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 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, Assistant Professor of Medicine at Brigham and Women’s Hospital in Boston. 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.”
- Managing Arthritis Pain
- Talking to a Doctor About Pain
- Hot and cold treatments
- Tips for heat
- Tips for cold
- Before and after treatments
- Use heat or cold safely
- Exercise and wise use of joints
- Pain and stress
- Counseling and other support
- Pain clinics
- Other pain management techniques
- Got Painsomnia? These 9 Patient-Tested Tips May Help You Sleep Well Again
- Why Does Pain Seem to Get Worse at Night?
- The Start of a Vicious Cycle
- 1. Practice good sleep hygiene
- 2. Exercise during the day
- 3. Try meditation or deep breathing
- 4. Create a relaxing pre-bed routine
- 5. Consider CBT
- 6. Use hot or cold therapy
- 7. Make sure your bed is comfy for you
- 8. Consider herbal remedies to help you snooze
- 9. Discuss your medication options with your doctor
- Keep Reading
- Is Arthritis Pain Keeping You Awake at Night?
- 9 Ways You Can Sleep Better with Osteoarthritis
- Learn more:
Managing Arthritis Pain
Protect your body
Ask a doctor about how to do routine tasks in a way that reduces stress on joints. Listen to your body when it signals that it needs rest.
Keep a positive attitude
Having arthritis and the pain that goes with it can lead to a life built around pain and sickness. One way to reduce your pain is to build your life around wellness, not pain or sickness. Live what is called a “wellness lifestyle.” This means to think positive thoughts, keep a sense of humor, eat a balanced diet, exercise every day and enjoy activities with others. It also means following your treatment plan, taking your medication properly and practicing relaxation.
Arthritis can limit you but it doesn’t have to control your life. Talk to your doctor, nurse or therapist about how you can make your life more healthy. Get involved in a favorite activity or hobby. Remind yourself of what you can do rather than what you can’t do. You’ll feel better and your pain will not seem as severe.
Change your pain habits
It’s easy to slip into the habit of drinking alcohol or taking more medicines to escape your pain. If you answer “yes” to any of the questions below, you may need to find new ways to handle your pain.
- Do you drink alcohol several times a day?
- Do you use up pain medication faster than you used to?
- Do you spend all day in bed?
- Do you talk about pain or arthritis much of the time?
Changing your pain habits will help you feel better. One way to make a change is to do something positive in place of the old habit and to reward yourself. Discuss these habits with your doctor, nurse or other health care workers who specialize in pain management. Ask them to help you find new ways to cope with your pain.
Create a pain management plan
You can make a chart of your own pain control methods. This will help you keep track of which methods you have used and which ones work best for you. Adapt it often. Post it where you can refer to it often such as on your refrigerator or medicine cabinet.
Share your successes and frustrations with others–whether it’s with family, friends, loved ones or others that have pain. Find out about support groups in the community and learn how others are overcoming their pain. Don’t hesitate to ask for help when you need it.
Take control of your pain so it doesn’t control you.
Talking to a Doctor About Pain
Your Health Care Team
To help manage pain you may want to consult a primary care physician, nurse, pharmacist, physical therapist or other health care professional. You may be referred to a rheumatologist a doctor who specializes in treating arthritis.
Gaining control through communication
Even though pain may interfere with work relationships and daily life, few Americans talk to their doctors about it. Did you know:
- Fewer than half (43 percent) of Americans with severe or moderate pain report that they have a “great deal of control” over their pain.
- Fewer than half (42 percent) of people who visit their doctor for pain believe that their doctor completely understands how their pain makes them feel.
One of the best ways to gain control of pain is to talk to a doctor about it. Unlike a broken leg, pain cannot be seen in an x-ray or identified by a medical test. What a patient says may be the only way the doctor will know about the pain. And because people experience and respond to pain differently, how a patient describes pain is the best way for the doctor to understand what the patient is feeling. Only then can the doctor help the patient treat the pain.
Remember the patient and the doctor should share the same goal–reducing the patient’s pain.
Patients may want to consider asking a friend or family member to accompany them to the doctor’s office. He or she can take notes or help listen to what the doctor says. Remember that pain not only affects the person suffering with it ,but it may also affect the people around them.
It may also be helpful to prepare in advance by writing down symptoms, allergies, medicines, previous medical procedures and conditions or diseases and to show this list to the doctor.
By being prepared to describe pain to the doctor, patients can make the most of their doctor visits. Thinking about these questions before a doctor’s appointment may help patients explain their pain to doctors:
- Where is the pain felt? (Knee hip feet?)
- Is there pain anywhere else?
- Does the pain move from one area of the body to another?
- How often is the pain felt? (Daily, weekly?)
- Is the pain felt constantly or every now and then?
- What time of day is the pain felt? (Upon waking up at night?)
- How strong is the pain?
- Is it sharp? (Stabbing, splitting, gnawing?)
- How does the pain make you feel? (Tired, upset?)
What makes the pain feel better or worse:
- What relieves the pain? (Exercise, rest, medicine?)
- What makes it feel worse (Inactivity?)
- What activities cause the pain to be felt? (Walking, bending?)
- Has any treatment worked so far? If so which ones?
- Does pain interfere with activities? (Bathing, dressing, sleeping, exercising, taking care of children?)
During a doctor visit
Here are some tips and suggested questions for a patient visiting a doctor about pain.
- Tell the doctor about the pain. Don’t wait for the doctor to ask about it.
- Be prepared to describe the pain using specific words such as: aching, searing, throbbing, stabbing, sharp, pounding, gnawing, cramping, burning, tingling, dull, blinding, intense, radiating, piercing.
- Ask the doctor to explain what the problem might be.
- Tell the doctor what relieves or worsens the pain.
- Talk to the doctor about diagnosis and treatment.
- Let the doctor know what prescription and over-the-counter medications are being taken even if they’re not for pain.
Ask the doctor:
- About options for pain relief (exercise, medication, alternative therapies).
- About the benefits and potential risks or side effects of any treatments or medications.
- About activities to avoid or modify.
- To explain anything that isn’t clear.
- When a follow-up visit should be scheduled.
Take notes to help remember what the doctor said.
If patients still have questions about the pain or the treatment plan after the doctor visit, they should call the doctor back.
Hot and cold treatments
Using either heat or cold treatments can reduce the stiffness and pain of arthritis.
Cold packs numb the sore area. They are especially good for severe joint pain and swelling caused by a flare (a period during which disease symptoms return or become worse). Heat treatments relax your muscles. You can use dry heat methods such as a heating pad or heat lamp or moist heat methods, such as a bath or hydrocollator pack.
Tips for heat
- Soak in a warm bath, shower, jacuzzi or whirlpool.
- Place a heating pad on the painful area. Don’t sleep with the heating pad on because you might burn yourself.
- Use an electric blanket or mattress pad. Turn it up before you rise to combat morning stiffness.
- Use flannel sheets. They feel warmer against your skin.
- Use a hot water bottle wrapped in a towel to keep your feet back or hands warm.
- Before getting dressed, warm your clothes by placing them on top of the dryer for a few minutes.
- Place hot packs on the painful area. These are filled bags that are heated in water and covered with a towel. Be careful not to let the pack get too hot.
- Dip your hands in a paraffin bath. This is a mixture of melted paraffin and mineral oil. The warm coating soothes stiff painful fingers. Ask your doctor or therapist about this method.
- Use a combination of heat and cold. This is called a contrast bath (see figure 1). Soak your hand or foot in warm water then cold water then warm water again.
Tips for cold
Place a cold pack or ice bag on the painful area. You can buy these at the drug store or you can make one by wrapping a towel around a bag of frozen vegetables.
Before and after treatments
Before using heat or cold:
- Your skin should be dry and healthy.
- Protect the skin over any bone that is close to the surface of your skin. Place extra padding over the area to prevent burning or freezing your skin.
After using heat or cold:
- Check the area for any swelling or discoloration.
- Carefully dry the area.
- Gently move your joint to reduce stiffness.
- Allow your skin to return to normal temperature before using another treatment.
Use heat or cold safely
- Use either heat or cold for only 15-20 minutes at a time. Let your skin return to its normal temperature before using another application.
- Always put a towel between your skin and any type of pack.
- Always follow the advice of your physical therapist or doctor carefully when using these methods especially heat.
- Check your skin before and after using heat or cold.
- Use milder temperatures for a child’s skin because it is more sensitive than an adult’s skin.
- Do not use either heat or cold if you have open cuts or sores.
- Do not use cold packs if you have poor circulation or vasculitis.
- Do not use heat that is too hot or cold that is too cold. It is normal for your skin to appear pink after using a hot or cold pack. If an area appears dark red or spotty red and white there may be some skin damage. Blisters also appear if the pack was too hot or too cold.
- Do not use creams, heat rubs or lotions on your skin while using a hot or cold treatment.
- Do not make your bath or shower water too hot. This may cause dizziness or fatigue.
Exercise and wise use of joints
Another key to coping with pain is to follow an exercise program designed by your doctor or physical therapist.
Your exercise program should include special range-of-motion exercises to help keep your joints movable. It should also include general fitness exercise such as swimming or walking. These help keep your heart, lungs, bones and muscles strong. Exercise also helps relieve stiffness and gives you an improved sense of well-being. Here are some tips to help you exercise properly:
- If you have a flare, do only gentle range-of-motion exercises.
- Start with just a few exercises and slowly add more.
- Listen to your body. If it hurts too much or if you begin to have too much pain, stop the exercise. Ask your doctor or therapist to help you learn the difference between normal exercise discomfort and too much exercise pain.
Using joints wisely and saving energy
Using your joints wisely means doing everyday tasks in ways that reduce the stress on painful joints. Saving your energy means “listening” to your body for signals that it needs to rest. It also means learning to pace yourself so you don’t become too tired. Here are a few guidelines for using your joints wisely and for saving your energy:
- Be aware of your body positions. Avoid activities that involve a tight grip or that put too much pressure on your fingers. Use self-help devices, such as jar openers, reach extenders, zipper pulls and buttoning aids. These aids put less stress on your joints and make difficult tasks easier.
- Use your largest and strongest joints and muscles. For example, use a shoulder bag to carry items. This protects painful elbow, wrist or finger joints. When you lift or carry objects, spread the weight of the object over many joints. This prevents you from placing too much stress on one joint.
- Avoid holding one position for a long time. Move or change positions often. Keeping joints in the same position adds to joint stiffness and pain.
- Balance rest with activity. Learn to understand your body’s signals that you’re getting tired. Take breaks when you need them. Don’t wait for the physical signals of pain before you rest. Plan your schedule to alternate activity with rest- even when you are feeling well!
- Respect pain. If you have pain that lasts for two hours or more after completing an activity or exercise, then you’ve done too much. Next time do a little less or go about it in a way that takes less effort.
- Simplify your work. Plan ahead, organize and create short cuts. Use labor-saving devices such as an electric can opener or electric garage door opener that require less energy on your part and place less stress on your joints.
- Ask for help when you need it. Family and friends would rather help you than have you become too tired or ill from doing too much.
Pain and stress
People who are in pain experience both physical and emotional stress.
Pain and stress have similar effects on the body. Muscles become tight and breathing becomes fast and shallow. Heart rate and blood pressure go up. Relaxing can help you reverse these effects. It gives you a sense of control and well-being and makes it easier to manage pain.
What is relaxation?
Relaxation is more than just sitting back reading or watching TV. It involves learning ways to calm and control your body and mind. Relaxation does not come easily especially if you are in pain. It takes practice. The best time to use relaxation skills to manage your pain is before the pain becomes too intense.
Some people find it very difficult to relax. They feel they don’t have time to practice it or they don’t believe it will help them. Others feel embarrassed for taking the time. With a little practice most people get some relief from relaxation.
There is no best way to learn how to relax. Everyone responds differently to different techniques. Try some of the methods below until you find some that work for you.
Guided imagery uses your mind to focus on pleasant images. First begin by breathing slowly and deeply. Think of yourself in a place where you feel comfortable safe and relaxed. This may be a favorite vacation spot or a porch swing in your own backyard. Create all the details–the colors sounds smells and how it feels. These images take your mind away from pain and focuses it on something more pleasant.
Prayer is very relaxing and comforting for some people. You may want to make a tape recording of a soothing inspirational message.
Hypnosis is a form of deep relaxation in which your attention is focused internally–away from the usual thoughts and anxieties. You’ll need to work with a professional trained in hypnosis who has been referred by your doctor. Some psychologists counselors or social workers who are trained in hypnosis may be able to teach you how to safely hypnotize yourself. Suggestions for positive change seem to be more easily accepted while a person is quiet and relaxed. Most people who find hypnosis helpful in relieving pain, report it as soothing and enjoyable as well.
Biofeedback uses sensitive electrical equipment to help you be more aware of your body’s reaction to stress and pain and to learn how to control your body’s physical reactions. The equipment monitors your heart rate, blood pressure, skin temperature or muscle tension. These body signals are shown on a screen or gauge so you can see how your body is reacting. Biofeedback helps you learn how you feel when your muscles are tense or relaxed. If you do a relaxation technique while using the equipment, you can learn to control some of your body’s responses to pain. One advantage to biofeedback is that it shows you that you have the ability to relax.
Relaxation audio tapes help guide you through the relaxation process. These tapes provide directions for relaxation so you don’t have to concentrate on remembering the instructions. Many professional tapes are available for purchase. You might also want to make your own tape of your favorite relaxation routine.
Tips for relaxation
- Pick a quiet place and time. Take at least 10 minutes for yourself with no noise from TV radio or other people. Use soft music to muffle other noises.
- Sit or lay in a comfortable position with your head supported and your eyes closed.
- Take a deep breath. Feel your stomach move in and out with each slow deep breath.
- Continue to breathe deeply and slowly focusing on just your breathing.
- Try thinking about words such as “peace” or “calm.”
- Don’t worry about whether you reach a deep level of relaxation. Allow the relaxation to go at its own pace.
- Other thoughts will come into your mind. Don’t try to chase them away but just quietly go back to your breathing. Concentrate on relaxing and staying calm.
- Do not practice right after a meal. If you fall asleep, don’t worry. Next time try to stay awake the entire time.
- Set aside time regularly to practice! Then relaxation will become easier.
Counseling and other support
Health care team
Any major disturbance in your life–such as illness or chronic pain–may make you feel anxious, depressed, angry or even hopeless.
This is your first place to turn for help. The team includes your doctor and a nurse. It may also include an occupational therapist or a physical therapist, a social worker, counselor, psychologist and a pharmacist.
Talk to the members of the team about ways to cope with pain. They may be able to help you find services in your area. Don’t be afraid to suggest to your doctor a pain management idea of your own or one from this program. You know yourself and your pain better than anyone.
Many people become depressed when they have severe pain. Some people feel so bad they cannot sleep or eat. In these cases, therapy or counseling may help.
Some people are afraid to admit they need help. They believe that others will think they are crazy if they talk to a professional about their problems. But it’s smart to get help when you need it. If you have the symptoms of depression–poor sleep, changes in appetite, crying, sad thoughts–talk with your doctor.
Some psychologists or counselors are specially trained to work with the emotional side of chronic health problems like arthritis. These people can also teach you how to manage stress. Pain is stressful. If you have increased stress, you may feel more pain. So learning to manage stress can also help you manage your pain.
Sharing your feelings and experiences with a group can make living with arthritis easier. The basic goal of a support group is to give you a way to share and learn about arthritis. A group also helps you to feel understood and can give you new ideas to help cope with problems. It can also help you feel good about yourself because you’ll be helping others in the group.
Groups may be run by professionals or they may be self-help groups led by people with arthritis. Some groups focus on pain control. Others have no certain topic but work with people who have different types of problems. Ask your doctor about local groups for people with arthritis or people with pain. Sometimes you can help yourself with the help of others like you.
Pain clinics specialize in treating pain. They may be located in a hospital or may operate independently. Some clinics treat all types of pain. Others specialize in treating certain types of pain. And some clinics specialize in certain types of treatments. The clinics can’t cure your health condition but they may help you to learn better pain management skills. Ask your doctor about pain clinics in your area.
Other pain management techniques
If a joint is very swollen and painful, your doctor or therapist may suggest you use a splint to rest the joint (see figure 2). This helps reduce swelling and pain. Your doctor may recommend that you wear the splint during certain activities all day or only at night. This depends on how severe the swelling or pain is.
Getting a good night’s sleep restores your energy so you can better cope with the pain. It also rests your joints to reduce the pain and swelling. Only you know how much sleep your body needs, so get into the habit of listening to your body. If you feel tired and ache after lunch every day, for example, take a brief nap. This can help restore your energy and spirits.
If you have trouble sleeping at night, try relaxing quietly in the afternoon rather than taking a nap. Here are some other tips to help you sleep better:
- take a warm bath before going to bed
- listen to soothing music or a relaxation tape
- spend some quiet time by yourself before you go to bed
Do not take sleeping pills unless your doctor recommends them.
Massage and topical lotions
Massage increases blood flow and brings warmth to the sore area. You can massage your own muscles or you can ask your doctor to recommend a professional who is trained to give massages. If you have arthritis in your shoulders, elbows, wrists or fingers, you may not be able to give yourself a massage.
When giving yourself a massage, use lotion or oil to help your hands glide over your skin. Menthol gels also provide a comforting tingle that can further ease the painful area.
Topical “deep-heating” rubs may contain medicines that block the sensation of pain. Or they may increase blood flow in the skin where they are applied and distract attention from the painful muscle or joint. Usually these ointments do not penetrate very deeply into the skin. Therefore claims that the active ingredients go directly to the joints and relieve pain are not true.
Tips for safe massage:
- When doing self-massage, stop if you have any pain.
- Don’t massage a joint that is very swollen or painful.
- If you use a menthol gel for massage, always remove it before using a heat treatment–otherwise you might burn yourself.
- If you have a professional massage, make sure the massage therapist has sufficient knowledge about arthritis.
TENS helps reduce pain for some people with arthritis. It is a small device that uses mild electric pulses to stimulate the nerves in the painful area. This blocks the pain message in several ways.
To use a TENS machine, electrodes are taped on the skin near the painful area. These electrodes are connected by wire to a small battery-operated stimulator. TENS doesn’t hurt but it may cause some tingling. Usually it feels like vibration or tapping. TENS works for some people but not for others. Talk to your doctor or therapist about whether TENS might help you.
1330 West Peachtree Street
Atlanta GA 30309
American College of Rheumatology
American Chronic Pain Association
P.O. Box 850
Rocklin CA 95677-0850
American Pain Foundation
111 South Calvert Street Suite 2700
Baltimore MD 21202
National Institute of Arthritis and Musculoskeletal and Skin Diseases
1 AMS Circle
Bethesda MD 20892
Some of this material may also be available in an Arthritis Foundation brochure.
Adapted from the pamphlet originally prepared for the Arthritis Foundation by Robert L. Swezey MD, FACP, FACR and Beth A. Ziebell PhD. This material is protected by copyright.
Got Painsomnia? These 9 Patient-Tested Tips May Help You Sleep Well Again
Painsomnia is the inability to sleep due to pain. It’s an all-too familiar symptom for those living with different kinds of arthritis. “Unfortunately, it’s an every night occurrence,” Lee Driscoll Dandan told CreakyJoints on Facebook.
“I’m woken and kept awake by pain most nights — it’s mentally and physically exhausting,” shared Damla Huss.
In a major 2012 National Institutes of Health study, insomnia was significantly higher among those with arthritis (all types), affecting 10.2 million people and 23 percent of people with arthritis. A recent study from this year found an even higher estimate of insomnia among osteoarthritis patients, at 34 percent; in a university of Pittsburgh study, one-third of rheumatoid arthritis patients reported pain-disturbed sleep three or more times a week.
Why Does Pain Seem to Get Worse at Night?
The answer is likely due to a few different factors. It could be that levels of the anti-inflammatory hormone cortisol are naturally lower at night; plus, staying still in one position might cause joints to stiffen up. Another explanation: The way you experience the same pain may actually change in the wee hours.
“It is not as much that the pain is worse at night, but rather that the perception of pain is more pronounced at night, or the pain thresholds are lower at night,” says rheumatologist Elena Schiopu, MD, of Michigan Medicine Rheumatology at the University of Michigan. “One explanation could be that stimuli that are abundant during the day, the distractors, are no longer present at night.”
In other words, you notice your pain more at night, so it bothers you more.
The Start of a Vicious Cycle
And once you start dealing with a lack of sleep, a vicious cycle can start.
“Poor sleep leads to daytime fatigue, which in turns leads to pain amplification,” Dr. Schiopu says. “When tired, the brain lacks the ability to dampen pain signals, also called anti-nociceptive pathways, so the pain is perceived to be worse.” Also, when you’re tired during the day you’re less likely to feel like exercising, which can help improve arthritis and its symptoms. Not keeping weight in check is also linked with sleep apnea, which causes further sleep problems. Tiredness is also linked to greater depression in arthritis patients, which is again linked to worsening pain.
It’s no wonder that painsomnia can seem almost inevitable with arthritis, but there are some steps you can take to make it better:
1. Practice good sleep hygiene
Do the things that can help everyone — with or without arthritis — get a better night’s sleep. “It is important to go to bed each night at the same time and wake up at the same time each morning, no electronics or screen time prior to bed, and no eating or any other activities unrelated to sleep before bed,” Dr. Schiopu says. Keep your room dark and at a comfortable temperature for you.
2. Exercise during the day
Moderate physical activity is an important part of your arthritis treatment plan, and it’s also associated with better sleep for arthritis patients. But if you’re someone who struggles with painsomnia, make sure to exercise earlier in the day, as opposed to after work or dinner, to keep from too much stimulation before bed, Dr. Schiopu says.
3. Try meditation or deep breathing
Any mental technique that can help you relax before bed is worth it. Arthritis patient Cindi Arnsdorff , a CreakyJoints Patient Council member, uses three go-to visualizations. “I close my eyes and picture myself on a Caribbean Island, lying in a downy soft bed with the doors open to the sounds of waves lapping on the beach outside my window,” she says. “Another trick is literally counting sheep: I visualize sheep jumping over a stump and count them in my mind. Never have I gotten to one hundred.”
Another exercise Arnsdorff likes is to visualize a flickering candle and to quietly chant “om” until her mind is cleared.
4. Create a relaxing pre-bed routine
If meditation isn’t your thing, find what works to calm your mind and body. “This can be highly individualized process,” says CreakyJoints community member Dawn Marie Gibson, who recently coauthored a paper about managing painsomnia that was presented at the 2018 American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago. “Soothing sounds like waves and fireplaces help me relax by taking the focus off my pain. I also enjoy crocheting when I feel up to it.”
Dr. Schiopu suggests a boring book to put you to sleep. In addition, Gibson says to eliminate anything that riles you up. “Reducing or taking something away may be as helpful as anything being added in,” Gibson says. “Less caffeine, less news, or less arguing on social media might make it easier to wind down and go to sleep.”
5. Consider CBT
Pain is partly psychological, which is why research shows that cognitive behavioral therapy (CBT) can help train your brain how to respond to pain. “Pain is the result of myriad electrical connections and a perfect communication between the peripheral and central neurons, with significant modulation via the vegetative nervous system,” Dr. Schiopu says.
Translation: Pain signals in your brain can get worse if they’re in a state of high alert and sensitivity. CBT with a licensed therapist can help you modify both your coping response to those heightened signals and the signals themselves. In addition, any mental health issues you’re experiencing, such as depression, should be treated in order to improve pain at night.
6. Use hot or cold therapy
A warm bath before bed may help calm sore joints and promote feelings of relaxation. “During colder months I pop my comforter in the dryer for about five minutes to warm it up before going to bed,” Arnsdorff says. “Then I use it like a cocoon to soothe my sore muscles and joints, and help me enter dreamland.” She also makes “sock buddies,” which are filled with dry rice heated in the microwave to put over sore hands. Or, you can try ice on swollen areas.
This may require some trial and error, Gibson warns. You don’t want to over-stimulate yourself before bed or risk any harm by falling asleep on the hot or cold object.
7. Make sure your bed is comfy for you
Check with your doctor or physical therapist, but in general, avoid a too-firm sleeping surface. “A soft mattress is very important,” Dr. Schiopu says. Although Arnsdorff says heavy blankets put too much pressure on her joints, Gibson says weighted blankets can help some people settle down, and they’re becoming more widely used among people with chronic pain, so see what works for you.
You can also experiment with “throw pillow therapy” to see what feels good — Arnsdorff says she uses many pillows to cushion sore joints.
8. Consider herbal remedies to help you snooze
With your doctor’s OK, “you could try melatonin or herbal teas, particularly those with calming properties,” Dr. Schiopu says.
9. Discuss your medication options with your doctor
If you’re experiencing painsomnia, consider tracking it with an app like ArthritisPower so you can talk to your doctor about the degree of your symptoms and correlate them with other factors, such as your medication regimen. Having good control of your arthritis with disease-modifying drugs is usually the first step, but other medications that can specifically help manage pain at night may be needed. These could include anti-epilepsy drugs such as Gabapentin, as well as muscle relaxers such as Tizanidine or Flexeril, says Dr. Schiopu.
In addition, it’s a good idea to review the other meds you take for your arthritis. Side effects like weight gain or higher cortisol levels (such as from corticosteroids) might be messing with your sleep. Talk with your doctor and pharmacist to make sure your regimen isn’t contributing to your painsomnia.
If you experience painsomnia, Gibson says to remember “sleep issues don’t make you a failure — sometimes our bodies just don’t do what we want them to.” Try different approaches, talk with your doctors, and see what helps.
And remember this good advice: “Take painsomnia seriously,” Gibson says. “You need and deserve your sleep and rest!”
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Is Arthritis Pain Keeping You Awake at Night?
Joint pain may make it difficult for people with arthritis to fall asleep and stay asleep at night. According to rheumatologist Scott J. Zashin, MD, an associate professor at the University of Texas Southwestern Medical School in Dallas, “Sleep problems are common in patients with arthritis pain caused by chronic diseases such as rheumatoid arthritis and osteoarthritis. Patients may have difficulty falling asleep or staying asleep due to pain, anxiety, or both.”
Here are some eye-opening facts:
- About one-third of people who have pain while trying to sleep suffer from arthritis pain, according to a National Sleep Foundation Gallup Poll.
- According to a National Sleep Foundation “Sleep in America” poll, 72 percent of older Americans diagnosed with osteoarthritis and other types of arthritis experience problems sleeping.
- People with fibromyalgia, a condition that causes joint and muscle stiffness as well as arthritis-like pain, also have difficulty sleeping. For these individuals, nighttime arthritis pain and problems sleeping can be a vicious cycle, each aggravating the other.
The Cycle of Arthritis Pain and Sleep Difficulty
In a study of 30 healthy adults, researchers at the David Geffen School of Medicine at the University of California, Los Angeles found that individuals who were kept awake from 11 p.m. until 3 a.m. for one night had higher levels of several chemicals that contribute to inflammation in the morning, compared to adults whose sleep was not interrupted. Elevated levels of these chemicals are also found in patients with arthritis. These results provide a clue to the connection between arthritis pain and lack of sleep.
More Tips for Better Sleep
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) offers the following tips to get more restful shut-eye:
- Develop a regular sleep schedule and try to stick to it every day.
- Stay away from alcohol and caffeine from late afternoon on.
- Don’t exercise within three hours of going to bed.
- Don’t nap during the day.
- Use your bed only as a place to sleep; don’t use it for watching TV or working.
- Make sure your bedroom is cool and dark.
- Don’t drink too many liquids or eat spicy food before going to bed.
- Incorporate relaxing activities into your routine (such as listening to music or soaking in a warm bath) before bedtime.
Zashin also recommends that patients with arthritis pain “talk to their doctor, as medications may help improve their sleep.”
Coping With Stress and Depression in Arthritis
The Arthritis Foundation recommends that patients with arthritis pain develop strategies to cope with stress as a way to improve their ability to sleep. For example, an osteoarthritis patient could try to identify sources of stress by keeping a stress diary. The patient could then try to make changes in situations that seem to routinely cause stress, and practice coping mechanisms, such as using support systems, exercise, and relaxation techniques.
Dr. Zashin notes, “Many patients with arthritis pain have depression, and this can cause patients to wake up earlier than they would like and not be able to fall back asleep.” He recommends that his patients get “daily aerobic exercise such as walking, biking, swimming, or running, can help people with conditions like osteoarthritis obtain a good night’s sleep.”
A few final tips to keep in mind: Investigate the type of bed you are sleeping on; your mattress may be too firm — or it may not be firm enough. Talk to your healthcare provider about getting expert advice from an occupational therapist or physical therapist who specializes in treating arthritis. They can provide tips tailored to your specific situation to help you maximize your snooze time.
If you roll out of bed bleary-eyed each day, thinking, “Oh, my aching ,” you’re not alone.
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Research shows that between 50 and 90 percent of people with chronic joint pain don’t sleep well. And, that sleep deprivation can lead to other health issues, including low energy, mood disorders and eating problems.
If you have chronic pain in your hips, knees or shoulders, there are things you can do to limit how much the discomfort affects your nighttime rest, says Michael Schaefer, MD, Director of Musculoskeletal Physical Medicine & Rehabilitation at Cleveland Clinic.
“A healthy brain is a well-rested brain. It can deal better with pain, such as arthritis, on an ongoing basis,” he says. “Lack of sleep, on the other hand, can directly affect your mood, and a bad mood can make it harder to cope with pain. This can become a vicious cycle.”
When you need a doctor
Some problems with broken sleep patterns are normal as we age, Dr. Schaefer says, but you shouldn’t wake up and stay awake every night because of pain. If that’s your situation, consult your primary care physician.
“If the pain goes on for more than three or four days in a row or intermittently for two to three weeks, it’s time to get it addressed,” he says. “If the pain is so severe that you require alcohol or over-the-counter sleep aids to fall sleep, then it’s worth getting it looked at.”
See your doctor if you have joint pain and:
- The pain isn’t in a typical spot for arthritis
- You’re losing weight unexpectedly
- Have a fever or chills
- Experience night sweats
- Have a history of cancer
Any of those problems can indicate a more serious condition in need of immediate medical attention, Dr. Schaefer says.
Get into a good sleep position
Finding the right position can be the most crucial part of avoiding pain during sleep. Twisting and turning to find a comfortable spot is normal, Dr. Schaefer says, but even the slightest twinge of pain can disrupt your rest. He recommends you start out sleeping on your side – avoiding a sore shoulder if you have one – with a pillow between your legs. Try to avoid lying flat on your back.
Side-sleeping won’t work for all shoulder pain, though. Minimize that discomfort by wrapping your arm in a bandage or wearing a sling to bed. It will keep your arm immobile and prevent you from sleeping with your arm in an awkward position.
Other tips offer sleep relief for all
There are additional, pain-specific steps you can take to decrease nighttime discomfort, Dr. Schaefer says. He also offers some general sleep recommendations to help nearly anyone, not only pain sufferers.
- Find the right mattress. For back, hip and knee pain, Dr. Schaefer recommends a firm mattress. Add a foam pad on top if you need it to help evenly distribute your weight and keep your joints in alignment.
- Take appropriate medication. If you’re using regular acetaminophen or ibuprofen and your pain breaks through the night, consider switching to a different pain reliever. Dr. Schaefer recommends pain killers that last between 12 and 24 hours, such as naproxen (Aleve®).
- Maintain good sleep hygiene. Keep your sleep schedule as consistent as possible – turn off the television, put all electronics away, turn off lights and keep your room as quiet as you can.
- Avoid substance aids. Alcohol might make you drowsy, but it won’t give you restful sleep. People often wake up after a few hours of drinking.
- Minimize how often you use over-the-counter sleep aids. If you take them too long, you’ll need higher doses and may have trouble breaking this habit.
- Do low-impact exercises. Regularly scheduled low-impact exercise, such as walking, bicycling or swimming, can help with both pain and sleep disorders.
Why sleep can hurt
Normal joint pain, especially in the hips, knees and shoulders, frequently worsens at night, he says. Your sleep position and the alignment of your body are responsible for most of the pain, but some comes from being so still at night.
“Joints swell at night, and motion gradually lubricates them and keeps the fluids moving round,” Dr. Schaefer says. “When you stop moving, they can swell more.” This can cause stiffness and pain, he says.
9 Ways You Can Sleep Better with Osteoarthritis
Coping with Chronic Pain and Insomnia
2 Ways to Treat Insomnia Caused by Chronic Pain
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Gout is a type of arthritis that was once known as “the disease of kings.” If you have gout, though, that’s probably slim comfort. Your first symptom is likely to be sudden, intense pain in a big toe that wakes you up at night – hardly the royal treatment.
The pain comes from needle-like crystals that form in joints, usually in the feet, ankles, knees, hands or wrists. The affected joints can also become red, hot and swollen, and stay that way for a few days to several weeks. Gout symptoms usually resolve completely, but most people have another attack within a year or two. Over time, gout attacks get more frequent.
All this happens because of an excess of uric acid in the body. Uric acid is formed from the breakdown of substances called purines, which occur naturally in your body and also in certain foods. When your body produces too much uric acid or your kidneys can’t remove it well enough, the buildup can lead to painful urate crystals forming in your joints. Certain foods and drinks may also increase uric acid levels, which could be the reason for gout’s early association with kings – these foods, including shellfish, organ meats and alcohol, may have been considered royal fare.
The sudden, painful, nighttime attack of joint pain is good clue to a diagnosis of gout. But the symptoms can begin at any time and can occur in more than one joint. To confirm the diagnosis, your doctor may extract fluid from an affected joint and use a microscope to look for urate crystals. X-rays can help rule out other causes for your symptoms. And a test to show the level of uric acid in your blood is often done along with other tests, but that measurement alone isn’t definitive. High levels don’t always indicate gout and normal levels don’t rule it out.
Gout occurs more often in men than women, and it tends to run in families. People who take certain diuretic medications and those who use immunosuppressants after an organ transplant are at higher risk for gout. It’s also more likely in people who are obese, and those who have high blood pressure, high cholesterol and triglycerides, and diabetes. In fact, losing weight – which can reduce your risk for these conditions – is a good way to avoid or control gout.
People with gout need to eat carefully for other reasons, too. They need to avoid:
- Certain types of seafood that are high in purines, such as anchovies, herring, sardines, scallops, mackerel and tuna.
- Organ meats such as liver and kidneys, which are also high in purines.
- Alcohol – especially beer – which may increase uric acid production in your body.
- Drinks and foods that are high in fructose.
On the other hand, gout may be unaffected or even improved by:
- Vegetables that are high in purines. Studies have shown that they don’t increase your risk of developing gout or having recurring attacks. Since fruits and vegetables are essential for a healthy diet, even people with gout can eat high-purine veggies like asparagus, spinach, peas, beans and lentils.
- Coffee. Moderate consumption of coffee may reduce the risk of gout.
- Vitamin C. A daily 500-miligram supplement of vitamin C may help lower uric acid levels.
- Cherries. Some research shows that eating cherries or drinking cherry juice can lower your risk of gout attacks.
- Drinking plenty of water.
Certain medicines can help minimize gout attacks by blocking uric acid production or lowering its levels in the blood. When gout does flare up, a medicine called colchicine can help relieve symptoms if taken early on. Nonsteroidal anti-inflammatory drugs, or NSAIDs, can also help. For some people, a corticosteroid such as prednisone is the best choice. And don’t forget the old standby – an ice pack on the painful joint.
About 3 million people in the U.S. have gout, and that number is rising. You can learn more about this condition by visiting the American Academy of Rheumatology at rheumatology.org. If you have symptoms of gout, see your doctor as soon as possible. Treatments work best if they are tailored for each individual, and the sooner you start the better.