Exploring the Impact of Sleep on Digestive Health

Podcast Transcript

Dr. Scott Steele: Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end. Hi again everyone, and welcome to another episode of Butts & Guts. I'm your host, Scott Steele, colorectal surgeon and president of main campus here at the Cleveland Clinic in beautiful Cleveland, Ohio. And I'm very pleased to have Dr. Brian Chen, who is a physician within the Sleep Disorder Center here at the Cleveland Clinic, going to talk to us today about how sleep impacts gut health. Brian, welcome to Butts & Guts.

Dr. Brian Chen: Hello. Thanks for having me.

Dr. Scott Steele: So, you have a unique background, pediatrics, NI, sleep disorders, everything. Tell us a little bit about your background for our listeners and how'd you get to the point that you're here at the Cleveland Clinic?

Dr. Brian Chen: Sure. Yeah, so I actually grew up in Morgantown, West Virginia and then I went to college undergrad at Princeton University. And then after that I went to medical school in West Virginia and West Virginia University and I did my pediatric residency here at the Cleveland Clinic and I stayed on here for my fellowship as well and then stayed on for the job.

Dr. Scott Steele: That's fantastic, and we're glad you're here. So today we're going to talk a little bit about how sleep or the lack there of a sleep can impact gut health. Before we get into this connection, can you give us a baseline of why do we need sleep?

Dr. Brian Chen: Yeah, that's a great question. Everybody needs sleep. Everything sleeps that is alive. And so in people, if we don't sleep, that's probably the best example of why we need sleep. We feel cranky. We feel fussy. We can't think straight. Our memory isn't as good. We feel tired, our muscles get weak and our nerves feel shot and we can't recover from injuries or work stress as well. So we need sleep to survive. It's a basic need of human beings, but it also makes us feel good.

Dr. Scott Steele: So, what happens to the body when we sleep?

Dr. Brian Chen: That's a great question. It's a complicated process. A lot of people think, hey, just turn off for a few hours and then it turn back on. But there's a whole lot going on in our brain. There's various stages of sleep. Of course, we only remember dream sleep and so we like to emphasize that that happens too, of course. But aside from dreaming, our brain is doing light sleep and deep sleep. It's called non-REM sleep. And all these stages are important for various functions in our body, including natural control, autonomic control of our systems in terms of our temperature, our repair of our muscles, making memories and gut health.

Dr. Scott Steele: So how much sleep should a person be getting on average?

Dr. Brian Chen: That's a good question. Now for adults it's seven to nine hours. Most people need seven to nine hours, kids need more. We never get enough. So the answer to that is probably you need more sleep. Now everybody hears seven to nine hours and they want to be a seven-hour sleep person, but you don't get to choose. On average, people need eight hours of sleep, some people need nine hours of sleep. And so if you're a nine-hour sleep person, that's how much you need. You can't change yourself without the test of time to have eventually less sleep. As we age, we need less sleep and thus children need more sleep. But most people, most adults need seven to nine hours of sleep.

Dr. Scott Steele: So, I was reading something that talked about a particular sleep gene. They're trying to identify that you need even less and less sleep. Is that a fiction type thing or what is that?

Dr. Brian Chen: So there's a lot of good research coming out of sleep research and there's a lot of breaking news research that may be a little bit sensational. However, that doesn't mean there isn't the possibility that will be able to say supercharge our sleep or hacker sleep or improve our sleep. Those things are already present, especially if you have a sleep disorder. We treat lack of sleep or poor quality sleep on a regular basis, and so keep glued to your seats for a super gene modification or a pill that allows you to supercharge your sleep. But in the meantime, we're working on just getting everybody good quality and good quantity of sleep.

Dr. Scott Steele: That's fantastic. I think we all should sleep more like my dogs who seem to get about 22 hours of sleep. So when should someone call a sleep specialist and are a few rough nights of sleep a cause for concern?

Dr. Brian Chen: That's a great question. Usually if you have one or two rough nights of sleep, that's totally normal. Occasional bad nights of sleep happen to everybody. However, if this is a week by week, month by month or oftentimes my patients it's years and years of poor sleep, not good quality, not enough sleep, choppy sleep, then you should certainly be calling us and we'd love to talk to you.

Dr. Scott Steele: So now that we have a little bit of a baseline for what sleep is and why we need it, how does gut health come into play?

Dr. Brian Chen: Yeah, so that's one of those groundbreaking research areas. There's current research ongoing in this area. We know that there's an interconnection between the microbiome of the gut and our inflammatory system and then sleep. We certainly know that when you don't sleep well, you're more at risk for illness. So your inflammatory system, your immune system isn't able to kind of recover and repair itself for the next day. And we know when your immune system is off balance, that can certainly lead to gut issues as well. There has been some research to show that there is an imbalance of your microbiome when you get less sleep, more choppy sleep. There's more research coming out about sleep apnea, thus causing poor quality of sleep leading to liver disease such as a non-alcoholic fatty liver disease. We know that sleep apnea can lead to all sorts of other diseases in your heart and your blood vessels, and so it stands to reason the gut would be affected as well.

Dr. Scott Steele: So, it's interesting you're talking about the effect of the gut from actually the sleep. What about the other direction in terms of are there specific treatments that we can improve the microbiome that can actually help improve their sleep?

Dr. Brian Chen: Now that's a really interesting question and there's certainly current research going on to look at, can we take some probiotics or prebiotics that would help with sleep? What we know is that the gut biome certainly can influence some of those inflammatory markers in our bloodstreams. But on the other hand, we also know that there's an interrelationship between poor quality sleep or feeling sleepy during the day and some of those inflammatory markers. But we haven't yet done any standard treatments to show that any changes to our gut biome can affect how well we sleep. But the linkages are coming together and I'm sure that that research is being done.

Dr. Scott Steele: So, I see a lot about melatonin as a popular sleep aid. Are supplements and melatonin or other supplements safe to take for sleep or should those be avoided?

Dr. Brian Chen: Melatonin is a hot topic. It does help us sleep, but it should be used sparingly just like anything else that is good for us, as should be used sparingly. Melatonin is a naturally produced hormone in our body and our brain uses it to feel sleepy. It provides a key aspect of the circadian rhythm in terms of helping us feel sleepy. When the sun has gone down, we've expended our energy, our brain will naturally produce melatonin. There are a few instances where people need melatonin on a regular basis, and so most people should use this supplement sparingly. Also, another aspect is melatonin as it's produced right now, is not controlled by the FDA. And so people should confirm that their supplements that they're taking don't contain anything other than melatonin, at least not anything that they wouldn't want. And you should use a trusted source of melatonin. So be careful when you're buying supplements.

Dr. Scott Steele: Truth or myth, truth or myth, stress has no impact on sleep quality?

Dr. Brian Chen: Definitely myth. So when we're stressed, it can certainly cause us not to sleep as well. We can have more wake after sleep onset. We can also have difficulty falling asleep, which can lead to insomnia, especially in the acute sense. When you have something on your mind, work or home or anything else that's causing you stress, then you're not going to be able to as easily drift off into sleep because you have those thoughts on your mind. And then if that continues to be an issue, difficulty falling asleep that goes on for more than a couple of months, then that can become chronic insomnia. Your brain can in a way learn that pattern, learn those bad habits and keep you awake at night time.

Dr. Scott Steele: So, I've heard some people when they drink alcohol, they say they fall right asleep. I take a glass of wine and I fall asleep. And I've heard other people say that if they drink, they may fall asleep, but they'll wake up right away and they won't be able to fall back asleep. Does alcohol play a role or affect sleep?

Dr. Brian Chen: Certainly, yes. So, alcohol makes your sleep worse. A lot of people have used alcohol to help them fall asleep. Perhaps that's part of taking a little bit of that stress away. So you trade one thing for the other, it helps you fall asleep, but it's not going to give you good quality of sleep. And some people may wake up from that poor quality sleep. Alcohol affects sleep in a number of ways. One, it relaxes our muscles, which if you have sleep apnea and you can't breathe well in your sleep, then your muscles being more relaxed wouldn't help that either. The alcohol would make your sleep apnea worse. Also, it changes the stages of our sleep and it kind of jumbles them up a little bit and it makes our sleep quality not as good because the sleep cycles aren't as nice and in its regular pattern. So some people will wake up after a little bit and their brain is a little lost and it doesn't quite know where it's supposed to go now. And be hard to fall back asleep then.

Dr. Scott Steele: What about the time that you eat dinner, for example, or have a snack? You get the early bird special, you're going to sleep better. If you're somebody who's like, I'm going to go out and eat my dinner at 10 o'clock at night. Does the timing that you take in, does that affect sleep?

Dr. Brian Chen: Yes. Generally we recommend people not eat too close to their bedtime and there's not a clear defined number of hours you should wait. Everybody is a little different in how fast they digest food, for example. But generally, if you eat a large meal around bedtime, it's not going to help you sleep well. Your body's going to be dedicating time and resources to digestion and not so much to falling asleep. Having foods that are heavy or cause any heartburn, that can certainly affect your ability to lay down flat, which is the position that most people sleep in. So generally you want to eat a light meal and earlier in the night in order to have a better night rest. There are certain foods of course, that you should watch for depending on your own dietary preferences, but if that causes you any issues, then avoid that food at dinner time.

Dr. Scott Steele: And finally, one of the other questions that gets commonly asked, does it matter the position that you sleep? Are you a belly sleeper or a back sleeper or a side sleeper? I got to have that long pillow, whatever that's called next to me. Does all that affect your quality or quantity of sleep?

Dr. Brian Chen: That's a great question. And that's kind of a hot topic. The answer changes every couple of years or so. But currently side sleeping is best. That's what we recommend, side sleeping. Of course, if your body cannot tolerate being on your side, if your shoulders or your knees hurt from being in that position, then do what is comfortable for you. Whatever is your preferred position is good. Now, side sleeping, we recommend mostly because a lot of people who have sleep apnea or undiagnosed sleep apnea. And when you're on your back, you have your jaw, your tongue and neck and chest muscles which are being pulled downwards by gravity and perhaps closing off your airway or making it harder to get enough air into your lungs. Now, sleep on your side, there can still be collapse of your airway, but less so you have your shoulder, you have the side of your neck, there's less there that is collapsing down from gravity. So generally side sleeping is better, off your back preferred.

Dr. Scott Steele: So, it sounds like lack of sleep has an impact on almost every system in the body. Can you tell us a little bit more about how that lack of sleep affects the gut?

Dr. Brian Chen: Sure. Yeah. So what we're currently thinking about is that when you don't get enough sleep, which again, most Americans don't attain the habitually, physiologically normal amount of sleep. Our body is going to have a little bit more increased inflammation and decreased immune function. And that inflammation and decreased immune function can cause all sorts of issues in our gut, in our diet. Again, there's not a clear direct line to what diseases can come from this. However, we're looking at colorectal cancer, heartburn, stomach ulcers, and liver disease as I mentioned earlier. Furthermore, certain diseases that are already affecting your GI system such as hepatitis C, your body may not be able to fight off those diseases or combat those issues and repair itself as well when you don't get enough sleep.

Dr. Scott Steele: So if a person is experiencing gut problems, we've had a lot of different experts here on Butts & Guts that have talked about that underlying cause, but when should sleep quality be examined as a possible cause?

Dr. Brian Chen: I recommend that every patient discuss with their physician their sleep quality just because sometimes it doesn't come up first line, especially in a field where it may not be top of mind when you're talking about your gut. And that's quite a distance away from your brain where people generally think sleep occurs, but every single cell in your body goes to sleep when you sleep. Every single part of your body has a circadian rhythm. And so when your sleep is disturbed, it can cause a whole number of other issues to arise. So it's good to just at least briefly touch on that. Could it be my sleep? Just keep the thought open there. And of course I recommend for all sleep doctors to discuss other parts of the body as well, other organ systems that may be amiss. What else could be going on and how could that be related to the sleep?

Dr. Scott Steele: So are there any advancements on the horizon when it comes to the relationship between gut health and sleep quality?

Dr. Brian Chen: Sure. Yeah. So I know a number of people who are doing research on gut health, sleep quality, particularly with respects to the microbiome looking for are there are certain probiotics or prebiotics that people could possibly try to help them sleep better. There hasn't been quite a proven recommendation there quite yet. But generally we recommend, especially if people have heartburn or GERD to consider that possibly being a sign of sleep apnea. Whenever you have to take a deep breath or breathe harder in your sleep to breathe, you can cause your stomach to get squeezed a little harder and cause some reflux there. And again, we know that we're pretty certain there's a connection here between non-alcoholic fatty liver disease and sleep apnea. And in general, your general immune system functions better when you sleep and thus it stands to reason the immune system that is affecting your gut health will function better as well.

Dr. Scott Steele: So now it's time for our quick hitters, a chance to get to know you a little bit better. So first of all, what was your first car?

Dr. Brian Chen: Honda Civic.

Dr. Scott Steele: What is your favorite food to eat?

Dr. Brian Chen: Pasta.

Dr. Scott Steele: Tell me about a trip that's upcoming or a trip you want to take that's on the bucket list.

Dr. Brian Chen: Oh, that's a good question. I want to go to Antarctica someday.

Dr. Scott Steele: Fantastic. And then finally, if you were to go back maybe at the end of the high school and give yourself a piece of advice, what advice would you give yourself?

Dr. Brian Chen: That's a tough question. I would say work hard but play harder.

Dr. Scott Steele: Fantastic. And so what's a final take home message for our listeners regarding this sleep impact of gut health?

Dr. Brian Chen: Sure. If you have questions about your sleep or if you have questions about how gut health may be related to your sleep, we are here to talk about it. Feel free to call us at the Sleep Center, make an appointment with the Cleveland Clinic Sleep Center, and we can certainly discuss more. Many times things go undiagnosed just because we aren't aware of that being an issue. And so we'd love to explore that with you. And if everything turns out fine, that's fantastic, but if not, then let's try to fix it. Let's do something about it. Let's try to improve your gut health, try to improve your sleep.

Dr. Scott Steele: That's great. And so to learn more about the Sleep Disorder Center here at the Cleveland Clinic or to schedule an appointment, please call 866.588.2264. That's 866.588.2264. You can also visit our website at clevelandclinic.org/sleep. That's clevelandclinic.org/sleep. Brian, thanks so much for joining us on Butts & Guts.

Dr. Brian Chen: Thank you for having me.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.