Sleep and Sleep Hygiene

Rheumatoid arthritis (RA) itself is often linked to symptoms like excessive daytime sleepiness, fatigue, pain, and depression. These symptoms may have a negative impact on the ability to get sound sleep. Sleep problems and related symptoms affect an estimated 54 to 70 percent of adults with RA and include difficulty falling asleep, non-restorative sleep, excessive waking during the night, and daytime sleepiness and fatigue.¹

There is some evidence that increased joint pain interferes with sleep. Such pain may increase body movement during the night and cause interruptions in sleep and reduced sleep efficiency. Several sleep studies conducted in patients with RA have shown that sleep problems are directly related to disease activity. Additionally, patients with RA are at increased risk for primary sleep disorders including restless leg syndrome, sleep apnea, and periodic leg movements of sleep.¹

What can I do to improve my sleep?

There are some simple steps that you can take to improve your sleep. These steps are designed to promote good sleep hygiene. We usually think of good hygiene in terms of washing our hands or keeping kitchen surfaces clean, but hygiene applies to sleep as well. If we practice good sleep habits, we can improve our ability to get a full night’s rest. Recommendations for good sleep hygiene include:²

• Avoid napping during the day. Napping during the day can disturb our normal wake-sleep pattern.
• Go to bed and get up at the same time every day (including on weekends). If you establish a regular time for getting to bed and getting up, there’s less chance that you’ll throw your body’s internal clock off.
• Avoid stimulants close to bedtime. Stimulants, including alcohol, caffeine (coffee, chocolate), and nicotine can interfere with our ability to sleep soundly. While alcohol may get us to sleep quickly, when it is fully metabolized it can cause arousal and can interfere with the next stage of sleep.
• Don’t eat too close to bedtime. Eating food before bedtime can cause sleep disruption. Do not eat large, heavy meals too close to bedtime.
• Get enough natural light. Exposure to natural light will help maintain a healthy sleep-wake cycle.
• Get regular exercise. Getting regular exercise is good for your overall health and will improve your sleep, as well. Just make sure that you don’t exercise too close to bedtime.
• Develop a relaxation routine before going to bed. Put aside an hour or so to wind down before getting into bed.
• Use your bed only for sleep and sex.
  It is important to associate your bed mainly with sleep, so do not read or watch TV in bed. Ideally, you should use your bed only for sleep and sex.
• Make sure your sleep environment is conducive to sleep. Make sure your bedroom is relaxing: your bed should be comfortable and your room should be dark and quiet. The temperature in your room should not be too hot or cold.

What can I do if sleep hygiene is not enough?

If you continue to have sleep problems despite trying to improve your sleep hygiene, talk to your doctor about ways to improve your sleep. Your doctor may refer you to a specialist who can evaluate your problem and suggest a treatment plan.

Your sleep problems may be related to nighttime pain or depression. So, adequate treatment of these conditions may improve your ability to sleep. A doctor who specializes in treating sleep problems can also recommend the use of a number of drugs with sedative properties, including selected antidepressant medications, benzodiazepines, or other insomnia medications.

Are there supplements that I can take to help with sleep problems?

There are several herbal and other supplements with sedative properties that may be beneficial in improving sleep. These include the natural body chemical melatonin and the herbal supplements valerian, kava kava, 5-HTP (Griffonia simplicifolia), and boswellia.

Talk to your doctor before you try an herbal or other supplement to improve your sleep. Because herbal and other supplements can react with pharmaceutical treatments for RA and may pose a risk themselves when taken at too high a dosage, it is important to discuss your use of these substances with your doctor. Your doctor has the resources and tools to identify potential harmful interactions between treatments, both prescribed and non-prescribed, to ensure your safety. In addition, your doctor can help you determine the proper dosage for any supplements that you decide to use.

Are there treatment options other than drugs and supplements for improving sleep?

A variety of complementary and alternative medicine (CAM) approaches can be useful in promoting relaxation and helping with sleep problems. These include meditation and hypnosis, as well as mind-body disciplines such as yoga and Tai Chi. Some CAM approaches that are effective at relieving pain may be useful in improving sleep, if joint pain is causing restlessness or interrupted sleep at night.