Are your RA symptoms affecting your sleep, or is your trouble sleeping making your symptoms worse? The answer may be both.

If rheumatoid arthritis (RA) has you tossing and turning at night, you’re not alone. While the exact percentage of RA patients who experience sleep problems is hard to determine, but most people with RA report fatigue as part of their symptoms.

Many people living with RA have sleep difficulties at least one night a week, whether it’s from the pain and discomfort of RA or other factors. If you have trouble sleeping, make a note of what your difficulties are. For example, are you having difficulty falling asleep or staying asleep? With this information your doctors will be able to help you get a better sleep by potentially adjusting your medications.  

Why Sleep Matters

Sleep problems can increase levels of stress hormones and aggravate flares. Also, if you have sleep issues, you may experience more pain. When you sleep, you make all those brain chemicals that you need to feel better. If you’re not rested you don’t have all of these good hormones, so it may be more difficult to cope with your pain.

Besides increased flares, RA patients with sleep disruptions tend to have more trouble with depression, pain severity and performing normal daily functions than RA patients who didn’t have sleep problems. In a US study , 61 percent of the randomly selected RA patients in the study were deemed poor sleepers and experienced these issues. Also, in the deepest stages of sleep, the body releases growth hormones to repair tiny muscle tears that occur during the course of the day. People with RA who sleep fitfully may not get enough growth hormone to make needed repairs.

Who’s Losing Sleep and Why?

There are generally two groups of people with RA that experience sleep problems: those with a new diagnosis who are still adjusting their medication, and those who have lived with RA long enough that their pain is under control.

With new patients, often providing additional pain relief will help. You may also be anxious about your RA – from worrying about the possible side effects of their medications to concerns about how you are going to function at work or at home. Achieving good control of your RA will help the situation.

Some common RA medications may also contribute to sleeplessness. Corticosteroids such as prednisone can cause insomnia, agitation or depression. Your doctor may recommend you take these medications early in the day to try and reduce the impact on your sleep. Another is hydroxychloroquine (Plaquenil) which can sometimes make people nervous.

If your RA is well controlled, you may still experience sleep problems due to other issues not related to your RA such as stress-inducing changes in work or relationships. Sometimes, small lifestyle changes like cutting out caffeine in the evening, “lights out” on screen time an hour before bedtime can improve sleep. In other cases, learning relaxation techniques with a therapist or talking with a psychiatrist or psychologist about underlying problems may help.

If you have problems with your sleep, talk to your GP and/or rheumatologist so they can help assess you and manage help you get a better sleep.

Good sleep hygiene

Tips for good sleep include:

• Eliminate caffeine.
• Avoid naps, during the day.
• Don’t drink alcohol.
• Don’t eat a large meal near bedtime.
• Exercise, but not too late in the evening..
• Try to go to bed and get up at the same times every day
• Reserve your bedroom for sleep – no TV, mobile phones or even books. If you can’t sleep, get up after 20 minutes.
• Go into another room and read or listen to music until you’re sleepy.
• Avoid bright lights and electronic screens before bedtime.