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(138) Bed Is a Battleground: A Qualitative Study Exploring Sleep Disturbance and Options for Treatment in People with Inflammatory Bowel Disease


Authors:

Amy Green, MBChB MRCPsych – Consultant Liaison Psychiatrist, Southmead Hospital, Bristol

Maria Barnes, BSc PhD – Senior Research Associate, University of Bristol

Claire Durant, BSc PhD – Senior Research Associate, University of Bristol

Aileen Fraser – Lead Inflammatory Bowel Disease CNS, United Hospitals Bristol NHS Foundation Trust

Amanda Beale – Consultant Gastroenterologist and Honorary Senior Lecturer, Bristol Royal Infirmary, United Hospitals Bristol (UK)

Jonathan Davies, MBChB MRCPsych PhD – Academic Clinical Lecturer, University of Bristol

John Potokar, MBChB MRCPsych MD – Consultant Senior Lecturer, University of Bristol


Co-Authors:

Presenting Author: Amy Green, MBChB MRCPsych, Southmead Hospital, Bristol
Co-Author: Maria Barnes, BSc PhD, University of Bristol
Co-Author: Claire Durant, BSc PhD, University of Bristol
Co-Author: Aileen Fraser, United Hospitals Bristol NHS Foundation Trust
Co-Author: Amanda Beale, Bristol Royal Infirmary, United Hospitals Bristol (UK)
Co-Author: Jonathan Davies, MBChB MRCPsych PhD, University of Bristol
Co-Author: John Potokar, MBChB MRCPsych MD, University of Bristol

Abstract:

Background and significance: Sleep disturbances in Inflammatory Bowel Disease (IBD) are prevalent (49%) (1), increase during acute relapse (70-80%) and affect quality of life (2). Little is known about the cause or nature of these disturbances, or how to help these patients. Hypnotic medications may be poorly tolerated, and are inappropriate for long-term use. Cognitive Behavioral Therapy for insomnia (CBTi) has proven efficacy in treating insomnia associated with chronic illness and pain (3). The efficacy and acceptability of psychological interventions for sleep disturbances in people with IBD has not been investigated and nature of sleep problems people with IBD encounter is not understood. This study explored the following topics: the causes and nature of sleep disturbance experienced by people with IBD, the acceptability of a psychological intervention aimed at improving sleep and the views of IBD clinicians regarding these disturbances, including how a psychological intervention could be provided.


Methods:
This study used qualitative methodology to explore sleep disturbances in IBD. This method provides rich descriptions about feelings and thought processes, providing unique insight into areas about which little is currently known. Fifteen patients with IBD and sleep disturbance and four IBD clinicians were interviewed.


Results:
Some patients had sleep disturbance prior to the onset of their IBD symptoms; all had disturbance since. Themes identified were: consequences of their IBD, psychological factors, behavioral factors and barriers to getting help.


Discussion:
Patients described bed, not as a place of rest, but a battleground where IBD always wins. This battle involves a complex interplay between IBD symptoms, behaviors to manage IBD and psychological factors, suggesting that CBTi could help. Patients and clinicians reported limited knowledge of how to treat sleep problems in IBD and described barriers to access and engagement with an intervention.

Conclusion/implications: This study highlights the degree of sleep disturbance experienced by people with IBD, the complexity of the problem, the limited understanding of it and the current barriers to treating it. It raises awareness of sleep disturbances specific to IBD among patients and clinicians. Findings suggest a psychological intervention tailored to sleep problems for people with IBD may be beneficial. This study will inform the design of such an intervention and determine practical strategies to help patients beat their IBD related insomnia.

References:


  1. Graff LA, Vincent N, Walker JR, Clara I, Carr R, Ediger J, et al. A population-based study of fatigue and sleep difficulties in inflammatory bowel disease. Inflammatory bowel diseases. 2011;17(9):1882-9.

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

  3. Currie SR, Wilson KG, Pontefract AJ, deLaplante L. Cognitive-behavioral treatment of insomnia secondary to chronic pain. J Consult Clin Psych. 2000;68(3):407-16.








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