Rheumatoid Arthritis and Sleep

If rheumatoid arthritis (RA) has you tossing and turning at night, you’re not alone. While the exact percentage of RA patients who experience sleep problems is hard to nail down, more than 80% of people with RA report fatigue as part of their symptoms. 

Why Sleep Matters

Sleep problems can increase levels of stress hormones and aggravate flares, says Rochelle Rosian, MD, a Cleveland Clinic rheumatologist. And even if you’re not flaring, you may not manage your pain as well if you’re not sleeping. “When you sleep, you make all those brain chemicals that you need to feel better. If you’re not rested, you don’t have all of these good hormones. So it may be more difficult to handle your pain.”

Besides increased flares, rheumatoid arthritis patients with sleep disruptions tend to have more trouble with depression, pain severity and performing normal daily functions than RA patients who don’t have sleep problems. Also, in the deepest stages of sleep, the body releases growth hormones to repair tiny muscle tears that occur during the course of the day. People with RA who sleep fitfully may not get enough growth hormone to make needed repairs.

Anxiety, Stress and Sleep

Jeffrey Fong, MD, a rheumatologist with Kaiser Permanente in Northern California, sees two categories of RA patients with sleep problems: those with a new diagnosis who are still adjusting their medication, and those who have lived with RA long enough that their pain is under control.

We need to get a new patient’s pain under control, says Dr. Fong. But anxiety about their new diagnosis may also be affecting sleep.

At the beginning, you may need more help identifying and dealing with the sources of your anxiety. “If I can help them identify those things so they can deal with them in very specific ways — like job modifications and things they can tell their family — it can help them get control of the situation,” says Dr. Fong. 

Patients whose RA is under control, says Dr. Fong, may have other issues like stress-inducing changes at work or in relationships, or chronic depression or anxiety that’s gone untreated. Sometimes realizing what’s upsetting you so you can deal with it can improve sleep. 

Medications and Sleep

Some common RA medications may also contribute to sleeplessness. One is the steroid prednisone, which can cause insomnia, agitation or depression. Taking it earlier in the day is best, says Dr. Rosian. Another is hydroxychloroquine (Plaquenil). It can sometimes cause people to get jumpy, nervous and twitchy.

Fragmented Sleep

Sleep fragmentation — not getting good quality sleep — occurs in more than half of patients with RA that Suneel Valla, MD, treats. Of this group, 25% to 40% report sleep disturbances related to RA, says the sleep specialist at St. Luke’s Hospital in Bethlehem, Pennsylvania. The rest, he says, may have a sleep disorder in addition to RA, such as sleep apnea or restless legs syndrome.

Dr. Valla says that when diagnosing sleep problems in RA patients, he distinguishes tiredness from drowsiness. Tiredness is physical tirednes — feeling drained and not able to do much. Drowsiness is trouble staying awake during the day. “If you’re falling asleep when you don’t want to or taking unplanned naps, that would be a clue to a primary sleep disorder.”

If your doctor suspects a sleep disorder, he may prescribe a sleep study to help determine the cause of your sleeplessness.

Sleep and Pain Processing

Studies of people with RA found they have a low pain threshold even when their inflammation was under control. Furthermore, research participants with sleep problems experienced higher pain sensitivity than those without sleep troubles. These results indicate a lack of sleep may interfere with the way the central nervous system processes pain.

Pain sensitivity and markers of inflammation increase when sleep is disrupted, even in people without RA or another chronic illness. 

Catch Some ZZZs

A good night’s sleep can improve your pain and your ability to manage it. Talk to your doctor, eat well, get plenty of exercise, and follow good sleep hygiene practices. 

Reviewed 3/15/22