Melatonin Effects on Sleep Quality and Symptoms in Inflammatory Bowel Disease

Introduction: Research suggests that sleep dysfunction contributes to symptoms and perhaps relapse in patients with Inflammatory Bowel Disease (IBD). Sleep disturbances stimulate the release of pro-inflammatory cytokines and sleep quality correlates with symptom severity in many studies. Melatonin is a readily available hypnotic compound which is located throughout the GI tract. It is also documented to suppress inflammatory cytokines. One study has described modest effects on IBS symptoms with melatonin administration, but no sleep assessment was included. This study aims to further this knowledge. Methods: This is a double-blind, prospective, randomized, cross over study comparing the effects of melatonin vs placebo on sleep quality, symptoms, and quality of life in patients with IBD. Twenty patients will be enrolled in the study at its conclusion. 8 patients have completed the study so far. Most patients were women (75%), with mean patient age of 40. All patients had IBD, and were in clinical remission with a Harvey Bradshaw index less than 5. All patients had baseline poor sleep quality indicated by a Pittsburg Sleep Quality Index (PSQI) > 5. 4 patients received melatonin 10 mg HS for 2 weeks, followed by a one week washout period, with initiation of placebo for 2 weeks in a cross over study design. The remaining 4 patients received placebo first. All patients completed the PSQI questionnaire and short inflammatory bowel disease questionnaire (SIBDQ) at the beginning and conclusion of each treatment period. Results: 6 out of 8 patients demonstrated a lower PSQI score following 2 weeks of therapy with melatonin, indicating an improvement in overall sleep quality. This data is demonstrated in Table. 3 out of 8 patients demonstrated an improvement in overall SIBDQ scores post-melatonin (Figure 1). Conclusion: In the preliminary data from this pilot study, 75% of patients reported higher quality of sleep, as indicated by a decreased PSQI score after administration of melatonin. Furthermore, 38% of patients demonstrated a higher overall SIBDQ score after melatonin administration. Systemic symptoms improved for 38% of patients, which is not surprising overall given the known anti-inflammatory effects of melatonin. While the sample size is not sufficient to obtain statistical significance at this time, SIBDQ scores post-melatonin increased in 38% of patients. This strengthens the argument that melatonin, a safe and readily available compound, can improve symptoms and quality of life in those with IBD.Figure 1.: SIBDQ Scores: Pre- and Post- Melatonin. Pre-melatonin scores are indicated in blue. Post-melatonin scores at indicated in orange. Increased SIBDQ scores indicate improved IBD symptoms.Table 1.: PSQI Scores: Pre- and Post-Melatonin. A lower PSQI score indicates improved sleep quality.