If you have poor or disturbed sleep night after night, you may begin to notice your health getting worse. If you have rheumatoid arthritis (RA), symptoms such as pain may disrupt your sleep.
Several of your body's functions are influenced by sleep:
If your body clock is altered by a change in your sleep pattern (for example, if you have jet lag), you may feel generally unwell and experience:
You may also find it difficult to think clearly, concentrate or carry out normal activities such as driving.
Most adults need about 7–8 hours' sleep per night, though this varies from person to person. Children tend to sleep more than adults, and older people tend to have lighter sleep.
The stages of sleep are commonly referred to as:
The pattern of your brainwaves differs in each stage.
Non-REM sleep happens in four stages:
These phases are repeated several times during the night. Each cycle lasts about 90 minutes, although the proportion of deep sleep and dreaming sleep changes as we get older.
A severely disturbed sleep pattern can cause all the following problems:
If this continues for a long time, it can cause increased muscle tension and can be linked with muscular pain. Sleep also has a major effect on our mood.
It's normal to wake up once or twice each night, and it's only a problem if you can't get back to sleep again or if you’re not happy with the amount and quality of sleep you’re getting.
Depression can result in disturbed sleep but a poor sleep pattern over a period of time often leads to anxiety or depression, or both. It’s sometimes difficult to know whether sleep disturbance is the result of depression or the cause of it.
Sleep disturbance may lower the point when you begin to feel pain (your 'pain threshold'). This could lead to:
RA can affect the way you sleep, especially if your condition causes pain that makes it uncomfortable to lie down.
People with RA are more likely to suffer disturbed sleep than people of a similar age who don’t have RA.
Sleep disturbance is usually worse when your pain is worse, and it’s linked to increased anxiety and depression as well as morning stiffness and fatigue.
Keeping a diary of your sleep pattern can help you and your doctor spot things that disturb your sleep. It can include:
Healthcare professionals will usually suggest you think about 'sleep hygiene' – things that you can do to improve your sleep pattern:
If you can’t sleep after about 20 minutes, get up and do something that’s not overstimulating (for example, listening to some soothing music). Only go back to bed when you’re sleepy.
If your mattress is old or uncomfortable, you should probably consider replacing it. Read more about finding a new mattress.
Changing the number or position of your pillows or choosing a soft or moulded pillow may be helpful if you have neck pain or upper back pain.
Some people find it helpful to sleep in a narrow soft foam collar.
If your sleep problems continue, speak to your GP, rheumatologist or rheumatology nurse. They'll be able to offer more advice and prescribe medication if you need it.
There are four main groups of medications that can be helpful. They’re most likely to have an effect when just one factor is causing your sleep disturbance. You may find it useful to take medications from more than one of these groups.
Taking paracetamol just before going to bed can ease pain to allow you to get to sleep, but it’s unlikely to last all night.
Non-drowsy pain-relievers that include caffeine are unlikely to help you sleep.
Slow-release NSAIDs such as naproxen reduce pain and stiffness throughout the night. Although these medications have potential side-effects, they can be very useful.
Some antidepressants, such as amitriptyline, have sedative effects, which means they make you feel sleepy. They may also reduce chronic pain.
These medications aren’t given as sleeping tablets but may improve your sleep as an added benefit. It’s often advisable to take them a few hours before going to bed so that the effect has worn off by the morning.
Temazepam, zolpidem and zopiclone are given specifically to help you got to sleep, although they may not stop you waking during the night. They’re sometimes called hypnotics.
Doctors often advise against using sedatives because of the risk of dependence, which means you become addicted to them. There's also a risk of side-effects, but they can sometimes be helpful for short-term use.
Therapists and psychologists may be able to offer relaxation tips or cognitive behavioural therapy (CBT). A number of studies have investigated CBT as a treatment for sleep problems in people with chronic pain.
CBT is a psychological treatment based on the assumption that our thought patterns and reactions are learned and can therefore be changed. It aims to help you change any thoughts, feelings or behaviours that may be having a negative impact on sleep. It can be given either in group sessions or to individuals.
CBT uses a number of different techniques:
Some rheumatology clinics also offer evidence-based self-management groups which deal with fatigue and sleep issues. Ask if your rheumatology team offer this.