; control, 0.01 ± 0.03, P = 0.691). These regression coefficients showed little change when daily psychological distress or stress was controlled for, the one exception being the coefficient for the across-women effect in the IBS group, which decreased substantially but still remained highly significant. Because it is possible that gastrointestinal symptoms could, in fact, cause poor sleep, we also fitted the temporally reversed model to evaluate the association between gastrointestinal symptoms on one day and sleep disturbance that night. The within-woman regression coefficients were nonsignificant in both the IBS and control groups. In conclusion, these results are consistent with the hypothesis that poor sleep leads to higher gastrointestinal symptoms on the following day among women with IBS.

This is a preview of subscription content, access via your institution.


  1. 1.

    Drossman DA, Li Z, Andruzzi E, et al: U.S. householder survey of functional gastrointestinal disorders: Prevalence, sociodemography, and health impact. Gastroenterology 38:1569-1580, 1993

    Google Scholar 

  2. 2.

    Longstreth GF, Wolde-Tsadik G: Irritable bowel-type symptoms in HMO examinees: Prevalence, demographics, and clinical correlates. Dig Dis Sci 38:1581-1589, 1993

    Google Scholar 

  3. 3.

    Sandler RS, Drossman DA, Nathan HP, McKee DC: Symptom complaints and health care seeking behavior in subjects with bowel dysfunction. Gastroenterology 87:314-318, 1984

    Google Scholar 

  4. 4.

    Gorard DA, Farthing MJG: Intestinal motor function in irritable bowel syndrome. Dig Dis Sci 12:72-84, 1994

    Google Scholar 

  5. 5.

    Heitkemper MM, Burr J, Jarrett M, et al: Evidence for autonomic nervous system imbalance in women with irritable bowel syndrome. Dig Dis Sci 43:2093-2098, 1998

    Google Scholar 

  6. 6.

    Kellow JE, Evans PR: Management of irritable bowel syndrome. J Gastroenterol Hepat 8:287-293, 1993

    Google Scholar 

  7. 7.

    Camilleri M, Choi MG: Review article: irritable bowel syndrome. Aliment Pharm Ther 11:3-15, 1997

    Google Scholar 

  8. 8.

    Jarrett M, Heitkemper MM, Cain K, et al: The relationship between psychological distress and gastrointestinal symptoms in women. Nurs Res 47:154-161, 1998

    Google Scholar 

  9. 9.

    Goldsmith G, Levin JS: Effect of sleep quality on symptoms of irritable bowel syndrome. Dig Dis Sci 38:1809-1814, 1993

    Google Scholar 

  10. 10.

    Kumar D, Thompson PD, Wingate DL, Vesselinova-Jenkins CK, Libby C: Abnormal REM sleep in the irritable bowel syndrome. Gastroenterology 103:12-17, 1992

    Google Scholar 

  11. 11.

    Orr WC, Crowell MD, Lin B, Harnish MJ, Chen J: Sleep and gastric function: Derailing the brain-gut axis. Gut 41:390-393, 1997

    Google Scholar 

  12. 12.

    Corney RH, Stanton R: Physical symptom severity, psychological and social dysfunction in a series of outpatients with irritable bowel syndrome. J Psychosom Res 34:483-491, 1991

    Google Scholar 

  13. 13.

    Nyhlin H, Ford MJ, Eastwood J, et al: Non-alimentary aspects of the irritable bowel syndrome. J Psychosom Res 37:155-162, 1993

    Google Scholar 

  14. 14.

    Weissman MM, Greenwald S, Nino-Murcia G, Dement WC: The morbidity of insomnia uncomplicated by psychiatric disorders. Gen Hosp Psychiatry 19:245-250, 1997

    Google Scholar 

  15. 15.

    Maxton DG, Morris J, Whorwell PJ: More accurate diagnosis of irritable bowel syndrome by the use of “non-colonic” symptomatology. Gut Function 32:784-786, 1991

    Google Scholar 

  16. 16.

    Guthrie EA, Creed FH, Whorwell PJ, Tomenson B: Outpatients with irritable bowel syndrome: A comparison of first time and chronic attenders. Gut 33:361-363, 1992

    Google Scholar 

  17. 17.

    Benca R: Sleep in psychiatric disorders. Neurol Clin 14:739-764, 1996

    Google Scholar 

  18. 18.

    Billard M, Partinen M, Roth T, Shapiro C: Sleep and psychiatric disorders. J Psychosom Res 38:1-2, 1994

    Google Scholar 

  19. 19.

    Heitkemper MM, Jarrett M, Cain K, Shaver J, Walker E, Lewis L: Daily gastrointestinal symptoms in women with and without a diagnoses of IBS. Dig Dis Sci 40:1511-1517, 1995

    Google Scholar 

  20. 20.

    Lydiard RB, Fossey MD, Marsh W, Ballenger JC: Prevalence of psychiatric disorders in patients with IBS. Psychom Med 34:229-234, 1993

    Google Scholar 

  21. 21.

    Talley NJ, Kramlinger KG, Burton MC, Colwell LJ, Zinsmeister AR: Psychiatric disorders and choldhood abuse in the irritable bowel syndrome. Eur J Gastroenterol Hepatol 5:647-654, 1993

    Google Scholar 

  22. 22.

    Levy R, Jarrett M, Cain K, Heitkemper MM: The relationship between daily life stress and gastrointestinal symptoms in women. J Behav Med 20:177-193, 1997

    Google Scholar 

  23. 23.

    Whitehead WE, Crowell MD, Robinson JC, Heller BR, Schuster MM: Effects of a stressful life event on bowel symptoms: Subjects with irritable bowel syndrome compared with subjects without bowel dysfunction. Gut 33:825-830, 1992

    Google Scholar 

  24. 24.

    Dancey CP, Taghavi M, Fox RJ: The relationship between daily stress and symptoms of irritable bowel: A time-series approach. J Psychosom Res 44:537-545, 1998

    Google Scholar 

  25. 25.

    Sul J, Wan CK, Blanchard EB: A multilevel data-analytic approach for evaluation of relationships between daily life stressors and symptomatology: Patients with irritable bowel syndrome. Health Psychol 13:103-113, 1994

    Google Scholar 

  26. 26.

    Drossman DA, Thompson WG: The irritable bowel syndrome. Ann Intern Med 116:1009-1016, 1992

    Google Scholar 

  27. 27.

    Burman ME: Health diaries in nursing research and practice. Image: J Nurs Scholarship 27:147-152, 1995

    Google Scholar 

  28. 28.

    Rakowski W, Julius M, Hickery T, Verbrugge LM, Halter JB: Daily symptoms and behavioral responses. Med Care 26:278-295, 1998

    Google Scholar 

  29. 29.

    Richardson A: The healthy diary: An examination of its use as a data collection method. J Adv Nurs 19:782-791, 1994

    Google Scholar 

  30. 30.

    Talley JJ, Phillips SF, Melton LJ, Wiltgen C, Zinsmeister AR: A patient questionnaire to identify bowel disease. Ann Intern Med 111:671-674, 1989

    Google Scholar 

  31. 31.

    Talley NJ, Phillips SF, Wiltgen CM, Zinsmeister AR, Melton LJ III: Assessment of functional gastrointestinal disease: The bowel disease questionnaire. Mayo Clin Proc 65:1456-1479, 1990

    Google Scholar 

  32. 32.

    Derogatis L, Cleary P: Confirmation of dimensional structure of the SCL-90: A study in construct validation. J Clin Psychol 33:981-989, 1977

    Google Scholar 

  33. 33.

    Mitchell ES, Woods NF, Lentz MJ: Recognizing PMS when you see it: Criteria for PMS sample selection. In Menstruation, Health, & Illness. DL Taylor, NF Woods (eds). New York, Hemisphere Publishing, 1991, pp 89-102

    Google Scholar 

  34. 34.

    Neuhaus JM, Kalbfleisch JD: Between-and within-cluster covariate effects in the analysis of clustered data. Biometrics 54:638-645, 1998

    Google Scholar 

  35. 35.

    Schwartz JE, Stone AA: Strategies for analyzing ecological momentary assessment data. Health Psychol 17:6-16, 1998

    Google Scholar 

  36. 36.

    Zeger SL, Liang KY, Albert PS: Models for longitudinal data: A generalized estimating equation approach. Biomectrics 44:1049-1060, 1988

    Google Scholar 

  37. 37.

    Stata Reference Manual: Release 5. College Station, Texas, Stata Press, 1985

  38. 38.

    Gorard DA, Vesselinova-Jenkins CK, Libby GW, Farthing MJG: Migrating motor complex and sleep in health and irritable bowel syndrome. Dig Dis Sci 40:2383-2389, 1995

    Google Scholar 

  39. 39.

    Aggarwal A, Cutts TF, Abell TL, Cardosa S, Familoni B, Bremer J: Predominant symptoms in irritable bowel syndrome correlate with specific autonomic nervous system abnormalities. Gastroenterology 106:945-950, 1994

    Google Scholar 

  40. 40.

    Iovino P, Azpiroz F, Domingo E, Malagelada JR: The sympathetic nervous system modulates perception and reflex responses to gut distention in humans. Gastroenterology 108:680-686, 1995

    Google Scholar 

  41. 41.

    Silverman DHS, Munakata J, Ennes H, Mandelkern MA, Hoh CK, Mayer EA: Regional cerebral activity in normal and pathological perception of visceral pain. Gastroenterology 112:64-72, 1997

    Google Scholar 

Download references

Author information



Rights and permissions

Reprints and Permissions

About this article

Cite this article

Jarrett, M., Heitkemper, M., Cain, K.C. et al. Sleep Disturbance Influences Gastrointestinal Symptoms in Women with Irritable Bowel Syndrome. Dig Dis Sci 45, 952–959 (2000).

Download citation

  • irritable bowel syndrome
  • sleep disturbance
  • women
  • insomnia