The Importance of Sleep with Rheumatoid Arthritis

Lene Andersen | May 3rd 2017

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Rheumatoid arthritis (RA) affects all areas of your life, including the ability to participate in your family, community, and work. It also affects your appetite, moods, and the ability to get a good night’s sleep. Anxiety about life with RA, pain, depression, and other symptoms can all contribute to sleep disturbances, which can increase fatigue during your waking hours. Getting enough sleep can have a profound impact on quality of life for people with RA.

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Fatigue and RA

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“The fatigue is almost worse than the pain.” This is a common statement in the RA community. RA fatigue feels as if someone has pulled your power cord, leaving you depleted of energy, too exhausted to move. It can severely impact your life. A UK study found that 38.8 percent of people with RA had a baseline of extreme fatigue. RA can also cause sleep disturbances in as many as 40 percent, resulting in increased fatigue.

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Biological foundations of fatigue

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There is a biological foundation for the fatigue experienced in RA. Proteins involved in the inflammatory response (cytokines) make you want to rest so it is easier for your body to heal. The more active your RA is, the more tired you are. Commonly, one of the first signs that a new medication is working is an increase in energy as the inflammation begins to be suppressed.

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Importance of getting enough rest

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Sleep is an essential part of improving your quality of life with RA. Lack of adequate sleep can increase sensitivity to pain and compromise the immune system. Getting a good night’s sleep, as well as getting rest during the day, can help reduce your overall experience of pain. “That one third of our life spent in bed quickly becomes two-thirds of your life out of bed. So really, your whole life revolves around sleep,” says Nicholas Vardon, sleep consultant at Hastens in Toronto.

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RA, sleep, and depression

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RA doesn’t just affect your body, but also your mental health. Between 13 and 42 percent of individuals with RA experience major depression. Of those, close to 11 percent have thoughts of suicide. Depression may be connected to the difficulties of living with chronic illness, but can also be linked to systemic inflammation. As well, inadequate sleep can contribute to not just an increase in pain, but also exacerbate depression.

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Medication impact on sleep

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Another factor that can impact our ability to sleep is medication. A couple of commonly prescribed RA medications can have side effects of insomnia. One is hydroxychloroquine (Plaquenil), and the other is steroids. Both can be important tools to suppress inflammation, so you need to weigh benefits and side effects. Taking your steroid medication earlier in the day may help you reduce insomnia.

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Painsomnia

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Painsomnia it is the word used in the chronic pain community to describe insomnia caused by pain. High pain levels can prevent you from falling asleep, but can also make it difficult to get sufficient deep sleep, which is where restoration and healing happens. This can result in increased pain sensitivity, which interferes with the ability to sleep — and the two can continue to become a vicious circle.

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Your sleep environment

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Getting a good night’s sleep starts with creating a calm and comfortable environment to help you relax. “Your room should be your oasis,” says Vardon. Think about colors, textures, and mementos that help you feel safe and cozy. Color psychology suggests that blue tones are associated with serenity. Soft textures are comfortable, and you may take a note from your kids and go to bed hugging a stuffed animal. Falling asleep is also easier in a room that is quiet, dark, and cool.

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Getting comfortable in bed with RA

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Being comfortable in bed is a big part of getting a good night sleep. One part of the solution is getting a good bed, which is extra important when you have RA or other chronic illnesses. Vardon says “you shouldn’t feel like you’re in a bed. You should feel like you’re floating.” Buy as good a bed as you can afford, perhaps even save up money for it. Think about what’s important to you, compare different makes and types, and test out several beds before you buy.

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Supporting your body in bed

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Being comfortable doesn’t end with having a good bed when you have RA. Sometimes, your body needs extra support. Splints, extra pillows, even a rolled towel can support your arms and legs as you sleep. You can also get specialized positioning pillows and cushions that can help you be more comfortable. Ask your doctor or an occupational therapist for advice to avoid putting your body in positions that may lead to contractures of the joints.

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Improving your sleep hygiene

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Getting a good night sleep starts before you go to bed with practicing good sleep hygiene. Avoid caffeinated beverages and rich food for several hours before bedtime. Also reduce screen time prior to the time you sleep, as bright monitors on your computer, tablet, and phone can persuade your brain that it is daytime. Relax with a good book, a warm bath, or cozy PJs, and don’t vary the time you get up and go to bed too much.

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Your doctor can help

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If you continue having difficulty sleeping or are fatigued, talk to your doctor. They may test for deficiencies in vitamin D, vitamin B12, and iron, as well as thyroid disease or sleep apnea. If your pain levels are interfering with your sleep, your doctor can also refer you to a pain management specialist. When you have RA, it may be necessary to get used to a certain level of fatigue, but there are certain tips you can use to manage and build your energy that can improve your day-to-day life.