If rheumatoid arthritis (RA) makes you toss and turn at night, you are not alone. While it is difficult to determine the exact percentage of RA patients who experience sleep problems, more than 80% of people with RA report fatigue as part of their symptoms.
Why is it important to sleep
Sleep problems can increase levels of stress hormones and aggravate flare-ups, says Dr. Rochelle Rosian, a rheumatologist at the Cleveland Clinic. And even if you don’t feel burning, you may not be able to control the pain as well if you don’t sleep. “When you sleep, you produce all of those brain chemicals that you need to feel better. If you’re not rested, you don’t have all of these good hormones. So it can be harder to manage pain.”
In addition to increased flares, rheumatoid arthritis patients with sleep disturbances tend to have more problems with depression, pain intensity, and performing normal daily functions than RA patients who do not have sleep problems. Additionally, in the deeper stages of sleep, the body releases growth hormones to repair small muscle tears that occur during the course of the day. People with RA who get little sleep may not get enough growth hormone to make the 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 medication and those who have lived with RA long enough for their pain to be under control.
We need to manage a new patient’s pain, says Dr. Fong. But anxiety about your new diagnosis may also be affecting your sleep.
At first, you may need more help identifying and dealing with the sources of your anxiety. “If I can help them identify those things so they can address them in very specific ways (like job modifications and things they can tell their family), I can help them take control of the situation,” Dr. Fong says.
Patients whose RA is under control, Dr. Fong says, may have other problems such as stress-inducing changes in work or relationships, or chronic untreated depression or anxiety. Sometimes realizing what’s bothering you so you can deal with it can improve your sleep.
Medications and sleep
Some common RA medications can also contribute to insomnia. One is the steroid prednisone, which can cause insomnia, agitation or depression. It’s best to take it earlier in the day, says Dr. Rosian. Another is hydroxychloroquine (Plaquenil). Sometimes it can make people nervous, nervous and nervous.
Fragmented dream
Sleep fragmentation (not getting good quality sleep) occurs in more than half of the RA patients Dr. Suneel Valla treats. Of this group, between 25% and 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 diagnosing sleep problems in RA patients, he distinguishes tiredness from drowsiness. Fatigue is physical tiredness: feeling exhausted and unable to do much. Drowsiness is difficulty 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 or she may prescribe a sleep study to help determine the cause of your insomnia.
Sleep and pain processing
Studies of people with RA found that they have a low pain threshold even when their inflammation was under control. Additionally, research participants with sleep problems experienced greater pain sensitivity than those without sleep problems. These results indicate that lack of sleep may interfere with the way the central nervous system processes pain.
Pain sensitivity and markers of inflammation increase when sleep is interrupted, even in people without RA or another chronic disease.
Catch some ZZZ’s
Getting a good night’s sleep can improve your pain and your ability to control it. Talk to your doctor, eat well, get plenty of exercise, and follow good sleep hygiene practices.
Reviewed 03/15/22
