House CallFeb/Mar 2017 Issue

A Good Night’s Sleep

Sleep disturbances are common in those with celiac disease. Here’s how to get more zzz’s.

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According to the American Academy of Sleep Medicine, 35 percent of adults aren’t getting the recommended seven hours of sleep each night. Insufficient sleep is associated with the development of a number of chronic diseases and conditions, including diabetes, cardiovascular disease, obesity and depression.

It may also affect the gut microbiome. A brand new study in mice revealed that when sleep was fragmented, there were imbalances in the circadian rhythm of the gut and gut bacteria (yep, the gut has a “clock”). In addition, genes involved in the integrity of the gut wall were blocked, potentially leading to a leaky gut.

This is very exciting research, says Amy Burkhart, MD, RD. “It calls attention to the importance of sleep and gut dysbiosis on overall health.” (Burkhart, who is an integrative medicine and celiac specialist located in Northern California, was not involved in the new research, which hasn’t been published yet.)

Many of Burkhart’s patients have celiac disease, gluten sensitivity or other digestive disorders. “We talk about sleep all the time,” she says. “Sleep disturbances are common in those with celiac disease and can occur before or after diagnosis. There’s often improvement with implementation of the gluten-free diet—but not complete resolution.”

Indeed, a 2010 study showed a whopping half of newly diagnosed celiacs had sleep disturbances, twice the rate of study participants without celiac disease. After treatment with the gluten-free diet, a third still experienced sleep trouble.

“I’ve seen everything from insomnia to excessive sleepiness,” says Atlanta-based gastroenterologist Cynthia Rudert, MD, who specializes in celiac disease and non-celiac gluten sensitivity. “And unless sleep problems are severe, they’re often overlooked.” Rudert notes that one of her patients has very vivid night terrors after being accidentally exposed to gluten.

Sleep Hygiene

Mood disorders like anxiety or depression, which are common in celiac disease, are sometimes to blame for sleep disturbances. Anything from physical ailments and chronic pain to lifestyle factors, like work stress and changes in routine, can also negatively influence sleep.

Burkhart advises her patients who have sleep issues to do these sleep-enhancing techniques.

► Keep to regular wakening and sleep times. Try to expose yourself to light upon awakening. It stops melatonin production.

► Avoid consuming caffeine after noon.

► Minimize or eliminate alcohol. Even one drink can affect your sleep cycle.

► Avoid vigorous exercise within 3 to 4 hours of bedtime. Mild exertion, like an after-dinner walk or light yoga, may help sleep. Note that vigorous exercise earlier in the day actually promotes healthy sleep.

► Keep your bedroom temperature cool (about 68°F).

► Turn your clock around. Lying there awake, watching the minutes tick by, can make you feel stressed and anxious.

► Use deep-breathing exercises or meditation to help you fall asleep.

► Avoid screen time (TV, computer, tablet, smart phone, etc.) within two hours of bedtime. The light from the screen suppresses melatonin and commonly causes sleep disruption. If you must use your computer before bed, try wearing UVEX glasses to block the blue light.

Natural Sleep Aids

Some research suggests that valerian root, a medicinal herb, helps promote sleep but Burkhart says she steers clear because it tends to cause sleepiness in the morning. Kava is another popular sleep supplement but Burkhart avoids it due to the (rare) risk of liver toxicity. She gives the following sleep-promoting items the green light:

► 5-HTP This natural chemical works in the brain and central nervous system by increasing the production of serotonin. Since serotonin helps regulate mood and behavior, 5-HTP may have a positive effect on sleep, mood, anxiety, pain sensation and more. 5-HTP is not found in food. However, its precursor in the body, tryptophan, is found in turkey, chicken, beans, collard greens and sunflower seeds.

► Chamomile Known for its calming effects, this herb can be used as a mild sleep aid. Widely enjoyed as tea (try drinking it 20 to 30 minutes before bed), it’s also available as an extract that’s added to water. Note: Chamomile may trigger a cross-reaction in those allergic to ragweed.

► Magnesium This mineral is thought to play an important role in sleep. One study in elderly adults showed magnesium supplementation improved multiple measures of sleep, including how quickly you fall asleep and your sleep efficiency (i.e., how much of your time in bed you’re actually sleeping). Dietary sources of magnesium include green leafy vegetables, broccoli, bananas, pumpkin seeds, almonds and yogurt. As a bonus, some of these foods are also rich in calcium, which appears to be important to a healthy sleep cycle.

Note: Too much magnesium can cause serious health problems and interfere with medications. Check with your doctor for appropriate dosage.

► Melatonin Popular among shift workers and those with jet lag, this hormone helps regulate the sleep/wake cycle. Although research on supplementation is inconsistent, melatonin is said to cause drowsiness, lower body temperature and help put the body into sleep mode. Certain foods, like tart cherries, tomatoes and bananas, help boost melatonin levels.

Editor’s note: It’s safest to use sleep supplements under the supervision of your healthcare provider. Interactions and toxicities can occur with supplements just as they do with prescription medications.

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