Getting Better Sleep When You Have RAby Jerilyn Covert Health Writer
Can’t sleep? Welcome to the club you never wanted to join. More than half of people with rheumatoid arthritis have trouble getting shut-eye—that’s as much as three times the rate of everyone else. “Sleep problems are ubiquitous in the RA population,” says Robert Hylland, M.D., a rheumatologist in Michigan. Given how uncomfortable the disease, that’s hardly a surprise. Find out how you can improve your sleep through tips for better zzz’s, and why that better sleep is beneficial for not only your mind, but your body too.
Better Sleep Tip: Assemble Your Support Team
A useful thing to do first? Find help. That means asking your family doctor for effective strategies, suggests Dr. Hylland, and possibly seeking a sleep specialist. Meanwhile, keep working with your rheumatologist to find the right balance of medications and therapies to control your RA symptoms. By seeking assistance across fields, you’re more likely to find solutions that work for you.
Better Sleep Tip: Manage Your Pain
If the ache in your joints keeps you awake at night, you’re not alone. Studies show that sleep problems with RA are often due to pain, so much so that the patient community calls it painsomnia. Staying ahead of your pain throughout the day helps, as does other pain-defeating tools: heat and ice, splints and extra pillows to support joints, and talking to your doctor about tweaking your meds.
Better Sleep Tip: Go Pillow Shopping
“That’s the number-one tip I hear from people,” says Cathy Kramer, 51, a HealthCentral patient advocate who has lived with RA for more than 10 years. “Buy lots of pillows.” Use them to provide extra support where you need it. Tuck a pillow under your painful shoulder, slip one under your knees to take pressure off the joint, or if you’re a side sleeper, try placing a pillow between your knees to keep them from stacking.
Better Sleep Tip: Create Your Oasis
Turn your bedroom into a calm, comfortable environment where you can relax. Think about all your senses. Use calming colors, invest in high-quality sheets, spray some lavender oil on your pillow, and tell Alexa to play soothing music. Research suggests that listening to relaxing tunes lowers cortisol levels, reducing stress. Most studies cite classical music but choose what works best for you.
Better Sleep Tip: Kill the (Digital) Lights
Exposure to bright lights at night—especially the harsh blue light emitted by digital devices—can trick your brain into thinking it’s daytime, priming you to stay awake. That not only makes it harder to fall asleep but can impact sleep quality too. In one small study, subjects who were exposed to blue light at night had less energy the next morning than those kept in darkness—even though both groups slept for eight hours. So power down your phone, turn off the TV, and skip bright LEDs in the bedroom. Try a red bulb instead—it won’t suppress sleep hormones.
Better Sleep Tip: Work on Pro-sleep Habits
Standard sleep hygiene applies here. Limit caffeine late in the day, avoid alcohol before bed, and try to go to bed and get up at the same time every day. Adopting a routine that prepares your body for sleep can also help: Try a warm bath, a good book, and some cozy PJs. Sleep routines work wonders for kids, and they can do the same for you.
Better Sleep Tip: Take Your Meds Earlier
Some commonly prescribed RA meds—like steroids and hydroxychloroquine (Plaquenil)—can cause insomnia. If you suspect your medications are keeping you up at night, talk to your doctor about taking them in the morning.
Better Sleep Tip: Meditate Before Bed
Stress management is key to good sleep, and meditation can help. Among older adults with moderate sleep disturbances, mindfulness meditation improved sleep quality more than twice as much as following sleep hygiene tips, according to a study from UCLA. Try five minutes of deep breathing before bed, recommends Weijia Yuan, M.D., a rheumatologist at the Hospital for Special Surgery in New York. Or try using an app (just turn the brightness down on your screen first!).
Better Sleep Tip: Invest in a Quality Mattress
A good bed is extra important when you have RA or other chronic illnesses. Look for a mattress that is firm enough to keep your body in a neutral position without sagging. Memory foam is a good option, but if you tend to sleep hot, you may want to try an innerspring mattress. The key word here is try–you should test any mattress before committing.
Better Sleep Tip: Listen to Your Body
An RA diagnosis takes some adjustment and can be difficult to accept. It often comes with feelings of regret that you can’t always perform the way you used to. “I’ve heard people say, they feel guilty about not staying up with their husband or doing activities with the kids,” says Kramer. “So they resist going to bed when they need to.” Realize that sometimes your body may require more rest now, and that doesn’t make you a bad person, she says. Plus, going to bed on time tonight will make it that much easier to get the most of your day tomorrow. And that matters for these reasons (and more):
Sleep Is Crucial Because...It Numbs Pain
Sleep helps regulate the central nervous system and not getting enough can make you more sensitive to pain. In a 2013 study from Brigham and Women’s Hospital, RA patients with sleep problems had a much lower pain threshold than their better-rested colleagues, suggesting that sleep affects pain perception regardless of inflammation. “If we want to get secrets out of spies, we sleep-deprive them for 72 hours,” notes Dr. Hylland. “Modest pain feels intolerable. Many of my patients are sleep deprived, and with the stress and pain of rheumatoid arthritis, they too can feel like their pain is intolerable.”
Sleep Is Crucial Because...It Reduces Stress & Brain Fog
Tossing and turning all night can cause stress hormones to rise, triggering inflammation and those painful flareups, says Dr. Yuan. What’s more, the body typically clears out inflammatory chemicals while you sleep, allowing it to function better during the day, says Dr. Hylland. A bad night impairs its ability to do that, leading to brain fog.
Sleep Is Crucial Because...It Curbs Fatigue
Yes, this is obvious. If you don’t sleep, you feel fatigue. But it's a double whammy when you have RA: The inflammation that triggers pain and swelling in your joints (proteins known as cytokines) is also a signal to the body that it needs to rest so it can heal. And the more active your RA, the more tired you feel. “Sometimes just lifting your bedsheet up over you can be a struggle,” says Kramer. In one UK study, 39 percent of people with rheumatoid arthritis had a baseline of extreme fatigue. You don't need insomnia making it worse.
Sleep is Crucial Because...It Stops the Vicious Cycle
Missing the train to Slumberland exacerbates your symptoms, which then makes it even harder to catch the next night. “The way you break that cycle is with restorative sleep,” says Dr. Hylland. That’s not just about the amount of sleep but the quality of it. When you’re constantly waking up, you may not bank enough deep sleep, the kind that’s key for tissue repair. “You know your sleep was restorative if you wake up feeling rested,” says Dr. Hylland. Simple as that.