The Link Between Sleep Quality and RA Symptoms

The Link Between Sleep Quality and RA Symptoms

Here’s How You Can Sleep Better With RA

About one-third of RA patients have trouble sleeping, and considering the relationship between pain and sleep quality; it’s not surprising that people struggle so much. After all, sore, inflamed joints are distracting, and a lack of sleep heightens those RA discomforts. Learn how to break the cycle of poor sleep and painful mornings so you can stay active and improve your lifestyle.

Rheumatoid Arthritis and Sleep Problems

Sleep disturbances are lapses in normal sleep. People with RA can also have a pattern of sleep disturbances related to sleep disorders, such as insomnia or sleep apnea.

Sleep quality is a problem if you consistently feel sleepy during the day, regardless of how long you have slept at night. Moreover, if you awake more than once or twice at night, and if you find it difficult to fall back to sleep, your sleep quality is might be suffering.

The way doctors determine if sleep quality is a bigger problem is based on frequency. If you are having problems getting good quality sleep for three or more nights a week or more than seven days a month and sleep problems are affecting your daily life, then it is time to talk to a doctor.

Why Sleep Is Important

People whose sleep is poor may not achieve the deepest sleep phases, which are important for releasing hormones that repair the damage done to our bodies during the day. Moreover, lack of good quality sleep means our bodies do not get all the feel-good hormones they need for managing and regulating pain.

Numerous studies have also found a connection between sleep problems and increased levels of stress hormones. Stress hormones trigger RA flares.

What the Research Tells Us

Poor sleep quality is a common problem for many people living with RA. The reasons for RA sleep problems are not well known, but researchers theorize that disease factors, such as pain and depression, may play a role.

RA symptoms, such as pain and stiffness, can make it hard to get a good night’s sleep. RA patients with sleep problems have a higher risk for depression, experience higher levels of pain, struggle to perform daily tasks, and have an increased risk for disability, according to various studies.

Studies in the general population (i.e., people without RA) also suggest if sleep is interrupted, pain sensitivity and inflammation markers increase.

“Sleep Problems Lower Pain Threshold”

In 2011, researchers from the University of Pittsburgh, Pennsylvania, USA, studied the link between sleep quality and disability in 162 patients with RA. All the patients had RA for at least two years, were mostly female, and their average age was 58.5 years.

Patients responded to questions about fatigue, depression, pain severity, and functional disability. The results were that 61 percent of the study participants experienced poor quality sleep, with 33 percent reporting pain disrupted their sleep three or more times a week.

The University of Pittsburgh researchers confirmed their findings were consistent with other research suggesting sleep problems lower pain threshold and worsening pain in people who are otherwise healthy.

“Sleep Loss Contributed to Pain Increases in People With RA”

A 2012 study from the David Geffen School of Medicine at UCLA, Los Angeles, California, USA, similarly looked at evidence that sleep loss contributed to pain and pain increases in people with RA. The researchers also noted sleep loss was attributable to exacerbations of pain, fatigue and depression, and management of RA should also include prevention and treatment of sleep issues.

In 2013, researchers from Brigham and Women’s Hospital looked at why people with RA had lower pain thresholds even when their RA was controlled. What they found was these patients experienced higher pain sensitivity that may be related to the way their central nervous systems process pain.

Researchers from Turkey have found a connection between disease activity and sleep quality. The 2014 study reported in the Journal of Clinical Medical Research found sleep disturbances were associated various aspects of RA, including disease activity, pain, fatigue, function, depressed moods, quality of life, and inflammation levels.

How to Sleep With Rheumatoid Arthritis

If RA is keeping you up at night, there are ways you can still get better quality sleep at night. Here are some traditional ideas:

Manage Stress

According to one report from the University of California, San Francisco, California, USA, people with RA are twice to four times more likely than others in the general population to experience depression.

Depression not only affects disease activity, pain, and coping, but it also interferes with your sleep. Moreover, depression and worry keep you up at night.

Try setting aside some time each day to deal with stress so that worries don’t keep you up at night. Write feelings down or manage stressful emotions with yoga, exercise, relaxation breathing, meditation or by talking to a friend.

Manage All Health Conditions

People with RA may have other health conditions, such as depression, anxiety, fibromyalgia, restless leg syndrome and sleep apnea – all conditions common in people with RA. Having untreated and or undertreated health conditions can cause further sleep problems.

Talk to your doctor about treating all your health conditions and any problems you have with getting a good night’s sleep. Sometimes, additional health issues may make it harder for you to sleep, and treating them may mean more rest for you.

Stick to a Sleep Schedule

Having the same sleep and wake up times is good advice for everyone, but it is more important for people with RA. Don’t change your sleep times and don’t sleep in, because changing your sleep times upsets your body’s internal clock.

Get Regular Activity

One 2011 study reported in the Journal of Aging Research finds that exercises improve symptoms of joint pain, stiffness and fatigue in people with arthritis. It also promotes psychological well-being and helps with sleep and relaxation.

Any and all types of exercise are beneficial. RA pain and fatigue can make it harder to be active, so do what you can to keep moving.

Talk to Your Doctor

If your pain is what is keeping you up at night, it might be time to talk to your doctor about better managing your pain. Your treatments can be adjusted for better symptom relief, including pain and inflammation, which eventually leads to getting better sleep.

Your doctor can prescribe a low dose type of antidepressant, such as amitriptyline, to help you sleep better. Other medications, such as muscle relaxers and prescription sleep aids, may also help with sleep.

My Personal RA Friendly Bedtime Practices

Having RA going on ten years, I have my own bedtime practice ideas for getting better quality sleep at night. Here are some bedtime practices that help me to sleep better at night:

  • Take a warm bath or shower before bed. I find a hot shower instantly relaxes my joints and muscles and helps me fall asleep faster.
  • I have invested in a heated mattress pad. An electric blanket or a heated water bed are also good alternative heat options.
  • I sleep on an orthopedic type mattress. Try to get a mattress that is as comfortable as possible. If a new mattress isn’t in your budget right now, try an orthopedic mattress topper.
  • I keep distractions out of my bedroom, including no electronics in the bedroom. Make sure your bedroom is for sleep only, and not for reading, watching TV or using other electronic devices.
  • I slip a pillow under my knees to raise my legs and alleviate pressure off my joints. A whole-body pillow can also help for positioning joints and make sleep more comfortable and less painful.
  • If I find that I am still struggling to sleep, I try meditating quietly. Other times, I have utilized binaural beats for sleep. Binaural beats send signal frequencies to the ears through your headphones that put your brain into sleep mode and promote deep sleep. You can find binaural beats videos on YouTube.

The Takeaway

Sleep and rest are the best ways to repair your body, and RA patients need good quality sleep to manage debilitating pain and fatigue. Sometimes, however, getting restful sleep is difficult and you may need to find creative ways to sleep better.

If the ideas above do not help you to get the sleep you desperately need, it is time to talk to your doctor. Medication and additional therapies may help to keep pain and inflammation down, manage symptoms of depression and/or anxiety and help you sleep better.

By managing and addressing sleep problems, your RA symptoms and pain could be significantly reduced.


National Institutes of Health (Sleep Quality and Functional Disability in Patients with Rheumatoid Arthritis)

National Institutes of Health (Sleep Loss Exacerbates Fatigue, Depression, and Pain in Rheumatoid Arthritis)

Journal of Aging Research (Physical Activity Among Persons Aging with Mobility Disabilities: Shaping a Research Agenda)

National Institutes of Health (The role of sleep problems in central pain processing in rheumatoid arthritis)

National Institutes of Health (Sleep Quality in Rheumatoid Arthritis: Relationship Between the Disease Severity, Depression, Functional Status and the Quality of Life)

National Institutes of Health (Depression in patients with rheumatoid arthritis: description, causes and mechanisms)