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Gluten & Insomnia - Can the gluten-free diet improve your sleep? Find out in Living Without's Gluten Free & More June / July '15 issue with writer Christine Boyd and Dr. Rudert
June 4, 2015
In Living Without's Gluten-Free & More magazine article, "Gluten & Insomnia", by author Christine Boyd, Dr. Rudert says, “In my celiac and gluten-sensitive patients, I’ve seen everything from insomnia to hypersomnia, or excessive sleepiness,” she says. “I also have a patient who clearly experiences gluten-related nightmares.
Read full article here: Mary Cannon Barnes, 45, first started having trouble sleeping in her 20s. Bouts with insomnia came and went over the years for the Atlanta-area editor. At its worst, Barnes would spend two hours trying to fall asleep, only to wake throughout the night. She tried everything from cutting caffeine to sleeping pills.
“I was exhausted all the time,” she says, “It was like when you have a newborn and only string together little clips of sleep. At one point, I had a minor traffic accident because I was so sleep-deprived I couldn’t determine the distance between my car and the next and I clipped its side window.”
Sleep troubles weren’t Barnes’ only health complaint, however. She also suffered from terrible migraines, unexplained joint soreness, frequent abdominal pains, infertility, anxiety and depression. Yet sleep troubles were the most debilitating, she says.
“When you don’t sleep, it negatively impacts every part of your life. It affected my job, my relationship with my husband and the type of mother I was.” Plus, not sleeping made every physical ailment worse, she says.
Two years ago, after doing her own research on gluten, Barnes cut the ubiquitous protein from her diet.
“I started sleeping well within a few weeks and haven’t had sleep issues since. Now I fall asleep easily and if I do wake in the night for any reason, I can quickly go back to sleep.” Many of her other health problems resolved on the gluten-free diet, too.
Barnes isn’t alone with gluten-related sleep problems, says her doctor, Atlanta-based gastroenterologist Cynthia Rudert, MD.
“In my celiac and gluten-sensitive patients, I’ve seen everything from insomnia to hypersomnia, or excessive sleepiness,” she says. “I also have a patient who clearly experiences gluten-related nightmares.”
Barnes has gluten sensitivity, not celiac disease. Non-celiac gluten sensitivity—gluten sensitivity, for short—causes similar symptoms to celiac disease but the intestinal damage characteristic of celiac disease isn’t present.
Little research has been done on sleep in gluten-sensitive patients like Barnes. However, a recent study in celiac adults suggests sleep issues are, in fact, a big deal in the gluten-free world. The study revealed a whopping 50 percent of newly diagnosed celiacs had sleep disorders, more than twice the rate of study participants without celiac disease.
What's more, nearly every measure of sleep quality was worse among celiacs—from how long it took to fall asleep and how often sleep was interrupted to use of sleep medications and daytime sleepiness. And treatment with the gluten-free diet appeared to be only marginally helpful in improving sleep. A third of celiacs still experienced sleep disorders after eliminating gluten. (A just-completed study that looked at the effects of the gluten-free diet in fibromyalgia—a disorder characterized by sleep disturbances and celiac-like symptoms—also failed to show significant sleep benefits.)
Researchers suspect mood disorders like depression and anxiety play a big role in celiac-related sleep problems.
“Insomnia can be associated with underlying mood or physical symptoms,” says Deirdre Conroy, PhD, clinical director of the Behavioral Sleep Medicine Program at the University of Michigan. “About half of those with insomnia have other psychological factors, like depression or anxiety.”
Indeed, celiacs have been shown to have higher rates of depression and anxiety in numerous studies, including the recent celiac sleep study.
“There’s no biochemical explanation for why celiac disease might affect sleep so it’s likely that any effect is of a psychological nature,” explains study author Fabiana Zingone, a gastroenterologist at the University of Salerno, Italy. “Celiac disease is a chronic condition with a considerable psychological impact. This may be caused by concerns about unexplained symptoms before diagnosis and, once diagnosed, worries about the long-term nature of the condition, as well as the impact of the gluten-free diet.”
Mood disorders aren’t to blame for all sleep troubles, however. Experts say everything from physical ailments and chronic pain to lifestyle factors like work stress and changes in routine can influence sleep.
“Sleep is one of the first things to be sacrificed but good sleep is vital to proper immune function and healing, as well as for coping with emotions and tolerating stress,” says Nevin Arora, MD, a sleep medicine doctor near San Diego, California. It’s not far-fetched that removing gluten or any food substance or toxin that’s having a negative impact on the body could improve sleep as well as other symptoms, he says.
But sleep problems may be overlooked, cautions Rudert. “Sleep issues may be glossed over in a typical 15-minute doctor’s appointment,” she says. And patients may only realize in hindsight that their sleep has been negatively affected. “Patients often say to me, ‘Since I’ve been gluten-free, I no longer take naps or I’m less tired or I wake up refreshed.’’’
Based on her research, Zingone recommends that sleep problems be added to the list of signs and symptoms of celiac disease. And she calls for more sleep research.
“We need a large study of celiac individuals before and after diagnosis to gain a considerably better understanding of any direct links between celiac disease and sleep disturbances and to help identify possible therapies,” she says.
Symptoms of Celiac Disease and Gluten Sensitivity
Symptoms of celiac disease and non-celiac gluten sensitivity—or just, gluten sensitivity—closely overlap. “You can’t tell from just talking to someone if they have celiac disease versus gluten sensitivity,” says Atlanta-based gastroenterologist Cynthia Rudert, MD. “You will be wrong as often as right. Some of the sickest patients I’ve seen were gluten sensitive.”