If rheumatoid arthritis (RA) keeps you tossing and turning at night, you’re not alone. While the exact percentage of RA patients who experience sleep problems is difficult to determine, more than 80% of people with RA report fatigue as part of their symptoms.
Why sleep matters
Sleep problems can increase levels of stress hormones and worsen flare-ups, says Rochelle Rosian, MD, a Cleveland Clinic rheumatologist. And even if you don’t flare, you may not manage your pain as well if you don’t sleep. “When you sleep, you’re making all the brain chemicals that you need to feel better. If you’re not rested, you don’t have all these good hormones. So it can be harder to manage your pain.”
In addition to increased flare-ups, rheumatoid arthritis Patients with sleep disorders tend to have more problems with depression, pain severity, and performing normal daily functions than RA patients who do not have sleep problems. Even in the deepest stages of sleep, the body releases growth hormones to repair small muscle tears that occur during the day. People with RA who sleep comfortably may not get enough growth hormone to make necessary repairs.
Anxiety, stress and sleep
Jeffrey Fong, MD, a rheumatologist at Kaiser Permanente in Northern California, sees two categories of RA patients with sleep problems: those with a new diagnosis who are still adjusting their medications, and those who have lived with RA long enough for their pain to be under control.
We have to get a new patient’s pain under control, says Dr. Fong. But anxiety about their new diagnosis can also affect sleep.
In the beginning, you may need more help identifying and dealing with the sources of your anxiety. “If I can help them identify these things so they can deal with them in very specific ways—like job changes and things they can tell their family—it can help them get control of the situation,” says Dr. Fong.
Patients whose RA is under control, says Dr. Fong, may have other problems such as stressful changes at work or in relationships, or chronic depression or anxiety that have gone untreated. Sometimes realizing what’s bothering you so you can deal with it can improve sleep.
Medication and sleep
Some common RA medications can also contribute to insomnia. One is the steroid prednisone, which can cause insomnia, agitation or depression. It is best to take it earlier in the day, says Dr. Rosian. Another is hydroxychloroquine (Plaquenil). It can sometimes make people nervous and anxious.
Fragmented sleep
Sleep fragmentation—not getting good quality sleep—occurs in more than half of the patients with RA that Suneel Valla, MD, treats. Of this group, 25% to 40% report sleep disturbances related to RA, says the sleep specialist at St. Luke’s Hospital in Bethlehem, Pennsylvania. The rest, he says, may have a sleep disorder in addition to RA, such as sleep apnea or restless legs syndrome.
Dr. Valla says that when he diagnoses sleep problems in RA patients, he distinguishes fatigue from drowsiness. Fatigue is physical tiredness – feeling drained and unable to do much. Drowsiness is trouble staying awake during the day. “If you fall asleep when you don’t want to or take unplanned naps, that would be a clue to a primary sleep disorder.”
If your doctor suspects a sleep disorder, he may order a sleep study to help determine the cause of your insomnia.
Sleep and pain management
Studies of people with RA found that they have a low pain threshold even when their inflammation was under control. Furthermore, research participants with sleep problems experienced higher pain sensitivity than those without sleep problems. These findings indicate that lack of sleep can disrupt the way the central nervous system processes pain.
Pain sensitivity and markers of inflammation are increased when sleep is disrupted, even in people without RA or another chronic disease.
Catch some ZZZs
A good night’s sleep can improve your pain and your ability to manage it. Talk to your doctor, eat well, get plenty of exercise, and follow up good sleep hygiene practice.
Reported 15-03-22
