A photo of a woman in bed with her blanket pulled up to her face.
Credit: Eileen Davidson

We’ve all experienced nights of bad sleep. I’ve had my fair share over the years — from a cold keeping me up, tossing and turning from drinking too much alcohol, and certainly when my son was a newborn waking up to eat every few hours. When I was pregnant with Jacob, countless people advised me to “sleep now — you won’t sleep well again for 18 years.”

They were wrong. Jacob, who is 8, sleeps fine these days. I still do not.

This has little to do with being a parent and everything to do with being in chronic pain. I’ve grown to have a very complicated relationship with sleep over the years, thanks to my arthritis.

What My Sleep Issues with RA Look Like

The word “painsomnia” was not in my vocabulary before I got rheumatoid arthritis, followed by a diagnosis of osteoarthritis not long after. Painsomnia means being unable to sleep because of pain that makes it difficult to fall or stay asleep. People with chronic pain are no stranger to painsomnia. Some struggle with it nightly. Here’s how sleep issues affect me:

Fragmented sleep: I often wake up several times in the night, sometimes for a few minutes or sometimes for a few hours. Sometimes it’s physical because my body is in pain. If I wake up in the middle of the night, pain can make it too distracting to fall back asleep. Other times it’s mental because my mind is racing from the anxiety and stress of living with a chronic illness. Other issues play a role too: infections, side effects from medication, heat waves, you name it.

Too much sleep: Some of the same things that can make me unable to sleep can also cause me to sleep too much. Sleeping too much can disrupt my life in a number of ways.

Fatigue and napping: When I am having bad fatigue, I need to nap during the day. But while my body craves the naps, this routine can throw off my sleep schedule at night.

Poor sleep impacts my health in many ways. And while my RA was responsible for a lot of my sleep problems, at the same time, getting poor sleep was also making my arthritis worse. Bouts of bad sleep make me:

  • Become very forgetful (increase in cognitive dysfunction, or brain fog)
  • Have more malaise (that flu-like feeling that is common in inflammatory arthritis)
  • Become more sedentary
  • Have more pain, stiffness, and inflammation
  • Experience more depression, anxiety, and stress
  • Struggle to do all the tasks and errands I need to get through each day (cooking, cleaning, self-care)
  • Turn into a flake (more often than I like, a bad of night sleep can cause me to cancel plans because I just don’t have the energy for it)

The Science Behind Sleep and RA: Why Does It Hurt More at Night?

Ever notice how when you have a cold, you feel worse at night? Well, RA does the same thing in the evening. One reason is that levels of the hormone cortisol, which helps control inflammation, are naturally lower at night. Another is that when you lie down, inflammatory chemicals pool in your joints, which can make them feel stiff and painful.

This leads to problems falling and staying asleep, thus triggering the start of a vicious cycle.

That’s because studies have shown that people with sleep problems experience more pain sensitivity than those without sleep troubles. In other words, getting too little sleep can make your pain feel worse. Pain and inflammation increase when sleep is disrupted — even in people without rheumatoid arthritis or other chronic illnesses — so it is no wonder we experience heightened symptoms when sleep becomes an issue.

What Helps Me Get At Least Half-Decent Sleep with Rheumatoid Arthritis

As a single mom — diagnosed with RA when my son was almost 2 years old — I couldn’t afford to be tired all the time or spend the day resting. I had no choice but to figure out how to cope with this perpetual tiredness. It did not happen overnight, though. And although I’ve learned a lot about how to help improve my sleep over the years, getting good sleep is still an ongoing struggle for me.

Here are the insights, tips, and tools that have helped me sleep better.

Find a medication regimen that helps you

It took a long time after I was diagnosed with RA to find a treatment that worked. Looking back, that’s when my sleep problems were at their worst. The biologic medication I take for my rheumatoid arthritis makes it easier to get better sleep. Sometimes I do experience an RA medication “hangover” where I feel extremely tired for a few days after my infusion, but at least I know it’s only for a few days. If I were taking sleeping pills regularly, I’d be dealing with side effects more often. (Plus, there’s a risk of becoming dependent on them, which concerns me.) I’m not against sleeping pills, but I try to take them only if I really need them.

Fight the urge to oversleep or rest

There are days when my body feels like rest is the only thing it needs or can do, and I acknowledge that. But I also know that over-resting can result in more pain and fatigue throughout the day and into the night. From consulting with an occupational therapist, I learned that resting for 20 to 40 minutes at a time can help recharge my batteries, but longer bouts can backfire and make me feel worse.

Give yourself some space to adjust this rule on occasion. Sometimes our bodies will require extra sleep or rest. Just remember to get up and move a bit.

Track your health

I discovered a lot about my sleep and overall health as I started tracking my rheumatoid arthritis and physical activity in a study with Arthritis Research Canada. Tracking gave me a deeper understanding of how long I need to nap to feel restored and how much physical activity is too much for me (especially when it will cause me to need a nap or flail in pain later). Not only was I able to have this deeper understanding of my health through tracking my RA symptoms but I was able to see my sleep improve over time, or observe when it worsens and so I know to make some adjustments in my self-care routine or address it with my health care providers.

You can use ArthritisPower to track symptoms like sleep and fatigue over time and share the results with your doctor.

Get regular exercise

My sleep drastically changed when I started exercising regularly. Following a routine that includes cardio and strength training has helped me get better sleep at night. It also helps keep my pain at a lower level than when I don’t exercise (which also plays a role in my sleep).

Take a hot bath or shower

A relaxing bath or shower before bed can really help soothe my achy joints and make me feel sleepy. I love to add Epsom salts and essential oils to my tub to make it an even more relaxing experience.

Relax in the sauna

The gym near my home has a sauna, which has become one of the most powerful tools in my arthritis self-care toolkit. It helps me recover after an intense workout. I also think it helps me relax generally, which contributes to better sleep by addressing stress and anxiety.

Use ice or heat to treat joint pain

Ice packs help relieve some pain and reduce swelling; they also help get better sleep when my joints are flaring or on days when it’s incredibly hot. Sometimes I use both heat and ice in the same night to soothe different areas of my body. Heat can also help relieve pain but I don’t like to put heat on already flaring joints.

Apply topical pain relievers

We all have our favorite creams to apply to where it hurts. Using them before bed can help. My favorite is Voltaren, with another topical that contains menthol applied on top of it. This is also especially relaxing on hot summer nights. (Note: Voltaren and other topicals can be dangerous to pets. Read labels and do not let them lick it off you.)

Get naked (or close to it)

When I’m flaring, fabric can feel painful on my joints. There have been many nights where I’ve had to sleep in my underwear because any clothing on my knees or ankles felt too painful. Sometimes I also get night sweats and have a difficult time regulating my body temperature, so sleeping without PJs is more comfortable.

Avoid alcohol

Some people swear by a drink before bed, while others swear that even a few sips of alcohol can aggravate their RA. I am one of the latter. Alcohol spikes my pain and fatigue, which leaves me uncomfortable, not sleepy. Alcohol can reduce the quality and duration of your sleep.

Cut back on foods that make you feel unwell

We all have our culprits. For me, pizza is a big one. It’s tasty but it can make me feel very unwell, whether it’s an increase in malaise or an upset tummy. Over time, I’ve been able to pinpoint which foods can disrupt my sleep.

Watch caffeine intake

Too much coffee or tea in the afternoon can cause insomnia. As much as I love coffee, I limit the amount I drink in a day to two cups in the morning and maybe (just maybe) one in the afternoon if I really need it — say, to attend an evening event.

Have a regular bedtime

Keeping a regular sleep schedule, where you go to bed and wake up at the same time every day, can help you sleep better. I try to make it my bedtime 10 p.m. But living with fatigue, some days I can’t quite stay up that late. Winter is when I really struggle to not go to bed too early.

Keep it cool

As I write this, British Columbia, where I live, is in a record-breaking heat wave. This reminded me how important it is to keep your room cool when trying to get a good night’s sleep. Turn on the AC, use a fan, open a window, and sleep with ice packs on you.

Turn off distractions

Put your phone on silent, out of arm’s reach, turn off the laptop and turn off the TV. These distract from getting good sleep. I know it can be a challenge to be left alone to your own thoughts; many times they are the reason I can’t sleep.

Make your bed comfortable for you

I realized that my old mattress was causing me more pain than restful comfort because it was too soft and was putting my body out of alignment. Pillows, too, are a very personal choice but my preference is a firmer bamboo pillow. I have multiple of them too, for my neck, my knees, hips, and feet. Pillows can help elevate those inflamed joints.

Ask your doctor about medication timing

Steroids can cause insomnia, so you may want to avoid taking them at night. Ask your doctor about when to take your various medications to make sure they won’t disrupt your sleep.

Consider cannabis

Getting a better night’s sleep was one of the main reasons I started using marijuana, especially when I played around with different indica strains. For me, the perfect combination to help with sleep is a 1:1 ratio oil followed by smoking a joint. But everyone is different, so find what works for you. Topical CBD with THC is another great relief option.

Stretch to soothe

Stretching before bed can be a relaxing part of your nighttime routine. As well, keeping up with regular stretching throughout the day can help relieve pain and stress and contribute to better sleep.

Sip herbal teas

Enjoying various teas is one of my go-to things when I can’t sleep. I like chamomile, peppermint, licorice, valerian root, lavender, lemon balm, and passionflower. Sometimes it works like a charm, sometimes I need to keep trying other tools.

Check out complementary therapies

I see a chiropractor and get acupuncture and reiki. I definitely sleep better after some of these sessions. Deep breathing and meditation are also good practices to help you relax when pain is getting distracting.

Consider supplements

My go-tos for better sleep are melatonin and magnesium. It’s always a good idea to talk to your doctor before taking any supplements to make sure they won’t interfere with your medications and are safe and healthy for you.

Know that ongoing poor sleep can be a warning sign

My bouts of worst sleep have all been when my disease activity was high or a comorbidity was raging. Figuring out that it wasn’t just RA causing my sleep issues helped me a lot. I’ve had sleepless nights due to a rare copper deficiency, infections, and anxiety. If getting decent sleep is becoming an ongoing problem, bring it up to your health care providers.

You may need a sleep assessment to check for sleep apnea or other sleep issues. Sleep is not talked about enough and it’s time to have that conversation. Let your rheumatologist and general practitioner know what’s going on. Other types of providers — like occupational therapists or naturopaths — can give sleep advice too.

Track Your Symptoms with ArthritisPower

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