Toss and Turn, Sleep and RA
RATE

I looked at the clock with uncertainty as I awoke to a dull but spreading pain in my hand. The darkness of the night crept through the slits in the blinds. “You can’t be serious,” I thought to myself, “I can’t handle another sleep deprived night.” Losing myself in the land between consciousness and alertness, I dosed on and off intermittently. Time crept along and a lugubrious march through the melancholy night of increasing discomfort in my fingers and knuckles. “Have I been sleeping?” I thought as the darkness persisted.

“Have I been sleeping?”

A dose of prednisone as mandated by the doc washed down my throat as thoughts of the coming day began to enter my mind. “If it is just my left hand, I will manage. But I’ve got to get some sleep, otherwise, it will be a drudge-fest.” I reached for the extra pillows I keep nearby, ready to be stacked, folded, or otherwise contorted to provide some comfort to swollen limbs, digits, joints, or feet. I tried elevating my arm, folding it across my chest with a pillow beneath my elbow, and an array of other desperate maneuvers to see if I could reduce the brewing wretchedness. The pillows didn’t work. Nothing would relieve the malevolent throbbing that announced its presence like an unwelcome Mephistopheles here to collect the damned.

“Just get moving, and things will be better.”

Strangely enough, I eventually fell back asleep with my hand squeezed tightly between my rib cage and arm. Reducing the pain was a matter of immobilization. When the alarm greeted me, so too did flashes of pain, building it seemed, through the last hours of the dark morning. I pulled my hand in front of my face and with sadness noted visible swelling and a constricting wedding band that would be difficult to remove. “At least I got a few hours of sleep,” I thought, trying to give naive encouragement to my sinking motivation. “Just get moving, and things will get better.”

Unfortunately, if I wake up in pain due to the capriciousness of rheumatoid arthritis, it is a toss up whether or not I will go back to sleep. I have developed a few strategies for handling such nighttime misadventures, one of which, stacking pillows, was mentioned above. Getting pillows just right, not an inch too high or low, and with my arms, wrists, of hands positioned just so, can be enough to appease the blessed Hypnos and bring a shaky slumber. Not every time, but sometimes.

A few other strategies

Immobilize: Whether the pain is in the wrist, knuckles, or fingers, I find immobilizing the entire hand with a brace or ace bandage can relieve the pain enough to get back to sleep. I keep a reversible brace near the bed.

Ice or Heat: Inflammation during a flare gives me a sensation of heat in the affected joints. This by itself is enough to keep me awake, though the accompanying pain doubles down on the RA-induced insomnia. I keep a few ice packs in the freezer and have used them on my knees and shoulders in the middle of the night. Fifteen minutes of ice has been enough on occasion to get me back to sleep, at least for a few more hours. Some people do not like cold with RA. Perhaps heat will provide nighttime relief.

Sleeping aids: Talk to your doctor about prescription sleeping aids. On occasion, if the pain is present before sleep or just after, a sleeping aid has helped get me through the night. I personally try to avoid sleeping aids as much as possible. I quickly become reliant. Yet on occasion, they have been a lifesaver when the morning held some critical event.

Resignation: Lastly, there is an unfortunate reality to RA and the sleeplessness it can induce. If a night spent awake tossing and turning seems inevitable despite my best attempts, I find reading a book or doing something work related can at least pass the hours.

What strategies work for you?

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