At my last rheumatologist appointment, my rheum and I talked about the significant fatigue I had been experiencing. I would get up for a few hours in the morning and then immediately have to go back to bed for several hours, despite getting between seven and 12 hours of sleep per night.
Since I got sick, sleep has been an issue for me, to a greater or lesser extent. I would say that I always have some pain while sleeping, but especially when I am flaring. It literally feels like my body is crushing in on itself. I take both anti-anxiety medication and a muscle relaxant to help me sleep at night, and for the most part, this works.
Fatigue is common in RA, and something that most of us struggle with.
I think a lot of times, we don’t necessarily associate the fatigue that comes with RA to the fact that we may not be sleeping well. Sounds simple enough. But I think we think of fatigue as a symptom rather than a suggestion of some other type of issue.
Sleep issues with RA might be more common than you think:
“Studies have found that between 50% and 75% of RA patients report problems with their sleep, as indicated by difﬁculty falling asleep, staying asleep, nonrestorative sleep, and excessive daytime sleepiness... Sleep complaints in RA are 2–3 times more prevalent than in the general population, and signiﬁcantly higher than in patients with other medical conditions such as obesity, hypertension, and respiratory illness... Importantly, sleep disturbance may contribute to greater pain, disease activity, and mood disturbance, creating a cascade of dysfunction for afﬂicted patients…” (Nicassio, et al. 2012: 107).
I like the idea of the “cascade of dysfunction” because I think it highlights how important good sleep can be for the overall health and wellbeing of RA patients. A lack of good sleep can also cause a vicious cycle (Irwin, et al. 2012), causing an increase in pain, depressive symptoms, and functional disability (Luyster, Chasens, Wasko, and Dunbar-Jacob. 2011).
So what did my rheum think about my current fatigue situation?
He thinks I may have sleep apnea.
To be honest, I thought my rheum was being kind of stupid. Like really? I have another problem?
Fatigue is so common to RA that I was frustrated that my rheum was pushing my fatigue off on something totally new and different for me. (I was also embarrassed to admit that in the last year or so I have started to snore).
But after reading some of the literature on the topic, it appears that people with RA do in fact have a higher incidence of sleep apnea (Reading, et al. 2009).
Sleep apnea is a condition that causes your breathing to pause or become shallow, causes loud snoring, and is responsible for causing fatigue (http://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea/).
And it is important to note, as my rheum told me, that contrary to what people may think, you do not have to be obese to suffer from sleep apnea.
My rheum wants me to have a sleep study done, and I’m still waiting for that to get set up. If it ends up happening, I’ll be sure to write about it.
Irwin, M.R., R. Olmstead, C. Carrillo, N. Sadeghi, J.D. Fitzgerald, V.K. Ranganath, and P.M. Nicassio. 2012. “Sleep Loss Exacerbates Fatigue, Depression, and Pain in Rheumatoid Arthritis.” Sleep 35 (4): 537-543.
Luyster, F.S., E.R. Chasens, M.C. Wasko, and J. Dunbar-Jacob. 2011. “Sleep Quality and Functional Disability in Patients with Rheumatoid Arthritis.” Journal of Clinical Sleep Medicine 7 (1): 49-55.
Nicassio, P.M., S.R. Ormseth, M. Kay, M. Custodio, M.R. Irwin, R. Olmstead, and M.H. Weisman. 2012. “The Contribution of Pain and Depression to Self-Reported Sleep Disturbances in Patients with Rheumatoid Arthritis.” Pain 153 (1): 107-112.
Reading, S.R., C.S. Crowson, R.J. Rodeheffer, P.D. Fitz-Gibbon, H. Maradit-Kremers, and S.E. Gabriel. 2009. “Do Rheumatoid Arthritis Patients Have a Higher Risk of Sleep Apnea?” Journal of Rheumatology 36 (9): 1869-1872.