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The Sleep Problem

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 had issues with sleep? What helps you fall asleep?

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

  • stormlight
    6 months ago

    Yeah, this sounds horribly familiar — lying awake hour after hour because:

    • Your joints and muscles hurt like crazy;
    • Your brain won’t switch off;
    • You can’t help thinking about the future and you get seriously anxious.

    I use Amitriptyline – or, as I call it, “chemical waste” (I imagine they taste just the same) – for this. The drug began life as a tricyclic antidepressant, but a number of incidents of suicidal thoughts (and sadly, a couple of actual suicides) in young people, had it pulled from the shelves for this use. However, it turned out to have two off-label uses, as a drowsy-maker and as a neuropathic painkiller. (I also tried Gabapentin – made me put on 12lbs in 10 days – and Pregabalin – less benefit than a sugar pill – before Amitriptyline.) But it’s to be avoided if you’re working, because the drowsy-making effects are severe, and they can take 12hrs to wear off.

  • vera
    10 months ago

    I find it very difficult staying asleep. Sometimes i just lay there to rest my body but never sleep. The only thing that helps is daily exercise, healthy eating. I also take benedryl and a flexeril at bedtime. I am lucky if i get 6 hours of combined sleep a night.

  • Kelly Dabel moderator
    10 months ago

    Thank you for sharing vera. You are not alone here. Sounds like you’ve found some strategies that are helping you sleep a bit better. Wishing you some good sleep ahead. We appreciate you sharing and being part of our community. Best, Kelly, Rheumatoidarthritis.net Team member

  • Alice
    12 months ago

    Yes I have problems falling asleep.I saw a sleep specialist and I have restless legs and sleep apnea even though my weight is normal.The restless leg medication has helped. Greatly and using CPAP machine also helps. I still have anxious times when sleeping is impossible.Some times it’s pain or just can’t get comfortable. I drink this sleepy time tea and boring tv shows sometimes works.For hand pain I wear compression gloves and I always use a electric blanket on my painful feet Hope something here helps someone.

  • mzfixitz
    12 months ago

    I can get to sleep now, however I can’t stay there at all, I’m up every hour some nights, once in a while Il get two hrs at a time. Trazadone and zanax n clonidine have helped me so much. Not only does it run in the family but I have it with my RA too.

  • starscream
    1 year ago

    I find having an orgasm before trying to sleep helps. The euphoria overcomes the pain for a little while, and also leads to a lazy relaxed feeling. Since RA can make having sex difficult, sometimes one needs just to use a vibrator or something. I struggled with the morality of using a vibrator, and decided I already had my kids anyway so it shouldn’t be too wrong. Of course a lot of people have no moral concerns about it at all but I am from a traditional family, so this was awkward for me. I’ve been told it isn’t sex addiction to do it once a night before sleeping. Or even doing it twice a day to have a nap. It seems healthier than loading up on pain meds before sleeping (although I do take ibuprofen too).

  • pattycakes
    1 year ago

    a warm bath with lavender helps

  • PamelaP
    2 years ago

    If my hubby had read your initial post in this wonderful thread, he would have thought I’d have written it! I wrote earlier here about only wanting to sleep. It’s been over a year since then.

    Here I am at almost 4:00am and I haven’t gotten to sleep…yet! In the mornings I want to put off starting the day so I often don’t get up till noon. I know. I need to work on this. And I do and it gets better, but not for long.

    Yes to the bad dreams too. They have stopped but not till two or so years ago they started breaking because I have Sjogren’s too. So now they are all capped and my new smile is prettier than it’s been since they were baby teeth. But I’m not suggesting anyone do this!

    Time for back to bed. Wish me luck!

  • starscream
    1 year ago

    I try to sleep 9-10 hours no matter how late I stay up. So that also means sleeping until noon at times. Luckily my job has flex hours.

  • JordynAshleyH
    3 years ago

    Ohhh Mariah! The teeth crumbling! I have many many anxiety ridden dreams as well and I too have and sooo despise the teeth crumbling dream!! I finally figured out why I have that dream though…. grinding and/or clenching my teeth. I’ve had it for so many years and I have had tmj and now have flares in my jaw too so I’m surprised it took me so long to figure it out. Now that I’m telling you about it I can’t remember how I Did figure it out, not sure if I was telling my mom about the dreaded dream and she told me?? By the way I can’t fall asleep right now! RA. What? Brain fog?
    Sorry that is how I’m feeling at the moment, thanks for the post!

  • Katdeere
    3 years ago

    At the moment I am having bone tired fatigue. Then when I fall asleep I wake up each time I turn or move in bed, or if I raise the head of the bed to ease my heartburn and I don’t move much I am far stiffer when I awake. However some nights I do sleep well. And I enjoy those whenever they appear.

  • Jana
    4 years ago

    Sleep is a huge problem that I’ve battled a long time. I can’t sleep for the pain but most pain meds keep me awake and steriods keep me from sleeping completely. I’m so limited in sleeping positions can’t lay on my right shoulder that I had surgery on but need to have completely replaced or my left hip that has a tendon tear from inflimation on and on. I’ve been given a few different meds to try to help with sleep but nothing is very successful. And like you said I’ve never had so many crazy dreams in the last month since changing my blood pressure meds 3 times.

  • Mariah Z. Leach moderator author
    4 years ago

    Hi Jana ~

    I also suffer from insomnia when I take prednisone – which is frustrating as it helps so much with pain and energy! I hope you will keep working with your doctor and experimenting with different techniques so that you can find something that works for you!

    Best,
    ~Mariah~ (Site Moderator)

  • PamelaP
    4 years ago

    I appreciate this post and the comments. It was quite informative. But I have the OPPOSITE problem. All I want to do is sleep! Probably 3 nights a week, perhaps 4, I sleep 11-12 hours. And then I might take a 2 hour nap in addition to this. If I do this, then the day following I’ll have a “good” day. And I don’t overdo on my “good” days. I feel like I’m sleeping my life away. I don’t like it at all. I’m new to RA (at least being diagnosed) and having trouble sorting it all out. Hopefully soon I’ll be given a medicine that really helps with the pain. I couldn’t take Paquenil so I’m on Methatrexate. I’m wanting it to work but am not sure that it is. If it is, then it’s not enough. But I don’t want to take a medicine with more dangerous side effects! What to do….

  • Mariah Z. Leach moderator author
    4 years ago

    Hi Pamela ~

    It can certainly take some time to adjust to the diagnosis and find the right combination of medications that work best for you. While there are certainly risks to some medications used to treat RA, I think it is important to keep in mind that your doctor will only recommend a medication when he/she thinks that the benefits will outweigh the risks. And please do keep your rheumatologist in the loop with how you are feeling. It is his/her job to make sure your treatment is something you are happy and comfortable with – in all aspects of your life!

    Best,
    ~Mariah~

  • Patricia
    5 years ago

    Actually, reading in bed relaxes me and allows me to fall asleep more easily than if I didn’t read in bed. Most nights I can fall asleep when I want to, but staying asleep is a problem. I sleep 2 or 3 hours and wake up; some times I go right back to sleep and other times I have to read for 15 mins. or so in order to fall asleep. Most times that will work, but at least once a week I have a night when 3 or 3 1/2 hours are the maximum amount of sleep. No reason, just happens with no obvious trigger. Crazy!…I don’t drink any thing hot ever (not my thing at all!) so no herbal tea for me. I’m a night owl any way, and always go to bed around 2 AM. If I could sleep straight thru, I’d wake around 8 or 9 AM; that’s the way it was before RA…but now..sheeeeeesh!!! Just a good thing that I’m retired and don’t have to get up for work!

  • Mariah Z. Leach moderator author
    5 years ago

    Hi Patricia~ So glad you’ve been able to identify that reading in bed works for you! Obviously these tips are just suggestions (based on my own experiences and research) but really each of us has to experiment to figure out what combination of techniques will give us the best results!

  • Melissa Davenport
    6 years ago

    So glad you wrote about this! Sleeping is a huge issue for me. Fortunately, I’ve worked out a few things that help me, like you have mentioned. I go to bed around the same time every night and wake up around the same time. I have a cup of herbal tea and, depending on how I’m feeling, I may take some herbal sleeping pills (normal sleeping pills have the opposite effect on me so I can’t use them). It helps some but it is a constant thing that I need to work on.

    It never ends with RA! 🙂

  • Mariah Z. Leach moderator author
    6 years ago

    Hi Melissa ~ So true that it never ends! Even the sleep problem goes up and down for me. Sometimes the things that used to work stop working and I have to start the search again. You are right that it is a just another constant thing to work on. Best of luck and wishing sweet dreams to you!!

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