The Vicious Cycle of Pain, Sleep Disturbance, and Depression
Discussions within the rheumatoid arthritis community have a recurring theme that RA is not just “a little arthritis.” Sometimes we get offended by others who seemingly disregard the seriousness of this disease or flippantly toss it aside as something which only causes minor aches and pains. However, osteoarthritis (OA) can be no walk in the park either.
Osteoarthritis affects nearly 30 million Americans, and I am one of those. At one time, I thought that perhaps RA was affecting my knees, but my rheumatologist said that she couldn’t detect any swelling in them. A few years ago, however, I was experiencing pain in my right knee such that I sought out an orthopedic doctor who could give me a steroid injection. It worked great and relieved the pain to a point where I could then feel how bad my left knee felt. But I didn’t seek treatment for that knee until last fall when x-rays confirmed osteoarthritis. A steroid injection relieved most of the pain for almost a year.
Near the end of this summer, the pain in my left knee escalated to the point where I sought treatment again. I wasn’t able to sleep through the night because of the pain, nor could I comfortably sit in much of our furniture. This time, however, the orthopedic surgeon suspected a torn meniscus (knee cartilage). MRI scans revealed fraying of the cartilage (no tears) with grade 2-3 cartilage loss (rated on a scale of 0, no loss, to 4, complete loss).
When the doctor called to give me the results, he stated that using an exercise bike on a regular basis would be the best thing I could do for my knees. I asked what else we could do because I still couldn’t sleep through the night, even after the steroid injection! He prescribed a series of injections of a substance called Orthovisc (which I still haven’t been able to try because of a hangup with insurance and the pharmacy).
Why am I sharing this on an RA website? I wanted to bring up the fact that OA can be excruciatingly painful! It can rob you of sleep, wear you down, lead to depression and disability. It may be minor aches and pains for some folks, but for others it can suck you into a vicious cycle of sleep disturbance-pain-depression-disability.
Studies have shown that those with knee OA report issues with initiating sleep (31%), difficulty maintaining sleep at night (81%), and general sleep problems (77%). Sounds like me lately. The only nights I’ve been able to sleep through since August are ones where I go to sleep in a recliner with pillows propping my knees up. Sleeping pills and pain pills can’t even get me through the night in bed if I roll around and put pressure on my knees in a particular way.
A new study published in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR), confirms that sleep disturbances are linked to pain and depression, but not disability, among patients with OA (n=288) at baseline. In individuals with low pain levels, sleep disturbance is unrelated to mood; but where pain is more severe, sleep problems exacerbate depression. Researchers found that sleep problems predicted increases in depression and disability, but not pain, at one-year follow-up 1.
“Sleep disturbance is a common complaint among those with pain, particularly among those with OA,” explains Dr. Patricia Parmelee from the Center for Mental Health & Aging at The University of Alabama in Tuscaloosa. “[Our] study shows that depression plays a strong role in the sleep-pain connection, particularly with severe pain. Further investigation of sleep in disability progression may lead to new interventions that disrupt the cycle of OA distress.”
While I never want to discount the pain and disability associated with RA, I also don’t want to disregard the potentially enormous impact of OA on a person’s life. This experience has led me to wonder just how much pain some of my relatives were in before they decided to undergo knee replacement surgery. I’m not there yet, but now think that it will be part of my future, someday.
An unintended consequence, however, of sleeping in the recliner that has helped to counter reduced mood has been the birth of a lap kitty. Each morning, I wake up with our gray cat, Oscar, happily curled up on my lap. He is literally a warm fuzzy that makes me smile throughout the day.
After the past 2+ years, how do you feel about telehealth appointments to manage your RA?