Sleep Problems in People With Arthritis

Arthritis pain can disrupt your sleep, and poor sleep can make your arthritis pain worse. If you can improve your sleep quality, you might also see less pain.

Despite this relationship, sleep is sometimes overlooked when considering arthritis treatment and management.

Arthritis affects 54.4 million adults in the United States. The word arthritis means joint inflammation. It's an umbrella term for about 100 conditions that affect the:

• Joints
• Tissues around joints
• Other connective tissues

This article will look at sleep problems in major forms of arthritis and how you can get better sleep through improved habits, medications, and more.

Sleep and Arthritis Types

Arthritis conditions are known for causing pain, aching, stiffness, and swelling in around the joints. The most common types of arthritis are:

• Osteoarthritis
• Rheumatoid arthritis
• Psoriatic arthritis
• Gout

All of these conditions can affect sleep and cause high levels of fatigue. 

Most people with arthritis say they deal with sleep problems and fatigue. However, these two symptoms often go undiagnosed and untreated.

Sleep and pain have a complex, two-way relationship. When you sleep, your brain releases hormones that help you feel better. When you don't get enough rest, your hormonal balance may be off.

That can lead to more pain, fatigue, and other symptoms. Those symptoms, in turn, can further disrupt sleep.

Sleep and Osteoarthritis 

Up to 31% of people with knee osteoarthritis (OA) report problems in falling asleep, according to studies. And 81% had problems staying asleep.

It's not just that pain makes it hard to sleep, though. Poor sleep in OA is also linked to depressed mood and functional disability. 

Pain, sleep, and depression each make the other two worse. That increases the amount of disability you have.

In one study, people with insomnia were more likely to have chronic pain, and people with pain were especially likely to develop insomnia in the next year. Treating sleep problems can lower pain levels and help alleviate depression.

Sleep and Rheumatoid Arthritis

A 2018 study looked at the sleep quality of people with rheumatoid arthritis, and its connection to:

• Inflammation
• Pain
• Functional disability

About 57% of study participants—mostly women—said they were having sleep problems. They also reported high levels of pain and functional disability.

An earlier study showed people with RA and sleep problems have low pain thresholds. That's the point at which sensation becomes painful. More pain means more sleep problems, and the cycle continues.

Sleep problems can trigger RA flare-ups—periods of high symptom activity and pain. Even if you're not having a flare-up, poor sleep makes it hard to manage your disease and handle daily activities.

Sleep and Psoriatic Arthritis 

In a 2019 study, 68% of people with psoriatic arthritis reported poor quality sleep. That led to poor quality of life and severe daytime fatigue.

People with PsA often have problems falling asleep, staying asleep, or waking up refreshed. PsA may not be the direct cause of sleep problems. But the main symptoms of the condition, including joint pain and skin problems, can keep you up night.

Further, PsA is often linked to two specific sleep disorders:

• Sleep apnea: Periodic pauses in breathing during sleep that disrupt deep sleep.
• Restless leg syndrome: An uncontrollable urge to move your legs while you're relaxing or sleeping.

Sleep and Gout

A 2019 study looked at common sleep disorders and other sleep complications in people with gout. Almost 25% of participants had been previously diagnosed with a sleep disorder.

The most common sleep problems were:

• Sleep apnea - 17%
• Symptoms of sleep apnea but no diagnosis - 45%
• Snoring - 86%

In research from 2015, researchers using a British health database determined having sleep apnea increased the likelihood of a gout attack by 50%. They were unsure why but speculated it may be due to:

• Being overweight: This is a shared risk factor for gout and sleep apnea. A physiological connection is suspected but as yet unknown.
• Hypoxia: A complication of sleep apnea, hypoxia makes oxygen levels fall during sleep. This causes tissue damage and cell breakdown, which can increase uric acid levels and lead to gout attacks.

So while sleep problems aren't directly related to gout, these consequences of sleep apnea can make the condition worse.

Sleep Better With Arthritis

The National Sleep Foundation defines healthy sleep as:  

• Falling asleep within 20 minutes of going to bed
• Regularly getting seven to nine hours a night
• Sleeping continuously through the night
• Waking up refreshed
• Feeling awake and productive during the day
• Sleeping without snoring, breathing pauses, and restlessness throughout the night

If that doesn't describe your typical night's sleep, don't just dismiss it as an inevitable arthritis symptom. Treatment options are available.

Talk to Your Healthcare Provider

The first step is to talk to your healthcare provider. They can help you best if you can offer specific details on how arthritis may be keeping you up at night.

Prepare for the appointment by keeping a sleep journal for a while so they can see what your sleep patterns are. Record details such as:

• What seems to disrupt your sleep
• How much you sleep
• How often it's interrupted
• How you feel in the morning

Include any things you've 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 your medications, especially any sleep aids or sleep supplements.

Improve Sleep Habits

Good sleep habits, or “sleep hygiene," can help to improve your slumber. You can improve your sleep hygiene by:

• Limiting alcohol: It may help you fall asleep, but it interferes with your ability to stay asleep. 
• Limiting caffeine: This includes soda, coffee, tea, chocolate, and energy drinks.
• Keeping a regular sleep/wake schedule: It helps regulate your internal clock, which tells you when it's time to sleep.
•  Eliminating distractions: Keeping your bedroom dark, quiet, and free of electronic devices including a television.
• Having a light nighttime snack: Eating a little after dinner may prevent hunger from waking you up in the middle of the night
• Avoiding over-arousal for 2-3 hours before bed: Heavy meals, strenuous exercise, arguments, paying bills, and action-packed movies can put you in "arousal mode."

Sleep Medications

If your healthcare provider thinks a sleep aid would help you, they may prescribe:

• Ambien (zolpidem)
• Restoril (temazepam)
• Halcion (triazolam)
• Rozerem (ramelteon)
• Sonata (zaleplon)

It may take a while for you to find the sleep medication that works best for you.

Natural Supplements

Some natural supplements can also 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 healthcare provider before starting any supplement. Ask about benefits and risks, how to take it, for how long, and what side effects and drug interactions to watch for.

Summary

Arthritis pain disrupts sleep and poor sleep exacerbates arthritis pain. Fatigue and depression are common symptoms of both chronic pain and sleep disorders.

In osteoarthritis, pain and poor sleep are linked to higher rates of depression and functional disability. Poor sleep lowers the pain threshold in rheumatoid arthritis.

Psoriatic arthritis is tied to sleep apnea and restless legs syndrome. Skin symptoms may also disrupt sleep.

Sleep apnea is common in gout. It can lead to weight gain and hypoxia, which can lead to gout attacks.

All chronic pain can impact sleep, and poor sleep increases pain and mood problems. Most people don't get the recommended seven to nine hours of sleep a night.

Improving sleep hygiene and exploring drugs and supplements to help you sleep can get you feeling more rested and lower your symptom load. Always involve your healthcare provider in treatment decisions.

A Word From Verywell 

Don't let sleep problems increase your pain and decrease your quality of life. If early attempts at improving sleep aren't successful, ask your healthcare provider about seeing a sleep specialist. They can help find the right treatments so you get more sleep, less pain, and all the benefits that go with them.