Most people with rheumatoid arthritis (RA), a chronic inflammatory disease of the joints, have sleep problems. While it is hard to pin down exactly how many people living with rheumatoid arthritis are affected, some studies have suggested that 60 to 70 percent have some sort of problem with sleep. Suffice it to say, it's more common than not.

Poor Sleep Connected to Worse Health-Related Quality of Life

There is a cyclical association between pain, fatigue, disability, and sleep problems, as you might expect. According to a study published online in January 2018 in the journal BMJ Open, people with rheumatoid arthritis have worse health-related quality of life (HRQoL) compared with those living with other rheumatic diseases or healthy persons. Even when rheumatoid arthritis is considered well-controlled, health-related quality of life can still be poor. While many factors affect health-related quality of life, people with rheumatoid arthritis point to sleep disturbance as a primary contributing factor.

What’s Considered Bad Sleep? The Definition of Sleep Disturbance

Sleep disturbance refers to insufficient total sleep time, sleep that leaves you unrefreshed, or frequent awakening. While it can be a consequence of pain, fatigue, and disease activity, there are other causes too, including sleep apnea or restless legs syndrome.

How Sleeping Impacts Your Body And Your Pain

During sleep, important bodily functions occur, such as rest, information processing, memory, buildup of molecules and cells, and circadian rhythm. Inadequate sleep has a negative impact on body processes. Each of the processes impacts pain level, too.

Managing Sleep Problems: What Patients Say and What Doctors Think

For many people with rheumatoid arthritis, managing sleep problems is as challenging as managing pain — especially because of their interconnectedness. “I’d say I have moderate sleep issues since RA,” reports Paula Mair of Woodbury, Minnesota. “I have trouble falling asleep, staying asleep and, at times, waking up is a bear!”

A Change in RA Treatment Helps Improves Sleep for One Woman

Mair says that, for her, sleeping improves when she can get comfortable. “So, it has improved since using Orencia (abatacept) — to a point.” Distractions help, says Mair, and she takes her iPad to bed and reads or watches movies until she can relax enough to sleep.

Mair says that when she discussed her sleep problem with her rheumatologist, “Her answer was Trazadone (Oleptro) at bedtime. I have a hard time with sleeping pills, don’t handle them well, so I’ve turned it down.”

“Sleep issues have been a constant issue,” says Lorraine Blank of Jupiter, Florida. “Falling asleep and staying asleep is next to impossible. I constantly switch positions trying to find a less painful side. I wake up often and the least little noise makes my eyes pop open," she explains. “I feel as if I will never wake up refreshed. I can't remember what that is like.”

Sleep Medication Helps Some People Living With RA

Blank uses sleep medication. “I have tried to not use it but then I simply do not sleep," she says, adding that she feels frustrated with her body and experiences tremendous pain in her lower back. “My knees hurt when they touch each other as I sleep on my side, so I have to have a pillow between them,” says Blank. While Lidoderm (lidocaine) patches have helped, Blank says her current insurance plan doesn’t cover them. “I have tried over-the-counter pain patches, heating pad, pain medication or muscle relaxers, and hot showers," she says, adding, “I find myself exhausted and at the same time almost dread trying to sleep.”

According to Sharon DuBose Evers, sleep has always been troublesome. “Even as a child, long before RA," she says. Since the diagnosis, sleep has become more problematic for Evers. “I have issues falling asleep and staying asleep,” she says, “Many nights I go to the couch and read.”

Night-Time Pain Medication May Help Improve Sleep

Evers says that while her rheumatologist sent her for sleep study years ago, it didn’t help explain her sleep issues, and her doctor has since prescribed sleep medication along with a pain medication for use at night. “I hate depending on a sleep medication to sleep, so I will only take it when I am exhausted or when I know I have a lot going on the next day. I am hopeful every night that I will fall asleep, stay asleep, and wake up refreshed!”

Sleeping Well When You Have Rheumatoid Arthritis

Poor sleep is commonly associated with rheumatoid arthritis largely due to pain, stress, and lack of exercise, according to Scott J. Zashin, MD, a rheumatologist in Dallas. Rather than prescribing sleep medication, such as Ambien (zolpidem) or Restoril (temazepam), Dr. Zashin shares sleep tips with patients and encourages exercise early in the day. “In certain cases, I may prescribe a non–habit forming medication, such as Neurontin (gabapentin),” he explains, adding that some people may benefit from taking tart cherries with natural melatonin after dinner. Magnesium is another natural option to try.

"While sleep problems are generally manageable, it can be difficult," Zashin stresses. "Also, when sleep problems are not well-managed with rheumatoid arthritis, it can be a trigger for secondary fibromyalgia. When indicated, I also check my patients for symptoms of sleep apnea, including snoring, snorting, or smacking noises.”

Studies Show Link Between Inflammation and Sleep Disruption

According to a study published in September 2017 in the Journal of Caring Sciences, pain severity and sleep problems in rheumatoid arthritis are predictive of increasing inflammatory markers (such as CRP), which correlate with disease activity. Pain relief and better sleep can decrease inflammation and affect disease activity.

Another study, published in August 2017 in the journal NeuroImmunoModulation, concluded that inflammation influences sleep. Researchers revealed that treatment with methotrexate or Enbrel (etanercept) improved sleep quality.

Healthy Sleep Habits Should Become Routine

Most people know about healthy sleep habits. Most would admit the habits are important. But, even so, something inevitably intrudes and those healthy habits become failed attempts — if they are attempts at all. When that happens, we are charged with the task of trying harder. Make the effort each night to include the following healthy sleep habits, and try repeatedly until it becomes your routine:

Establish a regular bedtime. Go to bed at the same time every night and get up at the same time every morning. This includes weekends and days off, too.
Get an adequate amount of sleep each night. While it is said that seven to eight hours of sleep is optimal for most people, you should determine what amount you need to wake up feeling refreshed.
Go to bed when you feel sleepy. If you feel sleepy when you climb into bed, you will fall asleep more easily. Reading before bedtime is a popular way to wind down.
Expose yourself to sunlight during the day. Sunlight exposure will help your body maintain its circadian rhythm.
Make sure your bedroom is conducive to sleep. Keep your bedroom dark, quiet, and at a temperature you find most comfortable for sleep. Keep electronic devices, work, phone calls, or anything else which may be disruptive to sleep off or out of the room.
Don’t eat before going to bed. Anything other than a very light snack should not be consumed within three hours of bedtime.
If caffeine is disruptive to sleep for you, avoid it. Most people should avoid caffeine for several hours before sleep. Determine how caffeine affects you and plan accordingly.
Avoid alcohol for several hours before bed. Alcohol has been associated with fragmented sleep, so it is best to avoid it for up to six hours before bedtime.
Get regular exercise. Exercise during the daytime, but avoid it in the evening hours.
Avoid napping. Nap only when it is necessary. Keep it brief if you must nap and don’t nap after 3 p.m. Long naps and late naps are disruptive to sleeping at night.

The Bottom Line

You can work at improving your sleep quality. Your best chance for good sleep with RA is tied to keeping the disease under control and maintaining good sleep habits. Sleep medication is not a long-term solution for most people.

Sleep Problems and Rheumatoid Arthritis: Can You Overcome Sleep Trouble?