RA sleep-related troubles can include not being able to fall asleep or sleep long enough, having fragmented sleep or frequent awakenings, or having sleep that leaves you feeling unrefreshed in the morning.
The Benefits of Good Rest
Not surprisingly, people with RA who sleep well are better able to recover from the activities of the previous day, says Christopher R. Morris, MD, a rheumatologist in private practice in Kingsport, Tennessee. But if a person sleeps poorly, “the muscles can’t fully relax. If they’re fatigued, they hurt. If they hurt, they get fatigued, and they hurt more.” RELATED: Sleep Problems and Rheumatoid Arthritis: Can You Overcome Sleep Trouble?
Pain Perception Changes When You Get Less Rest
Making matters worse, a study published in the January 2019 issue of the Journal of Neuroscience found that sleep loss makes certain pain centers in the brain more active and reactive than they would be after a good night’s sleep. Indeed, people with rheumatoid arthritis who don’t get enough good-quality sleep can get caught in a vicious circle. Research published in the Journal of Clinical Sleep Medicine found that poor sleep is associated with greater pain severity, increased fatigue, higher levels of depressive symptoms, and greater difficulty in functioning in people with RA. Besides disturbing sleep, RA pain can make it difficult to get out of bed in the morning or to exercise during the day. The trouble is, lack of physical activity can actually make RA disease activity or joint pain, fatigue, and sleep quality worse, according to research published in January 2016 in Arthritis Care & Research.
Sleep Medications and Rheumatoid Arthritis: What to Know
Research suggests that a number of factors contribute to chronic pain in rheumatoid arthritis — including underlying depression, notes Dr. Morris. In his practice, patients who experience trouble sleeping because of their joint pain are often prescribed antidepressants. A class of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) can help offset chronic pain, both directly and indirectly, by affecting a person’s perception of pain and by addressing symptoms of depression that many people with rheumatoid arthritis experience. While taking SSRIs, “I think patients feel better, they have more energy, they are able to function better; a lot of them will stay on [SSRIs] chronically,” Morris notes. RELATED: How to Deal With Morning Stiffness: Tips From People Living With Rheumatoid Arthritis
Symptoms of Depression Play a Role in RA Sleep Problems
What’s more, Marcy O’Koon Moss, the senior director of consumer health and content strategy for the Arthritis Foundation, notes that depression “is an underlying factor when it comes to sleep issues in patients with RA.” She suggests that people living with rheumatoid arthritis speak with their doctors about timing their nonsteroidal anti-inflammatory medications (NSAIDs) near bedtime to help ease nighttime joint pain and make it easier to sleep. She says to keep in mind, though, that certain other medications used to treat RA, such as prednisone, a corticosteroid, can disrupt sleep. RELATED: There’s a Large Impact on Mental Health and Sleep in People With Rheumatoid Arthritis, Surveys Suggest Multiple strategies are often needed to sufficiently address chronic pain and sleep disturbances in people with rheumatoid arthritis because so many different factors are involved, including ongoing joint inflammation and fatigue. Plus, the symptoms can vary from week to week, even day to day.
10 Ways to Sleep Better With Rheumatoid Arthritis
Some strategies to minimize pain and improve sleep with rheumatoid arthritis include: Additional reporting by Stacey Colino.
