Presentasi tentang hubungan gangguan tidur dengan gangguan lambung/gastrointestinal. Slides ini dipresentasikan pada Konas Psikiatri Biologi dan Psikofarmakologi di Makassar 30 Juli 2015 This presentation is talking about the relationship between sleep disorder and gastrointestinal disorder. Presented in National Conference of Psychiatry Biology in Makassar, Indonesia July 30th,2015

1. Relationship Between Sleep
Disorder and Gastrointestinal
Problem
ANDRI
andri@ukrida.ac.id
Division of Psychiatry
Faculty of Medicine Krida Wacana Christian University
Psychosomatic Clinic Omni Hospital

2. Objectives
• Biopsychosocial model of functional
gastrointestinal disorder
• Sleep disorder and gastrointestinal disorder
• Treatment option

3. Role of psychosocial factors
• Psychological stress exacerbates GI symptoms.
• Psychological disturbances modify the
experience of illness and illness behaviors
such as health care seeking.
• Psychosocial factors affect health status and
clinical outcome.
3

4. 4
FGID—biopsychosocial model

5. Cases from Clinical Practice
• Male, 34 yrs, feeling heartburn, uncomfortable feeling in
his stomach and sometimes bloating for almost 3 months.
He had already had a consultation with a gastroenterologist
and doing gastroscopy. Finding was normal. He had been in
a PPI test for 2 weeks.
• He complained about sleep disorder. He couldn’t start a
nice sleep. He mentioned that it didn’t relate to his
complaints since he had been better since PPI test.
• He asked his doctor and get referral to me
• He said that since he had gut problems, he worried about
something happened to his health in general
• Patient known for his perfectionist personality, not a very
easy going person and had burden in his work
• After psychiatric examination, his diagnosis was generalized
anxiety disorder

6. Cases from Clinical Practice
• Female,33 yrs, she complained about easily feeling
nervous and “tight” when she faced something
important
• She had frequent defecation when she faced a “big
problem”, stool was liquid (4-5 times a day)
• She had already consult to a gastroenterologist and she
was diagnosed with IBS (Irritable Bowel Syndrome).
• She complained about sleep pattern, easily woke up in
the middle of the night
• She referred to me by his gastroenterologist to asses
her anxiety

7. Sleep Disorder and
Gastrointestinal Disorder
• Patients with gastroesophageal reflux disease
(GERD) are reported to have a decreased quality of
sleep due to heartburn and/or acid regurgitation
disturbances
• Reflux symptoms (heartburn and acid regurgitation)
that occur during the nocturnal period, impair
sleep quality
• GERD with nocturnal symptoms must be
completely eliminated in order to relieve sleep
disturbances Yoshiya Morito, et al. Intern Med 53: 2014: 2179-2183
Hye-kyung Jung, et alJ Neurogastroenterol Motil 2010;16:22-29

9. Sleep Disorder and
Gastrointestinal Disorder
• Increased prevalence of gastrointestinal
symptoms, peptic ulcer disease, and colon
cancer in night-shiftworkers, whose sleep is
commonly disrupted
• Sleep disruption may contribute to increased
medical morbidity is by weakening the ability
of the immune system to protect against
endotoxins
Laurie Keefer,et al. .Journal of Clinical Sleep Medicine, Vol. 2, No. 4, 2006

11. Gastrointestinal Problems
and Quality of Sleep
• Treatment of GERD has been shown to
improve not only reflux symptoms but also
sleep quality
• Dyspepsia was reported to decrease sleep
quality
• FD- and IBS-like symptoms was identified to
be a statistically significant risk factor for sleep
disturbances
Yoshiya Morito, et al. Intern Med 53: 2179-2183, 2014

12. Gastrointestinal Problems
and Quality of Sleep
• IBS patients have more frequent rapid eye
movement (REM) sleep
• In addition, upper abdominal pain and diarrhea were
found to be especially related to sleep disturbances.
• Therefore, the presence of FD- and IBS-like
symptoms is considered to have a stronger
relationship with sleep disturbances than reflux
symptoms.
• Abdominal symptoms may decrease both sleep
quantity and quality via various mechanisms,
including frequent nocturnal awakening

13. • as many as 43% of patients with IBD reported
that gastrointestinal symptoms led to poor
sleep, and 64% of patients with IBS indicated
that poor sleep led to intestinal symptoms

14. Sleep and Immune System
• inflammatory cytokines interleukin (IL)-1 and tumor
necrosis factor (TNF) have been shown to promote
slow-wave sleep (SWS) in animal studies
• The proinflammatory cytokine IL-6 has been important
in promoting periods of wakefulness.
• Bacterial endotoxins have been shown to disturb sleep
in high doses and promote non-rapid eye movement
(REM) sleep in low doses
• Patients with immunoinflammatory diseases (lupus
erythematosus,multiple sclerosis,rheumatoid arthritis
and HIV often exhibit sleep abnormalities (increased
sleepiness, fatigue, and impaired daytime function)

15. Pharmacological therapies of
Functional Gastrointestinal Problem
• H. pylori therapy ? controversial
• Acid suppression and prokinetic agents
(digestive agents) ? may help
• Gut analgesics ? Relaxants of the nervous
system of the gut may be beneficial, but do
not use Benzodiazepine
• Antidepressant? SNRI, TCA May help
15

16. Treatment Options for Sleep Disorder
and Gastrointestinal Problem
• Melatonin is involved in the regulation of gastrointestinal
motility
• Melatonin may be involved in mediating gut visceral
sensation
– patients with functional abdominal pain are reported
to have lower urinary excretion of 6-sulphatoxy
melatonin and to exhibit a circadian rhythm of lower
amplitude compared with healthy controls.
• Efficacy of exogenous melatonin given at bedtime in
relieving IBS bowel symptoms, and in improving rectal
sensitivity also improve sleep disturbance
Song, Leng, Gwee, et al. Gut 2005;54:1402–1407

17. Melatonin and its effect on IBS
Song, Leng, Gwee, et al. Gut 2005;54:1402–1407

18. August 20th-23rd, 2015
Glasgow, Scotlandia