Unfortunately, for many people, rheumatoid arthritis and sleep problems are unpleasant bedfellows. With rheumatoid arthritis (RA), an autoimmune disease, the immune system mistakes the body’s own cells for foreign invaders, which often leads to inflammation of the joints and debilitating joint pain. This joint pain can be so intense that it interferes with your ability to sleep well.
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.”
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.
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.
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:
1. Take a hot shower or bath.
The combination of heat and water can act as a mini-hydrotherapy session for your muscles and joints, relieving pain and stiffness. Slip into warm water before turning in for the night.
2. Keep the heat on.
Invest in an electric mattress pad or an electric blanket and use it for 20 minutes to help you get comfortable before going to sleep, advises Moss. (Don’t leave it on all night; it’s a safety risk!)
3. Ice it up.
When joints are swollen, applying ice can be soothing and can help relieve inflammation.
4. Get moving during the day.
Whether you do aerobic exercise (such as walking or cycling) or resistance training, exercising regularly can help reduce pain and swelling from RA. A study published in May 2018 in Rheumatology International found that people with RA who are more physically active have longer total sleep time. Just don’t exercise too close to bedtime, or the physical activity could have energizing effects, warns Scott Zashin, MD, a rheumatologist in private practice and a clinical professor of internal medicine at the UT Southwestern Medical School in Dallas.
5. Avoid nighttime stimulation.
If you’ve been struggling with sleep, keep pets and television out of your bedroom, urges Morris. Also, avoid reading something exciting or disturbing or using an electronic device (such as a computer, tablet, or mobile phone) for at least an hour before bed. Your bedroom should be used for sleep and sex only.
6. Elevate your legs.
It can be helpful to slide a pillow under your knees to alleviate pressure on your joints while you sleep.
7. Practice meditation.
To set the stage for better sleep, try meditating and focusing your attention on your breath or relaxing images to help your mind and body decompress from the day.
8. Ask about sleep-supportive medications.
To facilitate better sleep among patients with RA, Morris sometimes recommends low-dose antidepressants such as Elavil (amitryptiline) or Oleptro (trazodone). You might also talk with your doctor about other sleep-promoting prescription drugs, such as muscle relaxants, Lunesta (eszopiclone), or Ambien (zolpidem).
9. Avoid bedtime snacks.
Don’t eat anything for a few hours before bedtime, Morris advises, because eating causes blood to be diverted to digestion, which can interfere with sleep. Also, avoid alcohol, which may help you fall asleep but can interfere with your sleep quality during the night.
10. Create a soothing sleep environment.
Both Morris and Moss advise people with RA to get a mattress that is as comfortable as possible. Also, consider buying a whole-body memory-foam pillow so you can better position your joints to relieve pressure and discomfort. Choose soft bed linens and blankets that don’t put extra pressure on your joints.