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RD “Sundowning”

You may have heard of the term “sundowning.” Generally, it refers to how some Alzheimer’s and dementia patients’ symptoms seem to grow worse late in the day and evening.

But recently, a Twitter friend of mine used the term “sundowning” to describe the way her rheumatoid disease symptoms ramped up in the latter part of the day.

Now, I don’t mean to compare RD to dementia in any way. They’re very different diseases and conditions. But I immediately understood what my Twitter friend was talking about because I frequently have the same experience. I start hurting more after about 3 p.m. most days. By the time I go to bed at night, I’d like to chop the offending limb off and have it over with once and for all.

I’ve looked and looked, but I can’t find any references or research on this odd phenomenon in regard to rheumatoid disease. But I know that my Twitter friend and I aren’t the only ones whose RD joints often start feeling worse later in the day. Like those of us whose joints hurt more when the barometric pressure is high, low, or changing, or when it’s cold, hot, or humid outside, the time of day is something that seems to affect RD symptoms for many of us but doesn’t have any definitive scientific explanation to back it up.

So, please allow me to do a bit of unscientific conjecturing.

Maybe our joints hurt more because our bodies are tiring out as the sun heads west in the sky. Coping with pain—even low-grade pain—on a frequent basis is, let’s face it, tiring. When the pain is moderate or severe, it’s more than that—it’s exhausting. Is it any wonder that we just hurt more—or perhaps are more sensitive to pain—as the day wears on?

Because the rise and fall of barometric pressure has always had an effect on my RD pain, I’ve become a barometer-watcher. I want to know why I hurt, dang it! Recently, I noticed that the barometer tends to rise and fall throughout the day. Maybe that’s why I tend to hurt more after lunchtime on some days and not others.

Or maybe RD acts like some acute illnesses do in the afternoon and evening. Who hasn’t had their cold or flu symptoms feel worse as the day becomes night? Your nose clogs up worse or runs more. Your cough gets more frequent. If you’re running a fever, it goes up some as the sun goes down. You just plain feel more miserable.

Maybe it has something to do with our circadian rhythm—our body’s internal clock, which is tuned naturally and instinctively into the rise and set of the sun. That rhythm governs all sorts of biological processes, including when we wake up, when we get sleepy at night, our hormone levels, and etc. Why shouldn’t it also influence our perception of pain, of fatigue, and of illness?

Whatever the reason it happens, I sort of like the term “RD sundowning” to describe that inexorable increase in RD discomfort as the day wears on. Do you experience this, too? Any thoughts on what might cause it? Tell what you think!

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Joni
    2 years ago

    I am sane way , I will get morning stiffness but it seems to me “sundowing “ is more my problem … we find so many things that cause pain or swelling .. God bless all and prayers going up …

  • Wren moderator author
    1 year ago

    Hi, Joni,
    This “sundowning” is something I think our rheumatologists ought to know about. They never mention or ask about it–just “morning stiffness.” It’s sort of funny, isn’t it? Of course we’re stiff and sore in the morning–we’ve been in basically one position all night, not moving much. Inflamed joints do stiffen up when we’re not using them….
    Thanks for taking the time to comment, and thanks for the prayers you’ve offered for all of us. Wishing you a lovely holiday and a joyous New Year. 🙂

  • Rals52
    2 years ago

    I think I have more things to distract me during the day and have accepted pain during the day as my new normal. As evening comes on and chores are done, family is in bed and I’m alone with little distractions the pain becomes much more noticeable.

  • Wren moderator author
    1 year ago

    Hi, Rals52,
    That makes so much sense! I tend to be busier earlier in the day, as well, with a lot to distract me from pain and other RD discomforts. Makes sense that when I start to slow down, I’d notice them more…
    Thanks so much for taking the time to comment. I really do appreciate it, and I hope to hear from you again soon. Here’s wishing you a lovely holiday and a joyous New Year! 😀

  • Olfalatumas
    2 years ago

    Yes Wren… this applies to me as well. Barometric pressure is prevalent in my symptoms and has been even before I knew the reason. I used to think my dad was nuts saying he could feel the weather change. Even though he was never diagnosed with RA, I am certain now that he was probably fighting it as well.

    I am very active during the day. It takes me a while to fire up in the am, but I do it just so I don’t hurt. 9 am yoga helps me 3 days a week and the gym and walking at least 2 days as well. Plus, I keep an 1 acre wildlife habitat in shape during the day, trimming trees, mowing etc. but when I come in for the evening… sundowner gets me. I am prone to using pain meds more during the evening and before bed than any other time of the day.

    I often just have to get up and move or sit on the floor and do some yoga postures to make it to bed time. Then during the night.. same thing. I often just get out of bed early to stop the pain. It is a daily thing, but more often than I would like. You are not alone.

  • Wren moderator author
    1 year ago

    Hi, Olfalatumas!
    It sounds like you’ve found the best way, for you, to deal with your RD. That’s a lot of activity–I’m delighted that you’re about to manage it all. It can’t be easy. Please know that you, too, are not alone. We’re out here rooting for you and for each other every day.
    Here’s wishing you a lovely holiday and a joyous New Year. Thanks so much for commenting. I hope to hear from you again in 2018! 🙂

  • Delia A White
    2 years ago

    This is so me!! By 3 pm, I’m done and start wanting my lovely bed – I want to be horizontal. Thanks for sharing.

  • Wren moderator author
    1 year ago

    Hi, Delia,
    Yep, me too–except I feel like I’m being a lazybones if I crawl into bed at 3 p.m.. So I just live with the symptoms until I can make a graceful exit (HAH! Graceful as I limp and stump my way out) to bed and some temporary horizontalness.
    You’re so welcome, I’m delighted to share. But sorry you have to live with RA ‘sundowning,” too.
    Here’s wishing you a lovely holiday and a joyous New Year. Hope to hear from you in 2018! 😀

  • Cassandra Bird
    2 years ago

    lol I do get a major sundowning each day, we are pretty much screwed most of the time I love how you describe the barometric pressures and temperatures effects, basically everything affects us, I get maybe two hours a day that are better than the rest and I try my best to use those two hours to be a mum who takes part in her family life. Great article thanks Hun much love and breathe easy x

  • Wren moderator author
    1 year ago

    Hi, Cassandra Bird,
    Oh, you’re so sweet! Thanks for your best wishes. It’s taken me a long while to reply to your comment, but I do hope you’re feeling better these days and getting more than two good hours to take part in life with your family. Here’s wishing you and yours a lovely holiday and a very happy, pain-free 2018. 🙂

  • 4anRACURE
    2 years ago

    So good to know I am not the only one feeling this in the evening and at night. It was explained to me after an MRI that my spine and lower back have been greatly affected. After a day of water exercise and normal activity my nerve endings in my lower extremities are driving me crazy. I am sensitive to many medications so I take 2 Tylenol, a hot shower and use a heating pad. I try to get to sleep quickly. I am better by morning after a night of rest. I try to sleep 8 hours. I also get epidurals once a year which work well. I am a 68 year old female and have had RA for at least 40 years but first diagnosed in 2009.

  • Wren moderator author
    1 year ago

    Hi, 4anRACURE,
    You are surely NOT the only one. I’ve been amazed at the number of comments this particular post inspired! It sounds like you’re doing all you can for your disease, including water exercise, which I’ve heard can be really helpful.
    Please know that you have friends out here who know exactly how you’re feeling, from physical pain to the emotional ups and downs the disease causes.
    Here’s wishing you a very happy holiday and a joyous New Year. 🙂

  • MehurtsNow
    2 years ago

    The barometric pressure is Ali I watch, most time I feel the change in weather 3 days out. Such as today, by tomorrow evening we’ll have a 40 degree temp charge.
    It makes sense to me that everything is worse at night. Gravity taking its toll all day, we’re stressed with pain.

  • melmason
    2 years ago

    I’m at my worst when I first get up in the morning, and in the late afternoon/evenings. The later it gets, the worse my pain gets. It sucks, especially when I have to chauffeur our daughter around to her after school activities.

  • HeidiKat
    2 years ago

    I’ve had RA for 24 years (diagnosed at 29), and I am wiped out with pain and absolute exhaustion by 3:00-4:00 in the afternoon. I have to schedule any activities during my “good window” (everything being relative), which is between 9 or 10 am to 3 pm

    I’m not sure if anyone else dreads going to bed. I try to explain to my husband that for me bed isn’t the comfy cozy place it is for him. I turn so often and omg when I have to pee in the night. Putting the weight on my feet and body before it decides It’s ready to rise (and I’m not overweight). I feel like I morph into a 90 year-old at night.

    So yes, I experience “RA Sundowning”

  • Wren moderator author
    2 years ago

    Hi, 251fcfb,
    Oh, my dear! I understand completely how you feel about going to bed at night! I’m like that, too–more nights than not, it’s not the cozy place it used to be. Just call me FrankenWren.
    That said, it sounds like you have your “window” figured out. Funny how living well with RD often means learning to schedule our lives to fit our pain and fatigue levels.
    Thanks so much for stopping by and taking a moment to comment. I do so appreciate hearing from you! 🙂

  • HeidiKat
    2 years ago

    Referring to your article, I should mention that “Rd Sundowning” is every day for me regardless of weather… For me, I think it’s exactly like your comparison to having a cold or flu. It’s just worse at night.

  • fairyboots
    2 years ago

    I agree with this 100%! By the mid afternoon most days, I feel the exhaustion really setting in. I almost always have to take a short nap just to continue functioning the rest of the day. The pain definitely intensifies and also the brain fog!

  • Wren moderator author
    2 years ago

    Hi, fairyboots!
    Ah, the mid-afternoon catnap! It’s so underrated! I do the same when I can, and most times, I only need 20 minutes or so to feel like I can get up and go on. It all depends on what my RD is doing on any particular day.
    Thanks so much for stopping in and taking the time to comment, fairyboots. Have I mentioned I love your “handle?” 😉
    Be well, and do come back. 🙂

  • Cherie46birds
    2 years ago

    I know exactly what you are feeling. I used to tell people that I have about 4 to 5 good hours in the middle of the day when I would be feeling my best. Felt bad in morning when I woke up, then take my meds then after taking my second dose of meds of the day I would start to feel “normal” at least partly. Then about 7 in evening I could feel myself going downhill. It has just become my way of sort of scheduling my day,as much as one who has RA can do that is.

  • Wren moderator author
    2 years ago

    Hi, Cherie46birds,
    Scheduling–or “pacing”–is absolutely vital when you have RD. I’m so glad you’ve worked out a way to do it so you can get things done before sundowning. And you know, we haven’t much choice, do we? Having this disease doesn’t mean that we have less work or responsibility than our healthier peers.
    I applaud your pluck and strength, Cherie. Thanks for stopping by, reading, and commenting. I appreciate hearing from you! 🙂

  • Jane Burbach
    3 years ago

    Wren, me too all the way. My rheumatologist concentrates on morning pain and stiffness. Mine is definitely worse in the evening and at night while trying to sleep. Why do they concentrate on the morning?

  • Wren moderator author
    2 years ago

    Hi, Jane Burbach,
    I’m not sure why rheumatologists focus so much on “morning stiffness,” as opposed to the stiffness and pain we experience during all those other parts of the day. Stiffness and pain in the morning seems an almost obvious condition in the morning, after we’ve spent hours barely moving!
    I think I’ll ask my rheumy next time I see her.
    Thanks for taking the time to read and comment, Jane. I’m delighted to hear from you! 🙂

  • MsKGMC
    3 years ago

    I do notice an increase in pain during the evening and night. I assume normal daily activities tire us out more due to pain and fatigue associated with RD.

  • Wren moderator author
    3 years ago

    Hi, MsKGMC!
    I’ve said it before and I’ll say it again: although I’m sorry that others ALSO hurt more in the afternoon and evening hours, I’m SO glad I’m not coping with this alone. It’s good to know that others completely understand.

    I hope this finds you feeling good! Thanks so much for commenting. 😀

  • Linda
    3 years ago

    Thanks for writing this article, Wren. I absolutely also experience sun-downing and had previously thought that RD’s manifestation in me was more unique in that way. For me, it’s almost like a switch gets turned on after 5pm and the pain ramps up and up from there. I’ve also figured that maybe pain got worse because I have to force myself to get through more mild pain and fatigue all day long and by the end of it my body has had enough. The cumulative effect of coping with RD’s effects every single day is so exhausting! Hope tonight holds less pain for you. – Linda

  • Wren moderator author
    3 years ago

    Hi, Linda!
    I’m agree that the cumulative effect of coping and compensating all day long with various RD symptoms, including pain and fatigue, must contribute to this “sundowning” phenomenon. But it’s happened to me when I’ve been resting most of the day, too. Perhaps the ongoing, systemic inflammation the disease causes is another reason it happens? There’s just so much about RD that’s still mystery–to us and to medical researchers and scientists.

    Thanks so much for such a thoughtful comment. Here’s to answers! 🙂

  • kikikk
    3 years ago

    The same thing happens to me! As the day progresses, my pain AND fatigue get worse and worse. Especially, if I don’t take my pain meds soon enough. I think it may be because we have worked, exercised, grocery shopped, attended doctor appointments, and whatever else we do. We do this all the while we are in pain too. By the time late afternoon and early evening comes, we are more exhausted and in more pain.

  • Wren moderator author
    3 years ago

    Hi, kiki!
    I’m right with you on this one. Along with the ongoing, systemic inflammation the disease causes, the many things we DO all day in spite of RD symptoms certainly may contribute to that “sundowning” effect. This disease is so mysterious and changeable! It didn’t used to affect me this way, which is probably why I decided to do a little research and write about it. I’ve been really surprised to discover that it’s so common among those of us with RD, and I hope that the medical/scientific folks will take note. It would be nice to have an explanation!
    Thanks for stopping in and commenting. I appreciate it and I hope you’ll speak up again in the future. 😀

  • Delia A White
    3 years ago

    This disease has so many variables. I like the term ” RD Sundowning.” The doctors always give me an odd look when I say that I hurt more in the evening and, yes, it starts around 3 pm.

  • Wren moderator author
    3 years ago

    Hi, Delia A. White!
    This makes me so curious! It seems like so many of us hurt more later in the day that doctors would be familiar with it. But you’re right–RD is unpredictable and varies from person to person. I’m sorry you “sundown” too, but I have to admit it’s nice to have company.
    Thanks for taking a moment to comment! 😀

  • Debby Stachler
    3 years ago

    I have been dealing with the same thing. So relieved to hear I’m not alone with this symptom. Only thing my RA Dr recommend to split my dose of prednisone, half in AM & half PM, which I usually all at night. This might be why things are in reverse is my only guess. Hope we all get relief soon!

  • Wren moderator author
    3 years ago

    Hi, Debby Stachler!
    Another “sundowner!” You’re certainly not alone, and it seems this particular symptom is fairly common. Has splitting your prednisone between AM and PM helped? I hope so!
    Thank you for taking the time to comment, Debby. 🙂

  • caddymom45
    3 years ago

    I have always hurt more at night than in the morning! Doctor always asks me how long it takes me to get out of bed, well I get out of bed fine, but getting into bed at night is another story!I have not found any ideas that make it hurt less!

  • Wren moderator author
    3 years ago

    Hi caddymom45,
    I think we should form a club–the “RD Sundowners!” I’m similar to you: I’m pretty stiff in the mornings (probably from being mostly still for hours) but only occasionally wake up with a lot of pain. That generally comes later in the day and in the evening. So I break out my ice and heat packs and do what I can to distract myself. I find that listening to music and reading help with that.
    I hope you’re feeling better. Thanks so much for taking a moment to comment. I love hearing from you! 😀

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