In the current issue of Intestinal Research, Barnes et al. [8] investigated the correlation between insomnia and IBD-related disabilities using an online questionnaire. Clinically significant insomnia, defined as an Insomnia Severity Index score > 10 was prevalent in 62% of a cohort of 670 respondents. Clinically significant depression, defined as a Patient Health Questionnaire-9 score > 15 and anxiety, as determined by a score of > 10 on the Generalized Anxiety Disorder 7-Item Scale were observed in 18% and 29% of the patients, respectively. The severity of insomnia was positively correlated with the disability score, which was determined by the IBD-disability index selfreport, with the disability scores worsening with increasing severing of insomnia (F(3,619) = 20.99, P< 0.001). Active IBD, abdominal pain, and clinically significant anxiety and clinically significant depression were correlated with clinically significant insomnia, nonetheless, clinically significant depression (odds ratio, 3.32; 95% confidence interval, 1.89–5.83; P< 0.001) exhibited the highest odds ratio. When separate analyses were performed for ulcerative colitis and Crohn’s disease, clinically significant anxiety and clinically significant depression were found to be correlated with the severity of insomnia in both diseases.

Thus, these findings support previous evidence regarding the important interactions of depression and anxiety with insomnia in patients with IBD. According to a recent study [9], patients with IBD are left feeling helpless and concerned, due to the consequences associated with their lack of sleep. Furthermore, they exhibit behaviors that perpetuate the insomnia and somatoform pain disorders. Two-thirds of the patients believe that physicians should enquire about potential sleep disturbances and provide recommendations for improving sleep. Unfortunately, patients frequently feel frustrated when they believe that their sleep disturbances cannot be managed. Thus, physicians should be ready to assess and screen for sleep quality as part of the standard clinical care.

Simple questions could include, “Are you experiencing any problems with sleep or are you feeling fatigued?” and, “How much do your weekday and weekend schedules vary?” The corresponding recommendation would be to advise the patient on keeping the same schedule for 7 days a week. Another question could be posed: “When you are worn out or in pain, which part of the house do you resign to?” The corresponding recommendation could be to resign to the couch and not the bed [9]. The modifiability of insomnia should be ensured when the provision of the appropriate treatment is available.

Barnes et al. [8] recommended cognitive behavioral therapy for insomnia (CBTi) which is the first-line treatment for insomnia, to improve sleep quality, mood, and pain. CBTi includes four to eight consultations with a sleep psychologist or another trained provider, sleep restriction and cognitive therapies, stimulus control, relaxation training, and sleep hygiene education [10]. CBTi is considered additionally suitable in patients with concomitant IBD and insomnia who exhibit cognitive and behavioral traits consistent with the general concept of insomnia [9].

The current study is an important reminder to gastroenterologists to focus on concomitant depression, anxiety, and insomnia associated with gastrointestinal symptoms, as pillars of IBD treatment. As Barnes et al. observed, questionnaire-based studies could result in biased inclusion of study participants and lack of objective measures. However, the advantages of this novel study include the large sample size in comparison with that of previous studies and the validated scales used to evaluate the disease activity, insomnia severity, and disability index. Because the existing literature regarding sleep disturbances in cases of IBD is predominantly limited to surveys, future studies should focus on screening for sleep disorders in clinical practice, using both self-reported and objective measures. Moreover, the effectiveness of CBTi in patients with IBD should be evaluated.