Pain, chronic inflammatory illness, and sleep issues all go hand-in-hand, often creating a perfect storm where one exacerbates the others until you’re a flaring, painful, insomniac mess. It’s a frustrating situation, but there seems to be one simple thing you can do to help yourself break this cycle: Take a nap.
Many patients with fibromyalgia, lupus, rheumatoid arthritis, and other related diseases swear by daytime napping to help their symptoms, but does napping really help? And if so, what’s the best way to nap?
The answers are more complicated than you may think.
When dealing with chronic illness like inflammatory arthritis, one of the first things that goes out the window is quality sleep, says Shanon Makekau, MD, chief of pulmonology and sleep medicine at Kaiser Permanente in Hawaii. Not only are sleep problems a symptom of many inflammatory diseases (for example, back pain at night is a telltale red flag for inflammatory back pain), but symptoms and medication side effects can also cause sleep issues, she says. “Then, as you get more sleep-deprived, people may resort to other means, including sleeping in on the weekends or taking naps, but these measures may be counterproductive,” she explains.
Napping and Arthritis: What the Research Says
“People living with rheumatoid arthritis, lupus, fibromyalgia, and other inflammatory
illnesses may feel exhausted or in pain during the day, which causes them to take naps,” Dr. Makekau says. “However, some studies have shown that napping is linked with worse symptom severity.”
Research published in the journal BMC Musculoskeletal Disorders found that daytime napping was linked with significantly increased pain, depression, anxiety, memory difficulties, and sleep problems in people with fibromyalgia. Other research published in the journal PLOS One found that naps were associated with decreased cognitive functioning, which lead to brain fog and exhaustion. To add insult to injury, both studies found that napping was connected with more fatigue — the very thing patients were trying to relieve by napping. A third study, published in the American Journal of Epidemiology, found that older adults who napped daily were nearly two times more likely to die of any cause than adults who didn’t nap. The results held up even when controlling for underlying factors like disease severity, mood disorders, and gender.
Of course, much of this research is observational and can’t prove cause and effect. It could be the case, for example, that people with worse fibromyalgia symptoms are more likely to need naps than people whose diseases have fewer symptoms or that people who need a daily nap have an undiagnosed underlying disorder, says Elyse Rubenstein, MD, a rheumatologist at Providence Saint John’s Health Center in Santa Monica, California.
And some studies show positive effects of napping. For instance, older adults who took a 45-minute daily nap reported feeling and functioning better during the daytime, according to a study published in the Journal of the American Geriatric Society. Research on mice published in Nature Medicine found that sleep loss increased pain symptoms but napping helped reduce that pain, even better than a pain reliever such as ibuprofen. A separate study, also published in the Journal of the American Geriatric Society, found that hour-long naps increased memory and cognitive functioning.
Confused? Keep in mind that research looks at whole groups of people and when it comes to pain and symptom management, what works for you will be very individual, Dr. Rubenstein says. “Different diseases require different treatments and what helps you feel better can vary greatly from patient to patient,” she explains.
“While individuals with chronic inflammatory diseases may take naps to manage
symptoms, we can’t say conclusively whether or not daytime napping is beneficial or
detrimental to their condition,” Dr. Makekau says. “More research is needed in order to develop evidence-based guidelines on napping to manage the pain and fatigue associated with autoimmune and inflammatory disorders.”
Napping and Arthritis: What Experts Recommend
Napping can be a mixed bag for people with inflammatory diseases, particularly arthritis, Dr. Rubenstein says. For many patients, even short naps can cause their joints to stiffen up, which causes pain, she says. Another issue is that many people don’t nap for just 20 minutes — which is what sleep experts commonly recommend — but end up falling asleep for hours, which then disrupts their critical nighttime sleep and helps create a vicious cycle of exhaustion, she explains. However, if you’re being properly treated and your pain is under control then a little nap can give your body a rest from the daily grind, she adds.
“I wouldn’t tell an arthritis patient to use daily naps necessarily, but I would tell them to make time to rest their body every day,” Dr. Rubenstein says. Resting could include some small movement to help lubricate your joints, like gentle stretching, a moving meditation, or an easy walk outdoors.
This type of rest can actually be more rejuvenating than falling asleep, she says. “However, the most important thing is to listen to your body. If you really need a nap then you should take a nap,” she adds.
The problem isn’t in taking the occasional nap when you’re exhausted — it’s when you feel like you need a nap every single day just to function. “This is a red flag that perhaps your treatment isn’t working properly and needs to be adjusted or that there is an underlying condition your doctor hasn’t found yet,” she says.
Needing a daily nap could also be a warning sign of a sleep disorder, like sleep apnea, Dr. Makekau says. “Research indicates that sleep apnea is more prevalent in patients with inflammatory conditions such as lupus, rheumatoid arthritis, and fibromyalgia and when present, can worsen both fatigue severity and pain perception,” she says. “Patients with untreated sleep apnea also have higher levels of proteins related to inflammation in their blood.” It’s very important for people with inflammatory illnesses who are experiencing significant daytime fatigue and the habitual need to nap to speak to their doctor about their symptoms. They may benefit from a sleep study to help diagnose a sleep disorder, she adds.
Napping and Arthritis: Patients’ Perspective
Regardless of what the experts say, many patients with inflammatory diseases rely on their naps as part of chronic illness management. No one is saying you shouldn’t nap to help you rest and recover.
“Napping doesn’t feel like a choice to me,” says Katie S., 27, of Seattle, Washington, who has rheumatoid arthritis and fibromyalgia. “I’ll fall asleep sitting up in my chair, on the bus, at the bar — it’s become a joke with my friends that I’m narcoleptic. Except they tested me for [narcolepsy] and I’m not; I’m just really freaking tired all the time.”
Unfortunately, even short naps do leave her stiff and sore upon waking, she says. But instead of fighting her constant need to sleep — an “unwinnable battle” — she tries to make her naps as high-quality as possible. “I’m going to be sore either way but I’ll be less sore if I lie down on a cot with a pillow between my knees and sleep for 30 minutes during my lunch break than if I fall asleep sitting up in some weird position on the bus home,” she says.
The Right Way to Nap with Chronic Illness
Napping needs are very individual to each person but it’s important to consider the following suggestions to ensure naps are helping, and not hindering, your disease management, Dr. Rubenstein says.
As many people with rheumatoid arthritis, lupus, and fibromyalgia know, when you’re that bone tired, a nap may feel as necessary as eating or breathing. Like Katie, you may even end up sleeping at times or in places you didn’t intend to.
“Given the common use of daytime napping, evidence-based guidelines on the use of daytime napping in people with chronic pain are urgently needed,” says Alice Theadom, PhD, a sleep researcher and an associate professor at the Auckland University of Technology. According to sleep experts, if you must take a nap:
- Take naps earlier in the day; avoid napping in the late afternoon or evening (Dr. Makekau recommends no later than 4 PM)
- Limit naps to 30 minutes or less
- Go to sleep as close to your normal bedtime as possible
- Use naps as a short-term solution, not a daily habit
The Right Length of Time for a Nap
The ideal length of time to nap is a science, literally. Napping for 20 minutes seems to be the sweet spot, according to the National Sleep Foundation. Nap for 30 to 60 minutes and you will hit deeper stages of sleep, where your brain waves slow down. When you wake up in the middle of these sleep stages, you may feel groggy, as if you have a sleep hangover. If you nap for 90 minutes, you can make it through an entire sleep cycle and wake up refreshed — but a nap that long runs the risk of affecting your nighttime sleep.
But napping length and frequency can be highly individual. People who were routine nappers showed better improvements in mood and cognitive functioning after a nap than people who didn’t normally nap, according to a study published in Biological Physiology.
“Sleep is a behavior, and human behavior is highly adaptable,” says Kimberly Cote, PhD, co-author of the study and a psychology professor at Brock University in Ontario, Canada. “A certain percentage of people are regular nappers. If you ask these people, they’ll be aware of benefits they get from napping: They’ll say they feel more alert, have better moods, and feel sharper. I think we self-select for this.”
Arthritis Patients’ Tips for Napping
You’ve heard what the experts have to say but what about people actually living with chronic illnesses? We asked people to tell us how naps work for them and their best tips for napping.
Schedule time for more sleep
“I’ve found I actually need closer to 11 hours of sleep per night to feel well,” says Christina G., 36, of Denver, Colorado, who has rheumatoid arthritis. This means the mom of two often keeps the same bedtime as her young children. “People think I’m crazy to go to bed at 8:30 PM but it works for me.” On days she can’t, however, she makes sure to schedule — as in write it as an event in her phone calendar — a short nap the next day. “Everyone in my life knows my sleep is non-negotiable,” she adds.
Stretch right when you wake up from your nap
You may notice increased stiffness and pain in your joints after a night’s sleep and the same may be true after even a short nap. “I wake up from naps so stiff and sore and I always have to remind myself that this is normal,” Christina says. “If you don’t move, you fuse!” She takes a few minutes to gently stretch her joints in bed before getting up from a nap. Try these gentle range-of-motion stretches, or this restorative yoga routine.
Time naps around your medication
Weekly biologic injections for rheumatoid arthritis are a lifesaver for Juanita M., 64, of Las Cruces, New Mexico. But they also make her really sleepy. “I am out cold for at least an hour right after I take my meds and I know I’ll need a nap for the next day or two afterward,” she says. “So I take my injections at a time when I can nap.” She adds that she takes any steroids in the morning as they interfere with her ability to nap later in the day.
Have an office nap kit
“When my psoriatic arthritis is at its worst I sleep a lot,” says Jennifer D., 31, of Washington, D.C. “I keep a duffel bag with a small pillow and blanket at my office so if I really need a nap I can shut my door and take one.”
Set an alarm
Napping for too long makes Jennifer groggy (not to mention risks getting her in trouble at work) so she always sets an alarm before lying down. “I’ve found that 20 minutes is my magic number,” she says. “I wake up feeling refreshed and I can still fall asleep fairly easily at bedtime.”
Ask for a flexible work schedule
If napping at work just isn’t an option, ask for a more flexible arrangement, like working different hours or working from home some days. “My boss is pretty understanding and I try to limit it to days when flare-ups are really bad and I really need a nap,” says Marco S., 37, of Mission Viejo, California, who has rheumatoid arthritis.
How to Practice Good ‘Sleep Hygiene’ at Night
One of the main issues with napping is that it can affect your nighttime sleep, which is so critical for general health and managing chronic pain specifically, Dr. Makekau says. Poor nighttime sleep can make joint pain worse, increase the length and severity of arthritis flare-ups, and even increase the likelihood that you may become disabled or depressed, according to a study published in Arthritis Care and Research.
If you’re experiencing nighttime sleep issues, such as difficulty falling asleep or waking up in the middle of the night, try not to nap at all during the day and to avoid sleeping late in the morning, says Dr. Makekau. Instead, try to aim for a regular sleep schedule in which you give yourself a bedtime (say, 11 PM) and wake up at the same time (say, 7:30 AM) that allows for eight to nine hours of sleep every night.
“It’s so important for people with chronic illnesses to make sleep a top priority, just like exercising regularly or eating right,” she says. (Of course, we know that sleeping with chronic pain can be very challenging. Check out these tips for sleeping better with arthritis.)
One of the best things you can do to get the rest you need is to make sure your treatment plan is working, Dr. Rubenstein says. Talk to your doctor about whether you need to adjust or switch medications if you feel like they may be interfering with your sleep or adding to your fatigue, she says.
In addition, Dr. Makekau recommends the following tips for good sleep hygiene, which is a set of lifestyle practices that’s associated with promoting sleep:
- Get regular exercise
- Eat an anti-inflammatory diet, aiming for more whole foods and fewer processed foods
- Avoid caffeine and alcohol close to bed
- Quit smoking
- Put away digital screens an hour before bed
- Sleep in a quiet, cool, and dark bedroom
- Settle your mind with meditation, light yoga, or stretching
- Use your bed only for sleeping and sex
Many of these tips are familiar and just general good health advice, but it can’t hurt to revisit with a critical eye and really consider whether you can make some of these lifestyle tweaks to help promote better sleep.