My lack of sleep
Yep, unfortunately, this sounds way too familiar when I think about my own sleep. Or lack of sleep, I should say. My quality of sleep on average is worse than it is good, and painsomnia has a lot to do with it, I suspect.
I saw a funny meme on Instagram recently that showed two illustrations: one was captioned "Chronic Pain During the Day" and depicted a person falling asleep at her desk at work. The other picture showed her lying in bed at night with her eyes wide open, unable to fall asleep. That one is captioned, "Chronic Pain at Night." I laughed at it because it rang so true. How many times have I felt dead-tired and exhausted during the day that I can barely keep my eyes open? And then how many nights are spent lying in bed with throbbing joints and an aching body, unable to fall asleep? A lot of them. And I'm not alone.
RA and sleep issues
According to an article for Healthline, "In 2012, it was reported in the Pain journal and other publications that 50 to 75 percent of people with RA have some type of sleep problem, ranging from insomnia to drowsiness."
The article also states that "sleep is an odd paradigm for people with rheumatoid arthritis (RA) who often feel they either sleep too much or not enough." And sometimes, both are true with "fatigue and insomnia often going hand in hand."
But which comes first, the insomnia or the pain?
Does it matter? It's true that a person can get easily trapped in a vicious cycle of insomnia and sleep problems causing or exacerbating RA pain and vice versa. Which should you tackle first? Both at the same time? Personally, I'm not sure, but my instinct as a patient suffering from both would be to try to work on improving both problems if possible.
When my RA is more stable and less active, my sleep is usually better. And when I'm able to get more and better quality sleep, I see and feel noticeable improvements with my RA. In a perfect world, I wouldn't have RA and it wouldn't keep me up at night. But I do, and it does.
Why does my pain seem to get worse at night anyway?
According to an article from Creaky Joints, a main reason could be that because I notice my pain more at night, it therefore bothers me more.
“It is not as much that the pain is worse at night, but rather that the perception of pain is more pronounced at night, or the pain thresholds are lower at night,” says rheumatologist Elena Schiopu, MD, of Michigan Medicine Rheumatology at the University of Michigan. “One explanation could be that stimuli that are abundant during the day, the distractors, are no longer present at night.”1
This seems like a plausible reason for seemingly increased pain at night. I know that when I'm lying in bed, in the quiet darkness of my room, the pain that's been stabbing at my feet and ankles during the day seem to be much more apparent in the silence of nighttime. I'm not distracted by my phone or work or other people buzzing around me. It's just me, alone, with stillness and pain. It's no wonder that I feel like it's 10 times worse than during the day.
The Creaky Joints article explains that there are likely other reasons for feeling an increase in pain at night, such as: 1. It could be that levels of the anti-inflammatory hormone cortisol are naturally lower at night, or 2. Staying still in one position might cause joints to stiffen up.1
Creaky Joints goes on to suggest some tips to help make painsomnia better:
- Practice good sleep hygiene
- Exercise during the day
- Try meditation or deep breathing
- Create a relaxing pre-bed routine
- Consider CBT (Cognitive Behavioral Therapy)
- Use hot or cold therapy
- Make sure your bed is comfy
- Consider herbal remedies to help you snooze
- Discuss your medication options with your doctor
For more detailed information about each tip, please check out the full article online. This is a good list and there are many things on it that I should be doing to help with my sleep issues and painsomnia. But it's a one step at a time process, I think, and I need to try to not get overwhelmed by making lots of changes at once--or I won't do any of them. But, I will work on it; my sleep health is too important to ignore.
Do you find the pain scale is an effective tool?