Joint Pain at Night: What You Need to Know
If joint pain and other symptoms of osteoarthritis keep you up at night, then you could soon find yourself trapped in a vicious cycle.
Mounting research not only ties inadequate sleep to a long list of chronic diseases, but also suggests that too much tossing and turning can make osteoarthritis harder to cope with.
As your symptoms intensify, it may become even more of a challenge to get some shut-eye, and pretty soon pain and insomnia could dominate your life.
Most adults should get at least seven hours of sleep each night to maintain good overall health. While older men and women often experience changes in sleep patterns that can interfere with getting a good night’s rest, it’s a myth that they require less sleep than younger people.
The good news: If you have osteoarthritis and battle insomnia, several recent studies suggest that some simple measures can help you drift off faster and stay asleep longer, which should make your symptoms easier to manage.
People with arthritis are more than twice as likely as others to report suffering from insomnia, according to one study.
Another study of older adults with knee pain from osteoarthritis and other causes divided sleep problems into categories: 31 percent said they had trouble falling asleep at night, 81 percent struggled to remain asleep once they drifted off, and 51 percent said they often awoke in the wee hours of the morning.
To make matters worse, some research suggests that osteoarthritis patients are more likely to be light sleepers, meaning they spend less time in deep, restorative phases of slumber. Devices that measure body movements during sleep show that people with osteoarthritis flinch and thrash about more than people without the condition.
A frequent question is whether it’s possible to experience pain while you sleep, since the capacity to perceive any experience—including aching joints—requires consciousness.
However, research suggests that the brain’s ability to process pain is at least partly active during sleep. And it’s not hard to imagine why a throbbing knee or hip joint might keep you from dozing off in the first place.
Consequences of poor sleep
A wave of research in recent years has linked poor sleep to a growing list of health problems, including obesity, cardiovascular disease, high blood pressure, diabetes, alcohol abuse, and others. There’s also growing evidence that getting too little sleep can pose a variety of problems for people with osteoarthritis.
Not surprisingly, osteoarthritis patients who report trouble sleeping are also more likely to say they feel fatigued during the day. Some experts believe that excess weariness helps explain why women with osteoarthritis have 25 percent more falls and a 20 percent higher risk of fractures than other women.
There’s growing evidence that poor sleep can also mean more pain for people with osteoarthritis. Studies have shown that osteoarthritis patients who have trouble sleeping report greater pain severity.
New research may help explain why this occurs. In a 2015 study published in Arthritis Care & Research, a team from Johns Hopkins University School of Medicine led researchers from several other institutions in an investigation of the connection between osteoarthritis, insomnia, and a phenomenon known as central sensitization.
In central sensitization, the nerve pathways that deliver pain signals to the brain become highly excitable. That causes pain signals to become “amplified,” or more intense, which makes people extremely sensitive to painful sensations, a condition known as hyperalgesia.
The investigators recruited 208 people to participate in the study. Some had knee osteoarthritis, a portion of whom also suffered from insomnia. The study also included a group of people without osteoarthritis, some of whom had insomnia.
All participants were subjected to various tests, including measurements of how much pain they could tolerate. For example, a device was used to apply increasing pressure to a volunteer’s knee until it became unbearable; sensitivity to hot and cold was tested, too.
Results of the study showed that people with knee osteoarthritis and insomnia were somewhat more sensitive to pain than osteoarthritis patients who slept well, and significantly more sensitive than the other participants.
This study’s findings support earlier research suggesting that lack of sleep causes central sensitization, intensifying pain signals to the brain.
Importantly, this study also found that short sleepers who catastrophized the most—that is, those who adopted a feeling of hopelessness and thought obsessively about their pain—were especially sensitive to painful stimuli.
More sleep, less pain
Research has shown that osteoarthritis patients with insomnia who overcome their sleep deficit notice that their pain levels improve.
If aching joints leave you wide-eyed at night, an important part of the solution is to make sure you’re taking all the needed steps to manage your pain, including using analgesics properly, maintaining a healthy weight, and getting regular exercise.
If you follow a good pain-management plan but you’re still counting sheep, adopting some new sleep strategies may help.
For example, research has found that a form of short-term psychotherapy known as cognitive behavioral therapy (CBT) can help osteoarthritis patients cope with insomnia.
The goal of CBT is to help people identify thoughts and actions that are causing problems in their lives, then adopt healthier attitudes and behaviors.
In a 2015 study published in Arthritis & Rheumatology, researchers recruited 100 people with knee osteoarthritis who complained of insomnia. Half of the volunteers were randomly chosen to take part in a three-month CBT program for insomnia.
They were taught to change their bedtime habits, such as turning in only when they felt sleepy and getting out of bed if they couldn’t fall asleep.
Other strategies for joint pain at night
Other strategies included limiting use of the bedroom for other activities—no more watching TV in bed—in order to help them associate that room with sleep. The remaining participants were enrolled in an insomnia-treatment program that didn’t use CBT techniques.
All participants were asked to use special devices that measured how long they slept, as well as keep “sleep diaries” of how well they rested. At the end of the study, diary reports indicated that 80 percent of people in the CBT group had achieved relatively normal sleep patterns, compared with 50 percent of participants in the non-CBT group.
Data from the sleep-measurement devices suggested that the CBT group slept better, too. Pain levels improved overall, but CBT appeared to have a greater benefit. An earlier 2013 study, involving 367 older adults with osteoarthritis, also found that CBT helped improve sleep.
Consult a licensed psychotherapist to learn more about CBT for insomnia. Other strategies that can help promote sound sleep include limiting your caffeine intake and avoiding alcohol or large meals before bedtime.
Go to bed at the same time each night, and rise at the same time each morning. Keep your bedroom quiet, dark, and at a comfortable temperature.
If improving your sleep “hygiene” doesn’t eliminate insomnia, a prescription sleep aid may help. But these medications carry a risk for serious side effects, so they should ideally be used on a short-term basis, if at all.
Find out if the supplement melatonin can help you sleep.