Sleep and Pain

As many as 80% of people with arthritis have trouble sleeping. With achy, stiff and sometimes swollen joints, getting comfy, dozing off and staying asleep while in pain due to arthritis can be a tall order. 

Many people blame their restless nights on arthritis pain. But research finds that the relationship actually works both ways — poor sleep can make your joint pain worse, and even increase the likelihood that you may become disabled or depressed.

“Patients often attribute sleep problems to pain. While pain can certainly contribute to sleep problems, the more we learn about sleep, pain and inflammation, the more we find the relationships are likely to be multidirectional,” says Yvonne Lee, MD, a rheumatologist at Northwestern Medicine in Chicago. Which problem starts first is different for different people — but once one of these issues occurs, they lead to the others and can come full circle.

Poor Sleep, Pain, Disability and Depression

Research shows that individuals with osteoarthritis pain who have sleep problems are more likely to experience depression and even become disabled over time. One study found that nearly 70% of more than 300 participants reported having sleep disturbances including having difficulty falling asleep, waking up in the middle of the night, or rising too early in the morning. Results showed that sleep problems predicted increases in depression and disability.

Studies also show that not sleeping at night exacerbates pain the next day. But there is something about sleep disruption that predisposes people with arthritis to become more disabled over time, explains Patricia Parmelee, PhD, Director of the Alabama Research Institute on Aging, University of Alabama at Tuscaloosa. “This is a scary finding that suggests we really need to treat the sleep problems so they do not contribute to the progression of the disease.”

What Causes Sleep to Affect Pain

The big question is why does disrupted sleep affect pain? 

The culprit, Dr. Lee says, may be found in the central nervous system (CNS). Dr. Lee explains that studies show CNS pathways (the spinal cord and brain) that regulate pain may be abnormal in people who are not sleeping well.

Another theory is that sleep problems may lead to increased inflammation throughout the body.

“Studies in healthy individuals have found that sleep deprivation is associated with an increase in inflammatory markers measured in the blood,” Dr. Lee explains. “It is possible that an acute inflammatory response to sleep deprivation could lead to more long-term problems.”

How You Can Sleep Better

Since pain, sleep and inflammation are inextricably linked, Dr. Parmelee says treating insomnia is an important step in managing arthritis. A restful night’s sleep often starts with developing good sleep hygiene, such as avoiding electronic devices and caffeine, and adhering to a strict bedtime schedule. 

“We are a sleep-deprived nation. When arthritis is in your face with pain, we tend to focus on treating the symptoms and less on our overall health picture,” says Dr. Parmelee. “A good night’s sleep is central to taking care of yourself so you can better cope with the disease.”

Reviewed 3/15/22