Sleep Problems in People With Arthritis

There is a shared relationship between arthritis pain and poor sleep. The pain of arthritis can make it hard to get a good night’s rest and the poorer a person’s sleep is, the more pain they will be in. To make matters worse, tossing and turning at night can increase the way in which you perceive pain. If people with arthritis conditions can improve their sleep quality, they can also reduce their day-to-day pain. But sleep problems in people with arthritis tend to get overlooked.

Here is what you need to know about the effect arthritis conditions have on sleep and what you can do help improve your sleep.

According to the Centers for Disease Control and Prevention (CDC), arthritis affects 54.4 million adults in the United States. Arthritis—a term used to describe joint inflammation—refers to about 200 conditions that affect the joints, the tissues around joints, and other connective tissues.

Arthritis conditions are known for causing pain, aching, stiffness, and swelling in around the joints. The most common types of arthritis are osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis (PsA), and gout—all of which affect sleep and cause high levels of fatigue. 

Most people who living with arthritis report sleep problems and fatigue as common symptoms they experience living with arthritis conditions. However, these two symptoms are often underappreciated, undiagnosed, and untreated. In fact, many patients do not make the effort to discuss sleep problems and fatigue with their doctors because they don’t believe there is anything that can be done. 

A 2015 report in Arthritis Care & Research reports up to 31 percent of people with knee OA report problems in falling asleep, with 81 percent having problems staying asleep, and up to 77 percent reporting sleep problems overall. Sleep problems in people with OA are also linked to depressed mood and functional disability. 

Why OA is keeping people up at night is may seem obvious; pain prevents a person from getting comfortable enough to fall asleep or wakes them up at night. While researchers confirm pain is part of the problem, they also believe sleep issues and arthritis pain seem to feed off of one another.

A study reported in the October 2018 Journal of Clinical Medicine aimed to determine the sleep quality of people with RA and its connection to a number of factors, including inflammation, pain, and functional disability. The RA study participants—mostly women—responded to questionnaires where 57 percent of them with were experiencing sleep problems. They were also experiencing high pain levels and higher incidences of functional disability. Researchers noted the importance of being aware of RA sleep issues and the effects they have on a person’s overall health and livelihood as it relates to disability.

According to a 2012 report in the journal Arthritis & Rheumatology, people with RA who have sleep problems also have low pain thresholds. This results in more difficulty with sleep and lack of sleep affects the way the brain handles pain, which means more pain.

Sleep problems in people with RA can trigger disease flare-ups—periods of high symptom activity and pain. Even if a person is not experiencing a flare-up, it is still hard to manage the various aspects of their disease if they are not getting needed sleep. This is because when you sleep, your brain releases hormones to help your body to feel better, but when are not getting enough best, you struggle to manage pain, fatigue, and other RA disease symptoms . What is more is that people with RA who struggle with sleep experience with higher levels of depression and tend to have more trouble performing normal daily activities and managing pain levels.

A 2019 report in the Polish journal Reumatologia finds up to 68 percent of people with PsA are reporting poor quality sleep. The reporter’s authors further note people with PsA who have sleep disorders experience poor quality of life and severe daytime fatigue. 

It is not usual for people with PsA to have problems falling asleep, staying asleep, or with waking up feeling refreshed from sleep. PsA may not be the direct cause of your sleep problems, but the main symptoms of the condition, including joint pain and skin problems, might be what is keeping you up night.

Further, PsA is often linked to two specific sleep disorders: sleep apnea and restless leg syndrome (RLS). Sleep apnea causes a person to stop and start breathing inferring with their sleep. RLS is a disorder that causes uncontrollable urge to move the legs. It typically occurs at night when a person is sitting down or lying down.

A 2019 piece in the journal Arthritis Research & Therapy reports on a study aimed to assess commonly reported sleep disorders and other sleep complications in people with gout. What the researchers found was 23 percent of those surveyed had a physician-diagnosed sleep disorder. The most commonly reported sleep disorder was sleep apnea, reported by 17 percent of the respondents. In addition, 86 percent reported snoring with sleeping and 45 percent reported experiencing snorting, gasping, or stopped breathing while asleep.

In older study reported in 2015 by Arthritis & Rheumatology, researchers reviewed records from a British health database to determine the effect having a sleep disorder had on a person living with gout. The researchers determined having sleep apnea increased the likelihood of a gout attack by 50 percent.

The researchers were unsure of the exact reason for this, but they speculate there may be two things that play a part: being overweight and hypoxia.

• Being overweight was a risk factor for shared by both gout and sleep apnea and researchers speculate a connection, but they are unaware what the link might be. 
• Hypoxia is a sleep complication of sleep apnea where a person’s oxygen levels fall while a person is sleeping. This complication can cause tissue damage and cell breakdown, which can bring up uric levels responsible for causing gout.

Any condition that causes pain—not just arthritis—has the potential to disrupt your sleep. When you experience persistent pain, it can wake you up at night, keep you from getting to sleep, and interrupt your sleep. According to the CDC, adults living with one or more of 10 chronic health conditions—arthritis being one of these—are sleeping less than the recommended seven to nine hours.

And regardless of what is causing your pain, the cycle is the same. You don’t sleep and when you do, it is not productive, leading to more pain, fatigue, and depression. In addition, your pain threshold is lowered, and your continued pain and lack of restful sleep eventually takes it toll on your overall physical, emotional, and mental well-being.

A study reported in the July-August 2019 Behavioral Sleep Medicine journal reported on 50 study participants whose sleep quality was followed for a period of two weeks. The study subjects kept a sleep diary and were tracked with a wrist-worn sleep device. The researchers determined that two things played a main role in sleep quality—the number of times a person woke in the night and how much they slept the prior night.

Interestingly, the study authors noted the results were only modest and didn’t really paint a picture of what normal or healthy sleep should look like. What they did confirm was what poor sleep quality could look like.

According to the National Sleep Foundation, adults should aim to get between seven and nine hours of sleep at night.

The National Sleep Foundation notes there are specific statements that indicate a person’s sleep is on track. For example: 

• If you are falling asleep within 20 minutes of going to bed
• You are regularly getting nine to nine hours every night
• Once you fall asleep, your sleep is continuous
• You wake up feeling refreshed
• You are awake and productive during the day
• You don’t experience out of the ordinary behaviors while sleeping, such as snoring, breathing pauses, and restlessness throughout the night

More attention needs to be paid to the often dismissed symptom of sleeping problems in people with arthritis. There may be a number of reasons for experiencing sleep problems.

The first step is to talk to your doctor. Your doctor can help you best if you share that you are having sleep problems and offer specific details on how arthritis may be keeping you up at night.

You may want to prepare in advance of talking with your doctor. Start by recording your sleep and describe what your sleep looks like. For example, if you are struggling to fall asleep at night or waking up several times a night, or if you are waking up as if you have not slept.

Include any things you have tried to help you sleep better and how long you have done these things. Also, write down any questions you have and bring a list of all medications you are taking, especially any sleep aids or sleep supplements.

Good sleep habits—referred to as “sleep hygiene"—can help to improve your sleep.

You can improve your sleep hygiene by:

• Limiting alcohol: Alcohol may help you fall asleep, but it interferes with the ability to stay asleep 
• Limiting substances that contain caffeine especially close to bedtime: This includes soda, coffee, chocolate
• Trying to set a regular sleep/wake schedule: A regular sleep schedule helps regulate and set the body's internal clock, which tells you when you are tired and when it is time to sleep
•  Making your sleeping area free from distractions: Aim for quiet surroundings such as keeping your bedroom dark and television-free
• Having a light nighttime snack: Light snacks after dinner may prevent hunger from waking you up in the middle of the night
• Avoiding over-arousal for at least 2-3 hours prior to going to sleep: Things that tend to get your body and mind in "arousal mode" include heavy meals, strenuous exercise, arguments, paying bills, and action-packed movies

There are a number of medications that are helpful for sleeping problems. Depending on your sleep symptoms and other factors, your doctor may prescribe a sleep medication.

Commonly prescribed sleep medications include:

• Ambien (Zolpidem)
• Restoril (Temazepam)
• Halcion (Triazolam)
• Rozerem (Ramelteon)
• Sonata (Zaleplon)

Some natural supplements can also help with improve your sleep. These include:

• Melatonin - Melatonin is a natural hormone produced by the pineal gland. Melatonin products are synthetic versions of the natural hormone.
• Valerian Root - Valerian herbal products are made from the roots or stems of the valerian plant. Dried roots are often prepared as teas, or put into capsules or tablets.

Many people find that natural sleep supplements work better than prescription sleep medicines and help them to wake up feeling refreshed and restored. You should always check with your doctor before starting any supplement. Ask what benefits and risks these have, how to take the supplement, and how long to take it for.

Sleep problems can affect anyone—even those who have never experienced pain associated with arthritis. You can follow all of the advice above and every single thing your doctor has suggested and still not get the restful sleep you need. If that is the case, it is possible there is some other issue causing your sleep woes that is unrelated to arthritis.

If you continue to struggle with getting a good night’s rest, make an appointment with a sleep specialist to discuss what treatments might be helpful to you. Working with a specialist might be the best way to get you back on track for getting a good night’s sleep and improve your arthritis pain.