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If you’re living with rheumatoid arthritis, you may be far too familiar with restless nights due to pain or other symptoms. However, getting enough sleep may be particularly important to protect you from infections like COVID-19 if you’re immunocompromised.
Researchers found that people who get more sleep at night produce a higher level of antibodies that can improve the efficacy of vaccines, per a new meta-analysis published in the journal Current Biology.
Self-reported short sleep (less than six hours per night) was associated with a robust decrease in antibody response, particularly in men — a reduction similar to the waning of COVID-19 vaccine antibodies over two months.
“These results provide evidence that insufficient sleep duration substantially decreases the response to anti-viral vaccination and suggests that achieving adequate amount of sleep during the days surrounding vaccination may enhance and prolong the humoral response,” note the study authors.
More research is needed to determine the window of time around vaccination in which sleep is most important, how the effects may differ for males versus females, and the amount of sleep that’s needed to protect the vaccine response. Still, the findings show that it may be particularly important to get a normal amount of sleep (seven to eight hours) around the time of vaccination.
Overall, getting too little sleep can affect nearly every aspect of your life — including your mental health, weight, and risk of developing diseases like diabetes and heart disease, per the Cleveland Clinic. Plus, it may exacerbate your condition if you have rheumatoid arthritis (RA).
“Patients with rheumatoid arthritis and sleep disruptions definitely have an increased risk of flares,” says Rajkumar Dasgupta, MD, Clinical Associate Professor of Medicine at the Keck School of Medicine at USC. “They also have more trouble with depression, pain severity, and performing normal daily functioning.”
For those with underlying conditions like RA, the answer isn’t always as simple as “avoid caffeine after 3 pm” — and fatigue is a hallmark symptom of the condition. That said, don’t assume fatigue is always an unavoidable part of living with RA.
“If you have rheumatoid arthritis and are feeling fatigued, you shouldn’t just say, ‘Well, it’s just from my rheumatoid arthritis,’” says Dr. Dasgupta. “It could be a manifestation of a sleep problem at night and it should open up the door for further investigations.”
There may be a wide array of symptoms causing your restless nights. Pinpointing the root with your primary doctor or rheumatologist can help you avoid health issues from too little sleep.
Causes of Restless Nights in Rheumatoid Arthritis Patients
Rheumatoid arthritis patients are more likely to have symptoms, medications, and associated conditions that increase the risk of sleepless nights. Here are five things that may be keeping you up at night to discuss with your doctor.
Perhaps the most obvious sleep wrecker is pain. This may be due to lower levels of cortisol (the hormone that helps control inflammation) at night, an increased perception of pain due to lack of distractions, or simply lying down and the resulting stiffness. Get tips for coping with “painsomnia.”
Addressing pain management with your doctor is the first step: “Whatever the doctor does to manage your pain during the day may translate to less pain at night as well,” says Scott Zashin, MD, a Board-Certified Internist and Rheumatologist in Dallas.
For instance, make sure you stay on top of your medication, pace yourself, and do physical activity when you’re feeling well, and exercise (but do it earlier in the day so it doesn’t keep you up).
Certain over-the-counter pain medications, if approved by your doctor, are also better to take at night than others.
“For pain, Tylenol won’t irritate the stomach, so you can take it on an empty stomach at night,” says Dr. Zashin. “That’s a good choice for people who have pain at night.”
Our patient community has also offered up several remedies for combatting pain at night, from sleeping with a thin pillow to snoozing naked (really!). See all 18 tips that patients swear by.
Certain medications — notably, steroids like prednisone — can keep you up at night.
“There are certain medications that may predispose you to having insomnia — and the big one is always going to be steroids,” says Dr. Dasgupta. “Many people with inflammatory disorders need steroids to help out with inflammation, but of course, there are a lot of side effects.”
Steroids may impair your ability to fall asleep, especially if you take them in the evening, per the Hospital for Special Surgery.
Reviewing medications with your rheumatologist is essential: Your doctor may recommend you take your entire dose in the morning, for instance, or recommend an alternative medication.
A disorder of the immune system characterized by dry eyes and dry mouth, Sjögren’s often accompanies other immune system disorders such as rheumatoid arthritis, per the Mayo Clinic.
This can keep you up at night, since it causes your eyes to burn or itch and your mouth to feel like it’s full of cotton. It’s most common in people older than 40, women, and those with rheumatic disease.
“We usually suggest sips of water by the bed for Sjögren’s,” says Dr. Zashin. “Some patients will use lubricant or goggles to help with dry eyes at night.”
There are also over-the-counter products available such as XyliMelts, which stick to your teeth or gums to relieve persistent dry mouth.
Several studies have suggested an increased prevalence of obstructive sleep apnea (OSA) among patients with RA.
In one 2020 study on rheumatoid arthritis patients published in the Journal of Clinical Sleep Medicine, researchers found that OSA is more common in patients with RA than in the general population — but that there doesn’t appear to be a relationship with disease activity.
Obstructive sleep apnea happens when your breathing is interrupted during sleep for longer than 10 seconds at least five times per hour, on average, per Johns Hopkins Medicine. Typically, relaxed muscles and narrowed airway contribute to this interrupted breathing.
“There have been studies in patients with rheumatoid arthritis that the OSA could be a result of structural abnormalities in the head, neck, and spine that we see in rheumatoid arthritis patients,” says Dr. Dasgupta.
As many as 90 percent of people who have OSA don’t realize they have it. Left untreated, it can lead to increased blood pressure, instability of oxygen levels, changes in your body’s response to insulin and glucose, changes in mental function and mood, and cardiovascular problems like stroke, heart failure, or abnormal heartbeat — which may be particularly impactful for those with rheumatoid arthritis, who are already at higher risk of conditions like heart disease and diabetes.
Learn more about the link between rheumatoid arthritis and sleep apnea.
Restless Leg Syndrome
This is a neurological disorder that causes uncomfortable or unpleasant sensations in your legs and the irresistible urge to move them, with symptoms most intense at night when you’re resting, per the National Institutes of Health. This can severely disrupt your sleep, which makes it difficult to fall asleep or return to sleeping.
Although experts aren’t exactly sure why, there seems to be a connection between restless leg syndrome and arthritis.
“This condition may be present in up to 30 percent of patients with rheumatoid arthritis,” says Dr. Dasgupta. “Restless leg syndrome prevents you from falling asleep, and if you’re not sleeping long enough, that is going to lead to chronic insomnia and symptoms of sleep deprivation — which can affect every organ in the body.”
It’s important to be aware of these associations and speak to your doctor if you have questions or concerns. While there isn’t a cure for restless leg syndrome, your doctor may recommend treatments like iron supplements, anti-seizure drugs, or lifestyle changes like avoiding alcohol, nicotine, and caffeine.
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Common Sleep Disorders. Cleveland Clinic. December 23, 2020. https://my.clevelandclinic.org/health/articles/11429-common-sleep-disorders.
Interview with Rajkumar Dasgupta, MD, clinical associate professor of medicine at the Keck School of Medicine at USC
Interview with Scott Zashin, MD, a board-certified internist and rheumatologist in Dallas
Restless Legs Syndrome. National Institutes of Health. February 7, 2023. https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome.
Sjogren’s Syndrome. Mayo Clinic. August 2, 2022. https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/symptoms-causes/syc-20353216.
Spiegel K, et al. A meta-analysis of the associations between insufficient sleep duration and antibody response to vaccination. Current Biology. March 13, 2023. doi: https://doi.org/10.1016/j.cub.2023.02.017.
Steroid Side Effects: How to Reduce Drug Side Effects of Corticosteroids. August 5, 2021. Hospital for Special Surgery. https://www.hss.edu/conditions_steroid-side-effects-how-to-reduce-corticosteroid-side-effects.asp.
Wali S, et al. Prevalence of obstructive sleep apnea in patients with rheumatoid arthritis. Journal of Clinical Sleep Medicine. February 15, 2020. doi: https://doi.org/10.5664/jcsm.8178.