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| Medical Information: Patients with Irritable Bowel Syndrome are Tired All The Time |
| Nicholas V. Costrini, M.D. Medical Director Georgia Gastroenterology Group, PC |
| Happy Birthday to us, that is my twin brother and myself. Dr. Anthony Costrini and I recently celebrated our birthdays together as we have for decades. It does not take a genius to figure out that twins almost always have their birthdays on the same day. This year was no different. I wish to make one thing quite clear, namely that I am very much younger than my uterine partner, give or take nine minutes. Except for our very significant age differences, we have a great deal in common. For starters, we had the same parents, same sister, and the same dog when growing up. We both attended college and both became physicians. We practice in the same town. In our personal lives, we have both married (one more often than the other) and both have great children. In our professional lives, we have chosen separate paths. Dr. Anthony is a specialist in lung diseases and sleep disorders. I am a specialist in digestive diseases. I question his choice of professions, all that coughing and snoring. Good grief. I seem to lose that battle when he questions my interest in belching, belly pain, and diarrhea. Twins do not have to agree on everything. Being that close is not healthy so Im told. So we practice in separate offices and generally see different patients. Quite frequently, however, we see patients requiring care by both a pulmonary or sleep specialist and a gastroenterologist. This happens so often, in fact, that we have contemplated a textbook dealing precisely with the multiple breathing and digestive disorders that may be linked and occur during the course of a patients illness. For example, the very obese patients also commonly suffer the sleep disorder known as sleep apnea. One of the benefits of obesity surgery is the correction of the sleep disorder. Patients with acid reflux disease commonly suffer with asthma, recurrent bronchitis, or chronic sore throat and cough. These associations have been known for years and the lung specialist and the gastroenterologist frequently care for such patients as a team. A very recently recognized additional example of both a lung and GI disorder occurring in the same patient is that of poor sleep quality found in patients with irritable bowel syndrome. Irritable bowel syndrome (IBS) is the disorder most commonly seen in a gastroenterologists practice. Patients with IBS have frequent episodes of crampy abdominal pain usually following a meal, and distressing episodes of diarrhea or constipation. Patients very frequently also experience excessive fatigue. The fatigue is often associated with the perception of poor sleep quality. Both the severe daytime tiredness and the poor sleep quality are worse in IBS than with other digestive disorders such as colitis and Crohns Disease. When the sleep specialist evaluates patients with IBS, he may find that while the IBS patient sleeps as many hours as the normal person, the IBS patient has a longer period of what is known as stage 1 sleep which is very light sleep. Light sleep does not produce a same degree of rest as do deeper stages of normal sleep. Hence part of the intense fatigue experienced by IBS patients may be due in part to poor quality, light sleep. There appears to be additional factors contributing to the fatigue and poor sleep quality experienced by many IBS patients. Both anxiety and depression are common components of the IBS disorder complex. While physicians prescribe antidepressants for such patients, clinical studies have provided mixed results. The GI complaints may or may not improve, but the patients generally feel better. It may be that these drugs improve the mood disorder component of IBS and thus improve the fatigue and sleep disorder components even if the abdominal distress is not directly improved. IBS patients should share with their family physicians the gastrointestinal symptoms but also mood changes, fatigue, and their perceptions of the effectiveness of sleep. The physician can then offer a usually successful program aimed at treating the GI, the emotional, and the sleep components of IBS. IBS patients probably will not need a consultation with a gastroenterologist or sleep specialist. Thats OK. You can come by just to drop off a present and have a piece of birthday cake. Happy Birthday, brother.
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