How to Sleep Better With Rheumatoid Arthritis

Is the pain of rheumatoid arthritis keeping you awake? Consider these sleep remedies.

elevate legs, ice, meditate, hot shower
Meditation and hot and cold therapy are some of the strategies that can help you sleep better with RA.Canva (3); Shutterstock

Unfortunately, for many people, rheumatoid arthritis and sleep problems are unpleasant bedfellows. With rheumatoid arthritis (RA), an autoimmune disease, the immune system mistakes the body’s own cells for foreign invaders, which often leads to inflammation of the joints and debilitating joint pain. This joint pain can be so intense that it interferes with your ability to sleep well.

RA sleep-related troubles can include not being able to fall asleep or sleep long enough, fragmented sleep or frequent awakenings, or sleep that leaves you feeling unrefreshed in the morning. A?study published in August 2022 in Arthritis Care & Research found that almost two-thirds of rheumatoid arthritis patients met the criteria for at least one sleep disorder, including obstructive sleep apnea, restless legs syndrome, or short sleep.

Good sleep, though, is essential for good health, and it’s important for everyone, says Yvonne Lee, MD, a professor of rheumatology at the Feinberg School of Medicine at Northwestern University in Chicago. “It may be particularly important for people with RA because poor sleep has negative impacts on inflammation and pain,” she adds.

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Why Sleep Is So Important for People With Rheumatoid Arthritis

Poor sleep can lead to a negative cycle: lack of sleep worsens your RA symptoms and your RA symptoms make it difficult to get the rest you need.

Pain Perception Changes When You Get Less Sleep

Sleep loss has been found to make certain pain centers in the brain more active and reactive than they would be after a good night's sleep, according to a study published in the?Journal of Neuroscience.

Research published in the Journal of Clinical Sleep Medicine found that poor sleep was associated with greater pain severity, increased fatigue, higher levels of depressive symptoms, and greater difficulty functioning in people with RA.

Besides disturbing sleep, RA pain can make it difficult to get out of bed in the morning or to exercise during the day. The trouble is, lack of physical activity can actually make RA disease activity or joint pain, fatigue, and sleep quality worse, according to research published in Arthritis Care & Research.

RELATED:?Sleep Disorders Are Linked to Rheumatoid Arthritis

Depression Plays a Role in RA and Sleep Problems

Depression occurs more commonly among patients with RA than individuals without RA, notes Dr. Lee. “The association between depression and RA is likely bidirectional. Patients with RA are more likely to experience depression, and patients with depression seem more likely to develop RA. Patients with depression often have poor sleep. Again, this relationship is likely bidirectional.”

Treatment with antidepressant medications might help. “Some antidepressants, in particular tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors (SNRIs), may improve pain,” says Lee. “In some cases, this may be via improving sleep or decreasing depressive symptoms. It is also possible that these medications may have a direct effect on pain itself.”

RELATED:?The Link Between RA and Mental Health

10 Ways to Sleep Better With Rheumatoid Arthritis

Multiple strategies are often needed to sufficiently address chronic pain and sleep disturbances in people with rheumatoid arthritis because so many different factors are involved, including ongoing joint inflammation and fatigue. Plus, the symptoms can vary from week to week, even day to day. If you’re suffering from ongoing insomnia, it may be time to see a sleep specialist. But here are some strategies that can help minimize pain and improve sleep with rheumatoid arthritis.

1. Take a Hot Shower or Bath

The combination of heat and water can act as a mini-hydrotherapy session for your muscles and joints, relieving pain and stiffness. Slip into warm water before turning in for the night.

2. Try Heat Therapy

Invest in an electric mattress pad or an electric blanket and use it for 20 minutes to help you get comfortable before going to sleep. (Don’t leave it on all night; it’s a safety risk!)

3. Ice It Up

When joints are swollen, applying ice can be soothing and can help relieve inflammation.

4. Get Moving During the Day

Whether you do aerobic exercise (such as walking or cycling) or resistance training, exercising regularly can help reduce pain and swelling from RA. A study published in Rheumatology International found that people with RA who are more physically active have longer total sleep time. Just don’t exercise too close to bedtime, or the physical activity could have energizing effects, warns Scott Zashin, MD, a rheumatologist in private practice in Dallas.

5. Avoid Nighttime Stimulation

If you’ve been struggling with sleep, keep pets and television out of your bedroom. “In one of our studies examining sleep in patients with RA,” says Lee, “we asked patients to complete sleep diaries, and we noticed that a relatively large proportion of patients reported that their sleep was interrupted by pets, particularly cats. Obviously, pets can improve quality of life in many domains, but perhaps not sleep.” Also, avoid reading something exciting or disturbing or using an electronic screen (such as a computer, tablet, or smartphone) for at least an hour before bed.

6. Elevate Your Legs and Find the Right Position

It can be helpful to slide a pillow under your knees, if you sleep on your back, to alleviate pressure on knee joints, hips, and back while you sleep. If you're a side sleeper, place a pillow or two between your knees, advises the Arthritis Foundation.

7. Practice Meditation

To set the stage for better sleep, try meditating and focusing your attention on your breath or relaxing images to help your mind and body decompress from the day.

8. Ask About Sleep-Supportive Medications

Depending on your situation, low-dose antidepressants, as mentioned above, might help. You might also talk with your doctor about sleep-promoting prescription drugs. As for melatonin, “I would say that the jury is still out in this area,” says Lee. “Melatonin appears to have anti-inflammatory properties in animal models of several autoimmune conditions. However, the data from animal models of inflammatory arthritis, as well as from human studies of RA, have been contradictory, with some studies showing anti-inflammatory effects, and others showing positive associations between melatonin and higher disease activity.” She notes that more studies are needed to better understand the effects of melatonin in patients with RA.

9. Avoid Bedtime Snacks

Try to stop eating about three hours before going to sleep, advises the Cleveland Clinic. This allows enough time for your body to digest what you last ate without disrupting your sleep. Also, avoid alcohol, which may help you fall asleep but can interfere with your sleep quality during the night.

10. Create a Soothing Sleep Environment

Get a mattress that is as comfortable as possible. Lee notes that studies have shown that sleeping on high heat capacity mattresses (such as cooling gel mattresses) is associated with better sleep than low heat capacity mattresses (that is, conventional foam mattresses). Also, consider buying a whole-body pillow so you can better position your joints to relieve pressure and discomfort. Choose soft bed linens and blankets that don’t put extra pressure on your joints.

Additional reporting by Stacey Colino and Deborah Shapiro.