The Sleep Problem
Although not technically a symptom of the disease, a lot of people with rheumatoid arthritis (RA) have trouble with sleep. Some people have trouble falling asleep. Some people have trouble staying asleep. Some people have trouble with both. Whether from pain, anxiety, depression, or even the side effects of certain medications, it’s not at all rare for people with RA to have trouble sleeping. In fact, some studies have found that the rate of sleep disturbances in people with RA is has high as 50% or 75%.
I have been one of those people. When I was first diagnosed, sometimes it would take me hours and hours to fall asleep. It took over a year to find a treatment that helped, so I was in pain a lot of the time. At night it felt like no matter what I tried I wasn’t able to get comfortable enough to fall asleep. I would lie there feeling like the pain was literally keeping me awake. But, unfortunately, treating the pain didn’t necessarily solve my sleep issues either. When I took a high dose of prednisone to reduce my pain, I dealt with the side effect of insomnia and was often unable to sleep at all.
When I did actually manage to fall asleep, I had nerve-wracking anxiety dreams on a regular basis. I’d dream that I was driving but my eyes wouldn’t open. I’d dream that it was snowing and the windshield of my car was shattered but my car wouldn’t start. Well before I actually became a mother, I’d dream that I was pregnant and being chased by wild animals. Or I’d dream that I had a sick baby and didn’t know how to care for it. Or I’d dream that I had twins and lost one of them. Sometimes I would dream that I couldn’t wake up no matter how hard I tried. But the dreams I hated the most were the ones where my teeth were falling out. Sometimes my teeth would fall out because I got hit in the face, but other times they just crumbled into my hands for no reason. I would wake up feeling more anxious than ever – and more exhausted than if I hadn’t slept at all.
Unfortunately, not sleeping only made me feel worse overall. And it turns out I’m not the only one. A study at the University of Pittsburgh found that in people with RA, poor sleep quality is associated with greater functional disability. The researchers also said that it is possible that increased disability can affect depression, pain severity, and fatigue, which in turn affect sleep quality. This creates a vicious cycle: you can’t sleep because you are in pain, but then you are in more pain because you couldn’t sleep.
If you have trouble sleeping, here are some ideas that might help:
Create a sleep routine. This can include a warm bath or shower or other relaxation techniques. Try to go to bed at the same time every night and wake up at the same time every morning, regardless of when you actually fell asleep. Having a sleep routine may help your internal clock naturally realize when it is time to sleep.
Make sure your bedroom is a comfortable environment by regulating the temperature, keeping noise to a minimum, and making sure it is suitably dark. And keep your bed as a place you use only for sleeping and sex. Doing other activities in bed, like watching TV, reading, or working, can teach your body not to be ready to sleep when you are in bed.
Avoid caffeine before bedtime, because it can stay in your body for a long time and make it even more difficult to fall asleep. If you want to have a hot drink before bed, try herbal tea or warm milk. Or try mixing warm milk with half a teaspoon of turmeric, a quarter teaspoon of cinnamon, and some honey. Turmeric may naturally aid sleep and, as an added bonus, both cinnamon and turmeric are natural anti-inflammatories which could help reduce your pain.
During the day, try to get regular, low-impact exercise. But, on the other hand, try not to over-exert yourself to the point of intense fatigue or exhaustion. Pacing yourself is key. It can also help to make sure you get fresh air and sunshine regularly.
If you try to fall asleep for thirty minutes and find that you can’t, don’t just lay awake in your bed. Go to another room to read, watch non-stimulating TV, or do something else quietly until you feel drowsy. Then go back to your bed and try to fall asleep again.
If none of these ideas help, you need to ask your doctor for help. You may need to have your pain medications adjusted, as chronic pain can be a major cause of sleep disturbances. You may need medication or therapy to help with depression or anxiety. Your doctor may even recommend medications just to help you fall asleep. (I needed all of these things!) By treating sleep problems, either with medication or therapy, your RA symptoms may actually be reduced.
Have you managed RA fatigue better than you used to?