Sleep and Ankylosing Spondylitis: What’s the Connection?

Ankylosing spondylitis (AS) and sleep often go hand in hand; sleep disturbances can exacerbate (worsen) AS symptoms like pain, stiffness, and depression, and AS symptoms can make it challenging to get a good night’s sleep.

Over 300,000 Americans live with ankylosing spondylitis, and up to 90% report having sleep problems. Restful sleep is essential for everyone, and it's especially crucial for maintaining quality of life with a chronic condition like AS.

This article explores the connection between sleep and ankylosing spondylitis and provides tips to help you sleep soundly. 

Woman with ankylosing spondylitis feeling exhausted after a bad night sleep.

VioletaStoimenova / Getty Images

Does Ankylosing Spondylitis Affect Your Sleep? 

Symptoms of ankylosing spondylitis, such as low back pain and stiffness, joint pain, and depression, can all contribute to sleep disturbances.

As a result, people with AS may be stuck in a vicious cycle of feeling more uncomfortable due to poor sleep and being unable to sleep the next night due to pain and discomfort. This can worsen fatigue and brain fog many people with AS experience.

Pain and Stiffness

AS-related back pain and stiffness tend to be aggravated after long periods of rest. Many people with AS wake up in pain sometime during the night, making it difficult to find a comfortable position and fall back asleep.

Depression

AS is associated with an increased risk of depression. Several factors may contribute to higher rates of depression in people with AS, as it can affect quality of life. Depression is linked to sleep problems, such as waking more frequently at night and having trouble falling asleep.

Sleep Apnea

Research shows that people with AS are nearly 3 times more likely to develop obstructive sleep apnea than people without it. Sleep apnea is associated with pauses in breathing or periods of shallow breathing throughout the night, resulting in broken sleep and excessive daytime sleepiness.

High Disease Activity

AS disease activity describes the amount of inflammation a person with AS has at any given time. Periods of high disease activity (e.g., increased inflammation markers in the blood) are associated with increased sleep disturbances.

Does Sleep Have Any Effect on Ankylosing Spondylitis?

AS-related back pain and stiffness tend to worsen after periods of rest or sleep. If you have AS, you may have noticed the more time you spend in bed, the more stiff and sore you feel the following day.

Waking up in the middle of the night with pain also contributes to sleep troubles for people with AS. Research shows that poor sleep is strongly associated with worsened AS symptoms, including low mood, high levels of fatigue, and worsened spinal pain and stiffness.

Types of Sleep Issues Likely Caused by Ankylosing Spondylitis

If you have ankylosing spondylitis, you may struggle to get a good night's sleep due to the following: 

  • Obstructive sleep apnea: Intermittent episodes of breathing pauses occur when the airway narrows or collapses. This causes a decreased oxygen intake during the night and results in broken sleep.
  • "Painsomnia": When pain makes it difficult to fall asleep or stay asleep, it may be described as "painsomnia."
  • Sleep apnea-hypopnea syndrome: Shallow breathing episodes during sleep are defined as hypopnea episodes. These are characterized by at least a 30% reduction in airflow and blood oxygen levels, resulting in fragmented sleep. 
  • Sleep-onset insomnia: Sleep-onset insomnia is a term to describe difficulty falling asleep at bedtime. For people with AS, pain, depression, or the impact the disease has on their quality of life may contribute to this form of insomnia.

Treatments of AS-Induced Sleep Issues

If lack of sleep interferes with your ability to function throughout the day, talk with your healthcare provider. They may recommend certain treatments to help you get a better night's sleep. 

Medication

Medications used to treat ankylosing spondylitis reduce pain and inflammation and prevent or slow disease progression. The most common medications for AS are nonsteroidal anti-inflammatory drugs (NSAIDs), but biologics, such as tumor necrosis factor (TNF) inhibitors, and corticosteroids (although not good for long-term use), may be prescribed as well.

Research shows that TNF inhibitors may improve sleep in people with AS.

Exercise

High-intensity exercise, including cardiovascular workouts and strength training, has improved sleep in people with AS. In one study, participants with AS exercised three times a week for three months. Participants reported significant improvements in their sleep as well as improvements in mood and overall quality of life.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is the first-line treatment for insomnia. This evidence-based therapy helps you identify negative thoughts and behaviors linked to poor sleep and replace them with habits that promote more restful sleep.

Research shows that CBT improves sleep in people with chronic pain and may be more effective when paired with another intervention, such as exercise.

Continuous Positive Airway Pressure (CPAP) Therapy

Your healthcare provider may recommend CPAP therapy if you've been diagnosed with sleep apnea. This involves wearing a face mask connected to a CPAP machine that provides a constant flow of pressurized air to help keep your airway open throughout the night.

CPAP is the gold standard treatment for sleep apnea, and research suggests that this therapy may increase pain tolerance in people with chronic pain.

Relaxation Techniques

Relaxation techniques, such as deep breathing exercises, promote relaxation of your body and mind to help you fall and stay asleep. Other techniques that may help you get a good night's rest include yoga, meditation, music, tai chi, reading, and taking a warm bath.

You may need to try a few methods before finding the most effective relaxation technique. 

Good Sleep Hygiene to Improve Sleep Issues 

Sleep hygiene refers to healthy habits and environmental factors that promote a good night’s sleep. These habits may include the following: 

  • Set a regular sleep schedule by going to bed at the same time every night, even on the weekends.
  • Avoid caffeine, alcohol, and large meals about four hours before bedtime.
  • Create a comfortable sleep environment (e.g., sleeping on a firm mattress, using pillows to support your back and/or legs, and sleeping in a quiet, dark, and cool room). 
  • Skip naps; while they can be an excellent way to boost energy during the day, they can derail a good night’s sleep.  
  • Wind down with relaxation techniques (e.g., meditation, yoga, or gentle stretching about 30 minutes before bedtime).
  • Turn off all electronics, including your mobile phone, tablet, and television, at least 30 minutes before bedtime. 

When to See Your Healthcare Provider

Most adults need about seven or more hours of sleep each night to feel their best. If you have ankylosing spondylitis and are concerned you are not getting enough sleep, see your healthcare provider if: 

  • Your partner says you snore, or you’ve woken yourself up by snoring. 
  • Fatigue and excessive daytime sleepiness prevent you from participating in your daily activities.
  • Pain prevents you from falling asleep or staying asleep at night.
  • Symptoms of insomnia have persisted for more than four weeks. 
  • Feelings of depression and anxiety are worsening due to lack of sleep. 

Depending on your symptoms, your healthcare provider will recommend appropriate treatments, natural remedies, or lifestyle habits to improve your sleep.

Summary

Ankylosing spondylitis (AS) can cause sleep disturbances, and lack of sleep can worsen AS symptoms, like pain and stiffness. Up to 90% of people with ankylosing spondylitis report having sleep problems.

Treatments, such as medications to reduce pain and inflammation, cognitive behavioral therapy, exercise, and CPAP therapy may help improve sleep in people with AS. Good sleep hygiene practices, such as sticking to a sleep schedule and practicing relaxation techniques before bedtime, may also help improve sleep. 

A Word From Verywell

If lack of sleep interferes with your ability to function throughout the day or makes your ankylosing spondylitis symptoms worse, talk with your healthcare provider. They may suggest a medication change or other treatments to help improve your sleep and quality of life.

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