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The Magic of of Sleep Hygiene and Where it Fails for People With RA

The Magic of Sleep Hygiene and Where it Fails for People With RA

About ten years ago, I had had it. My sleep patterns had become so awful that I spent three weeks sleeping about two hours a night. My body had become an overtired infant that screamed all night, but my screams were silent screams of frustration, anxiety, and pain that got worse every night. I’ve had difficulties with falling asleep for as long as I can remember- as a child I would spend hours lying in bed looking out the window at my favorite tree, dreaming about ways I would climb it someday and seeing shapes in the silently moving leaves. Once I fell asleep I was golden; often I’d wake up to the off-key tunes my Dad liked to sing while marching up the stairs in the late morning, “Good Morning To You, My Children!” he would happily wail as I covered my ears and groan. Over the years, though, bedtime became a time filled with fear as I wondered what the night would bring. I tried every herb I heard of and some of them really helped for awhile, and took medication for many years but even with all of these helpers, at times my body would just completely refuse to sleep. The first step to changing anything is understanding it, and the day I’d had it, I booked an appointment with a sleep specialist to finally figure out how to fix my problem.

I wish I could say that the appointment solved my problem; it didn’t. What it did do is make me more aware of my sleep habits, what sleep experts call sleep hygiene. Much of sleep is learned behavior; in order to help your body to sleep you need to create the right environment, both internally and externally. Sleep hygiene teaches you how to give it the right cues. As I learned and began to try these tips I also became very aware of where these guidelines fail people with RA, as our sleeplessness usually begins with the same causes- inflammation and pain, two things that can’t be trained away.

So, what are the guidelines that encompass Sleep Hygiene and how can you tweak them to help you sleep, even with pain and swelling? First I’ll list the guideline and then I’ll talk about the “hacks” I’ve created for myself.

  1. Have a regular schedule: As much as you can, go to sleep and get up at the same time every day, even on days off.
  2. This works in theory, but for people in pain, any minute of wasted sleep matters so I don’t bother with waking myself up unless I absolutely have to; if my body will sleep in it means my pain and fatigue will be lower so I’ll have a better chance sleeping the next night.

  3. Sleep when sleepy
  4. Meaning don’t go to sleep unless you are really sleepy, so you don’t lie in bed too long.

    This is a good suggestion, although I amend it a bit, I go to sleep as I’m getting sleepy not when I’m exhausted because the act of getting into bed takes time and energy, and my bedtime ritual involves lying with a hot pack on my back for a few minutes. If I wait until I’m exhausted often I can’t sleep, which is a paradox I’ve found many people with chronic pain face.

  5. Get up if you can’t sleep in 20 minutes and do something that doesn’t stimulate your senses like reading the phone book.
  6. This one I never follow with one exception- if my pain is so bad I need to stretch or do something to alleviate it a bit. I can’t remember the last time I fell asleep that fast, and I’m not convinced that it ever happened after the age of two for me. So, getting up every twenty minutes is simply a way to stay up all night, not get me to sleep.

  7. Avoid caffeine,alcohol and nicotine.
  8. This is a good suggestion. We all know caffeine and nicotine are stimulants, obviously bad choices for sleep, and alcohol makes you drowsy, but interrupts sleep quality, so even if you are asleep you aren’t; getting the rest you need.

  9. Use your bed for sleeping and sex only. No reading, watching TV, or looking at your computer or phone in bed.
  10. This is another one I don’t pay attention to fully. I always read in bed, this is part of my nighttime ritual and has been since I was a kid. I understand the rationale for the guideline, but I know that for me, reading is essential to relax my mind, and that relaxes my body. The blue lights coming off your phone and computer are known to interrupt your circadian rhythm, so I avoid them, and I avoid reading from tablets at night for the same reason.

  11. No napping allowed.
  12. This one made me laugh- I ignore it completely. Again, for someone without pain or inflammation I understand the reason, but naps have saved my sleep. And by naps, I mean taking time to lie down in the afternoon, to listen to meditation music and rest my body/mind, and feeling like I won the lottery if I actually drift off. If I lie down and relax during the afternoon, I don’t end up overtired as much at night and as I said, over-fatigue is a sleep killer for me.

  13. Use sleep rituals that encourage sleep.
  14. Some ideas would be deep breathing before sleep, having a lavender sleep pillow, or a cup of herbal tea.

    This idea I love. I have a ritual that involves a heating pad, sleep herbs, reading, and brainwave music that I listen to. I highly encourage everyone with sleep issues to start a ritual, keeping in mind things that help you to relax, and definite no-nos. Anything that interrupts your circadian rhythm, your bodies internal clock, is a bad idea, and basically that means you need to keep the lights down after sunset.

  15. Use a warm bath or shower to relax, one or two hours before bed.
  16. Love this idea, and as someone with JRA, I move the timeline up a bit. If I do a shower or bathe too early my muscles my tighten back up before bed. But you need your core body temperature to be lower when you got to sleep so getting too hot is counter-producitve.

  17. Don’t watch the clock.
  18. I follow this religiously. I don’t have a clock in my room and keep my phone turned off by the bed. Just last night I had to turn on my phone to check a reminder after I tried to get to sleep, and saw the time. It did nothing but stress me out more.

  19. Use a sleep diary.
  20. I did this once and it didn’t help. But I do recommend this idea, because it makes you pay attention to what you are doing and how it may be impeding your sleep.

  21. Exercise regularly.
  22. A good idea, but there are obvious issues with this. I move my body every day in some way, but try to avoid over-doing it because this will increase my pain and make it harder to sleep.

  23. Eat right- don’t go to bed hungry but also don’t have a heavy meal close to bedtime.
  24. A good idea all around. Focus on foods that you are confident don’t upset your digestion.

  25. Keep your bedroom cool, and dark.
  26. Again, a great idea, and I follow this one to the tee. These two thing help you circadian rhythm to encourage sleep.

I hope these guidelines, with tweaks, can help you to sleep soundly in the upcoming days and weeks- let me know if you have tweaks of your own!

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


  • Linda
    1 year ago

    Hi, Kat. Thank you so much for writing this article. I have struggled with sleep my entire life. In the past I have beaten myself up for feeling like I haven’t followed the sleep hygiene strategies closely enough. I’ve realized more recently that pain and inflammation are key causes of my insomnia and interfere with my ability to follow them. I know exactly what it is like to have daily fear about whether or not you’ll get to sleep. Then the lack of sleep causes worse pain and fatigue and round and round it goes. I really appreciate the ways that you’ve suggested to modify sleep hygiene techniques. One thing I have also learned is to use blue light blocking glasses in the evenings when it comes to electronic devices. It hurts my hands to hold a physical book so using a tablet is the only way I can read and often watching some tv is a perfect way for me to relax. Blue light blocking glasses solve that issue and are relatively inexpensive. Hope you sleep well tonight. Warmly, Linda

  • Monica Y. Sengupta moderator
    1 year ago

    Same here, Linda! I definitely want to try those glasses! All the best, Monica

  • kat-elton author
    1 year ago

    Hi Linda- thanks so much for letting me know about the blue light blocking glasses. I’m going to look into this today. Have a great day and thanks for chiming in

  • Disney1962
    1 year ago

    I too have made a habit of going to bed at 10 every night. Or as close to 10 as possible. Sometimes a show runs over, but I make that my new thing. ALSO sometimes I do fall asleep in my lift recliner and I don’t care, it’s a great feeling to get those hours of sleep.

  • kat-elton author
    1 year ago

    Hi Disney! Sounds like you have a few tweaks of your own- glad you have some things that work for youhave a great day!

  • astrobarn
    1 year ago

    Thank you for the amended tips. I will definitely try some out. I don’t have problems falling asleep but wake up with nightmares and find it difficult getting back to sleep due to pain.

  • P.J.
    1 year ago

    Thank you for the tips. I do nap when I can because I can make it through the rest of my day. 10-15 minutes works for me. I just recently got a diffuser and put lavender oil in it at night, ok, I was skeptical but a friend with RA told me this works, so I tried it. I don’t sleep solidly, but a lot better. Also I got an electric blanket and keep it on very low. For some reason this helps too. I don’t keep a sleep diary but I do have a diary in which I start off with ” I am grateful for…” I know it is hard to be grateful when you have RA (I also have OA) but the small wins help me see the positive things I do have in my life.

  • Lawrence 'rick' Phillips moderator
    1 year ago

    All great ideas but I have to admit I am a non compliant best sleep hyginer (it should be a word). I do like the idea of following best practices and I hope someday it will help me as well.

  • Tich
    1 year ago

    Thanks for the article Kat. My sleep is a reflection of my overall wellness. My feet haven’t been well this winter following our flood disaster. Both gave me serious pain when walking and even when sitting or laying prone. The radiologist called it mid-foot collapse. I walked less and less, and in so doing experienced more tightness and spasms in my back. I used muscle relaxer in addition to my pain meds to get a few hours of sleep. Remarkably the pain eased and I was able to walk more frequently, but not as long as before. But I am oh so grateful to be able to walk a bit to loosen up and get some sleep without spasms.

  • kat-elton author
    1 year ago

    I agree Tich, When my sleep isn’t good, it means other aspects of my health aren’t either and usually if I work on those, my sleep gets better. Glad the muscle relaxer worked for you, and I hope your walking gets better too!

  • Jo J
    1 year ago

    I agree with many of your tweaks. I just wish I could sleep later and wake up more comfortable and rested. It does help if I watch TV from bed for about 30 minutes before arising in the morning. I think it wakes my brain and allows me some gentle movement to wake up my joints. I do find a sunrise clock – custom set to gradually lighten up over 30 minutes to my target rising time – is helpful. Especially in the winter.

  • kat-elton author
    1 year ago

    Hi J0dspace, I agree, waking up too early is so disheartening, especially when you wake up tired. I like your idea of turning on the tv for a bit before getting out of bed, and I’m going to look into a sunrise clock- thanks!!

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