Association between gastrointestinal symptoms and insomnia among healthcare workers: a cross-sectional study

This study examined the association between gastrointestinal symptoms and insomnia among healthcare workers and found a significant positive correlation between the two. That is, an increase in the severity of gastrointestinal symptoms was associated with a higher risk of insomnia. This finding complements existing literature on the relationship between gastrointestinal symptoms and insomnia in both general and specific populations while providing new insights into this relationship in the unique occupational group of healthcare workers.

Association between gastrointestinal symptoms and insomnia

A growing body of research has consistently highlighted the co-occurrence of GI symptoms and sleep disturbances in both community and occupational settings. For example, Gastrointestinal distress has been positively correlated with sleep disturbances, with pain, discomfort, and nocturnal gastrointestinal events potentially disrupting sleep continuity²⁴. Additionally, One study examined the combined effects of psychological stress and insufficient sleep on GI function, revealing that elevated stress markers and reduced sleep duration significantly predicted GI complaints among office workers²⁵. Although this study did not specifically target healthcare professionals, the high-pressure work environment and irregular schedules it described mirror those experienced by clinical staff, implying a similar pathophysiological trajectory in which stress-induced autonomic dysregulation could potentiate GI dysfunction and sleep impairment.

Notably, other investigations have identified specific disorders, such as irritable bowel syndrome (IBS), as being significantly intertwined with both insomnia and nonrestorative sleep²⁶. One plausible mechanism is that inflammatory and nociceptive processes associated with IBS can heighten nocturnal arousal, leading to frequent awakenings and unrefreshing sleep. Conversely, chronic insufficient sleep may worsen GI symptoms by amplifying systemic inflammation and stress hormone levels, thus perpetuating a “vicious cycle” of exacerbated GI distress and cumulative sleep loss²⁷. Taken collectively, these studies reinforce the notion that GI symptoms and sleep disturbances are linked by shared biopsychosocial factors, including autonomic dysfunction, heightened nociception, maladaptive coping mechanisms, and anxiety. They also underscore the need to move beyond viewing GI disturbances and insomnia as isolated conditions and instead regard them as mutually reinforcing domains, particularly in occupations (such as healthcare) where stress and irregular schedules further amplify this bidirectional interaction.

The uniqueness of gastrointestinal symptoms and insomnia in healthcare workers

In contrast, studies focusing on healthcare workers are relatively scarce. Our findings align with a study of South Korean nurses, which found that long working hours and night shifts could lead to poor sleep quality and digestive system problems among nurses¹¹. Moreover, due to their high-stress work environment and irregular working hours, healthcare workers are more prone to gastrointestinal symptoms like indigestion and stomach pain, further exacerbating insomnia²⁸. This underscores that the relationship between gastrointestinal symptoms and insomnia may differ in healthcare workers compared to the general population, especially given the role of work-related stress and lifestyle factors.

Furthermore, the persistent mental stress and emotional burden faced by healthcare workers may also be a key factor. Stress and emotional issues are common triggers of gastrointestinal symptoms and major contributors to insomnia. Our univariate analysis showed that anxiety, depression, and SSD were associated with insomnia risk. Previous research demonstrated that short sleep duration and poor sleep quality significantly affected the mental health of military healthcare workers²⁹. Another study revealed that sleep disorders are closely related to the mental health issues of healthcare workers, particularly during the COVID-19 pandemic, where healthcare workers with sleep disorders had 3.74 times the risk of psychological problems compared to those without sleep disorders³⁰. When facing gastrointestinal symptoms and insomnia, healthcare workers may need to emphasize stress management and emotional regulation due to the unique nature of their occupational stress.

This study focused on doctors and nurses, revealing that 48.7% of nurses experienced insomnia compared to 37.1% of doctors, which aligns with prior evidence indicating that rotating shift schedules contribute to disturbed sleep and poor recovery⁴. Additionally, nurses exhibited significantly higher GSRS scores. These findings underscore the greater health challenges nurses face in high-intensity, shift-based work environments. Frequent night shifts disrupt circadian rhythms and reduce sleep quality, leading to gastrointestinal dysfunction. Moreover, the high-stress clinical environment, characterized by long hours and heavy workloads, further exacerbates these symptoms among nurses³¹. In contrast, while doctors also endure high stress and long working hours, they typically have fewer shifts and concentrate more on diagnosis and decision-making, which may help mitigate some insomnia and gastrointestinal issues. Nevertheless, emergencies and extended hours continue to pose significant health risks for doctors³². Furthermore, the predominantly female nurse population contributes to these disparities, as research indicates that females are more susceptible to insomnia and gastrointestinal symptoms³³.

Exploring the mechanisms of gastrointestinal symptoms and insomnia

While this study did not directly investigate the biopsychosocial mechanisms between gastrointestinal symptoms and insomnia, our findings align with existing literature regarding the gut-brain axis and the impact of stress responses on sleep. The possible mechanisms include: (1) Gut-Brain Axis and Neuroimmune Modulation: Emerging research emphasizes the pivotal role of the gut-brain axis, a bidirectional communication network involving the enteric nervous system, central nervous system, and gut microbiota, in maintaining the homeostasis of both GI and sleep functions³⁴. Alterations in gut microbial composition can trigger neuroimmune responses, leading to increased production of proinflammatory cytokines and changes in neurotransmitter availability (e.g., serotonin, gamma-aminobutyric acid)³⁵. These mediators not only modulate local GI motility and sensation but may also disrupt sleep architecture and circadian regulation. Furthermore, chronic low-grade inflammation has been implicated in both GI disorders (e.g., irritable bowel syndrome) and insomnia, underscoring a shared inflammatory pathophysiology that heightens perceived pain or discomfort, disrupts autonomic balance, and ultimately degrades sleep quality³⁶. (2) Psychosocial Stress and hypothalamic–pituitary–adrenal (HPA) Axis Dysregulation: Healthcare workers, particularly those in high-acuity clinical environments, frequently encounter prolonged work-related stressors such as demanding schedules, critical patient care, and emotional labor³⁷. This chronic stress can upregulate the HPA axis, leading to elevated cortisol levels that persist well beyond the work shift³⁸. Elevated cortisol and sustained sympathetic hyperarousal are known to impair the restorative aspects of sleep, resulting in difficulty initiating and maintaining sleep, fragmented sleep cycles, and nonrestorative sleep³⁹. Concurrently, these hormonal and autonomic shifts may compromise GI motility and increase visceral hypersensitivity, exacerbating symptoms such as pain, bloating, and reflux. Over time, this cyclical pattern of stress-related GI distress and sleep disruption can reinforce maladaptive behaviors, such as the use of stimulants, unhealthy dietary patterns, and insufficient relaxation. These behaviors further exacerbate both insomnia and GI dysfunction⁴⁰. (3) Circadian Rhythm Disruption and Gastrointestinal Dysregulation: Irregular work hours and night shifts are hallmarks of many healthcare professions. Such schedules can dramatically disturb circadian rhythms by misaligning an individual’s internal clock with environmental light–dark cycles⁴¹. Circadian misalignment influences melatonin secretion, core body temperature rhythms, and peripheral clock gene expression in tissues including the GI tract⁴². Under normal conditions, circadian regulation helps synchronize GI motility, digestive enzyme secretion, and nutrient absorption with feeding times. However, night shift work disrupts these processes, precipitating erratic GI activity and potentially leading to symptoms such as constipation, diarrhea, and reflux. Meanwhile, the misalignment also impairs sleep initiation and maintenance, creating a dual burden on the individual⁴³. (4) Psychological and Behavioral Components: In addition to biologically mediated mechanisms, psychological factors such as anxiety, depression, and somatization can intensify the association between insomnia and GI symptoms. Individuals with heightened anxiety or depressive symptoms often exhibit increased attentional bias toward bodily sensations, perceiving GI discomfort or pain more intensely⁴⁴. This can precipitate a cycle in which nighttime ruminations about work stress or physical discomfort amplify pre-sleep arousal and worsen insomnia, in turn fueling further GI distress the following day⁴⁵. Over extended periods, negative affect and poor sleep quality can lower stress tolerance, further accelerating the dysregulation of both GI and sleep systems⁴⁶.

Limitations and future research directions

This study has several limitations. First, we employed convenience sampling through hospital e-mail lists, intranet notices, and WeChat groups. Although this approach facilitated rapid, anonymous recruitment, the sampling frame was indeterminate and a precise response rate could not be calculated, which may limit the representativeness of the findings. Second, the cross-sectional design precludes any inference of causality. Third, reliance on self-reported questionnaires may introduce recall and social-desirability biases. Fourth, the study was conducted in a single geographic region, so it may not capture variations in work environments and stressors experienced by healthcare professionals elsewhere. Future studies should adopt probability-based, multi-centre longitudinal designs to clarify causal relationships and to further elucidate the biopsychosocial mechanisms linking gastrointestinal symptoms and insomnia—particularly in high-stress clinical settings.