Sleep and Rheumatoid Arthritis
If you are anything like me, sleep comes hard with RA. I never had an issue with sleep until I was in my first full-blown RA flare and coincidentally or not, started treatment for RA at the same time.
I know many of the meds used for RA, some nearly universally, can cause sleep issues, Prednisone being the first to come to mind. Not that Pred needs any help with a bad rap, but as I started out for my first two years of treatment on 40 mg a day, I believe this was the start of my sleepless nights. Many of the friends I have made over the years on RA sites suffer from the same insomnia, and we have chatted way into the wee hours of the morning on many, many nights. I started some time ago to try and break the sleepless cycle that RA has spun me into, and have had a few wins over the years.
Sleep is very important to RA patients, a Johns Hopkins’ Rheumatoid Arthritis treatment information page says Rheumatoid Arthritis patients “often need over ten hours of sleep a night, or eight hours a night and a two-hour nap during the day.” Sleep is one of the few things that can truly help fight the pain and fatigue that auto immune arthritis brings to us. A great post on Sleep and RA by RA Warrior also poses a few other very real causes of insomnia and RA. CVA, or cadio vascular disease, which can be very prevalent in RA and Sleep Apnea due to the breakdown of the mandible joints due to RA. I know when I am hurting bad, or the fatigue has run my batteries to empty, or RA has just beat me down for the day, I want to be in my bed.
So far I have been fortunate in the cardio area, passing a stress test and heart ultrasound. Sleep apnea, however, has become a constant companion of mine for the last two years. I have been to the sleep lab several times and am already on my my second CPAP machine. I can tell you if you wake up feeling like you have not slept, or your significant other complains of your constant snoring… get to a sleep lab I can tell you, with the proper treatment for sleep apnea, you will at least feel more refreshed after whatever sleep you can acquire.
A few years ago, after discussing sleep issues with my doctor he prescribed Ambien for me. He also told me that there is really no “grey area” with Ambien, you either love it, or hate it. I awoke one morning, after sleeping quite well, or so I thought… My laptop was missing! I could not find it anywhere, my wife and I searched the shop, where I normally keep it, and found the mouse, power cord, printer etc. - no laptop! After searching the house to no avail I was beginning to wonder if someone had broken in and stole my computer. I went to get dressed wondering what my next step should be, opened my dresser drawer and there was my laptop! How it got there, or whatever else may have gone on is anyone’s guess. One of the more common side effects of Ambien is sleep walking, and even driving! I stopped taking Ambien that day.
After this scary trial of sleep by medication I decided to take a different approach to the problem. Trying hard to not nap during the day just did not work, for some reason come dinner time the fatigue kicked in and I stiffened up while we ate. 90 percent of the time I head from the dinner table to my bed. That made my main target the bed!
I have a VERY thick orthopaedic mattress by Stearns and Foster with a 6 inch pillow top, and I added a 4 inch memory foam mattress pad to it. This makes for a VERY tall bed, think Grandmas old feather bed. It is literally hip high on me and I am 6’ tall. This works for me as well as I can just lay down on it without bending down, and to get up I just slide my legs off and I am standing. I also use two memory foam queen pillows, two standard foam queen pillows and two body pillows. With all these pillows I can pretty much prop up, or put under anything that hurts, and pretty much get comfortable. I use a blue lit alarm clock, and have read that it is NOT recommended for insomnia. RED is the suggsted LED color, but blue seems much less harsh to me. I have a tower fan in the corner of the room blowing full speed and a ceiling fan on medium for white noise, plus I find the breeze, no matter what the weather outside is, comforting. I am one of those people that like the sheets and a comforter right up around my neck, all pulled in tight. I have a TV as well, and keep the fan and tv remotes close on my nightstand. Bottom line is, make your bed and bedroom an escape for you, whichever way you prefer to sleep, outfit it to your needs and you will rest much easier.
A few months ago, soon after I recieved my new CPAP, my Rheumy again brought up the sleep issue. He suggested I try Restolin. After some thought I agreed. For me, I have found Restolin to be a very good sleep aid. It makes me groggy, but I dont sleep walk and never feel like a zombie with it. It, as most RX sleep aids, can become addictive. I discussed this with my doc as well, he made a very good point… I already take Morphine and Oxycodone, both addictive, and I have no qualms taking those, the option I have is to NOT take it and go back to struggling with sleep again. So I take it! My doc is monitoring it and said we will switch up drugs from time to time to decrease the chance of addiction. And, frankly, addiction is a bit overblown in my non-medical opinion.
Many people also watch how late they eat, WHAT they eat, etc. I rarely have a night time snack, so I dont worry about that as much. I do occasionally have a beer in the evening, and that is one old wives tale I do follow. Alcohol, is NOT a good way to get to sleep. Most of us cannot drink anyway due to medications, but I thought it was worth mentioning.
I would be curious to find out any other ideas out there on how to get a good night’s sleep. I know you insomniacs are out there! Give us your tips!
I just took my Restolin, and am off to my “nest” of pillows! I wish you all a good nights sleep!