Sleep Well Despite Rheumatoid Arthritis | Everyday Health

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

RA sleep-related troublescan include not being able to fall asleep or sleep long enough, having fragmented sleep or frequent awakenings, or having sleep that leaves you feeling unrefreshed in the morning.

The Benefits of Good Rest

Not surprisingly, people with RA who sleep well are better able to recover from the activities of the previous day, says Christopher R. Morris, MD, arheumatologistin private practice in Kingsport, Tennessee. But if a person sleeps poorly, “the muscles can’t fully relax. If they’re fatigued, they hurt. If they hurt, they get fatigued, and they hurt more.”

Pain Perception Changes When You Get Less Rest

Making matters worse,a study published in the January 2019 issue of theJournal of Neurosciencefound that sleep loss makes certain pain centers in the brain more active and reactive than they would be after abob ios下载 .

Indeed,people with rheumatoid arthritiswho don't get enoughbob ios下载 can get caught in a vicious circle. Research published in theJournal of Clinical Sleep Medicinefound that poor sleep is associated withgreater pain severity, increasedfatigue, higher levels of depressive symptoms, and greater difficulty in 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 toresearch published in January 2016 inArthritis Care & Research.

Sleep Medications and Rheumatoid Arthritis: What to Know

Research suggests that a number of factors contribute to chronic pain in rheumatoid arthritis — including underlying depression, notes Dr. Morris. In his practice, patients who experience trouble sleeping because of their joint pain are often prescribedantidepressants. A class ofantidepressant medicationscalled选择性5 -羟色胺再摄取抑制剂(SSRIs) can help offset chronic pain, both directly and indirectly, by affecting a person’s perception of pain and by addressingsymptoms of depressionthat many people with rheumatoid arthritis experience. While taking SSRIs, “I think patients feel better, they have more energy, they are able to function better; a lot of them will stay on [SSRIs] chronically,” Morris notes.

抑郁症的症状在扮演一个角色RA Sleep Problems

What’s more, Marcy O'Koon Moss, the senior director of consumer health and content strategy for theArthritis Foundation, notes that depression “is an underlying factor when it comes to sleep issues in patients with RA.” She suggests that people living with rheumatoid arthritis speak with their doctors about timing their nonsteroidal anti-inflammatory medications (非甾体抗炎药) near bedtime to help ease nighttime joint pain and make it easier to sleep. She says to keep in mind, though, that certain other medications used totreat RA, such asprednisone, acorticosteroid, can disrupt sleep.

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.

10 Ways to Sleep Better With Rheumatoid Arthritis

Some strategies tominimize painand improve sleep with rheumatoid arthritis include:

Take a hot shower or bath.The combination of heat and water can act as amini-hydrotherapy sessionfor your muscles and joints, relieving pain and stiffness. Slip into warm water before turning in for the night.
Keep the heat on.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, advises Moss. (Don’t leave it on all night; it’s a safety risk!)
Ice it up.When joints are swollen, applying ice can be soothing and can help relieve inflammation.
Get moving during the day.Whether you doaerobic exercise(such as walking or cycling) orresistance training, exercising regularly can help reduce pain and swelling from RA. Astudy published in May 2018 inRheumatology Internationalfound 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, warnsScott Zashin, MD, a rheumatologist in private practice and a clinical professor of internal medicine at the UT Southwestern Medical School in Dallas.
Avoid nighttime stimulation.If you’ve been struggling with sleep, keeppetsand television out of your bedroom, urges Morris. Also, avoid reading something exciting or disturbing or using an electronic device (such as a computer, tablet, or mobile phone) for at least an hour before bed. Your bedroom should be used for sleepand sexonly.
Elevate your legs.It can be helpful to slide a pillow under your knees to alleviate pressure on your joints while you sleep.
Practice meditation.To set the stage for better sleep, trymeditatingand focusing yourattention on your breathor relaxing images to help your mind and body decompress from the day.
Ask about sleep-supportive medications.To facilitate better sleep among patients with RA, Morris sometimes recommends low-dose antidepressants such asElavil (amitryptiline)orOleptro (trazodone). You might also talk with your doctor about other sleep-promoting prescription drugs, such as muscle relaxants,Lunesta (eszopiclone), orAmbien (zolpidem).
Avoid bedtime snacks.Don’t eat anything for a few hours before bedtime, Morris advises, because eating causes blood to be diverted to digestion, which can interfere with sleep. Also, avoid alcohol, which may help you fall asleep but can interfere with your sleep quality during the night.
Create a soothing sleep environment.Both Morris and Moss advise people with RA to get a mattress that is as comfortable as possible. Also, consider buying a whole-body memory-foam 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 byStacey Colino.