Louise Chang, MD
The pain of arthritis makes it tough for many people to get a good night’s sleep. Worse yet, tossing and turning at night can actually increase the perception of pain.
“There’s a reciprocal relationship between pain and poor sleep. The poorer people sleep, the more pain they tend to be in,” says Kevin Fontaine, PhD, assistant professor of rheumatology at Johns Hopkins University. “If people with arthritis can improve the quality of their sleep, they can usually reduce their day-to-day pain.”
Here are eight tips for better sleep from arthritis experts.
Managing arthritis pain is important at all times, but it’s particularly crucial before bed time. “If you go to bed in pain, you’re almost certain to have trouble sleeping,” says Fontaine. Try to arrange your medication schedule so it provides peak relief around the time you want to hit the hay. Avoid doing activities in the evening that cause flare-ups of arthritis pain. “Some people with arthritis find they sleep better after taking a hot shower before bed time or using an electric blanket to ease joint pain,” says Andrew Lui, PT, DPT, assistant clinical professor, University of California, San Francisco.
It’s hardly news that having coffee or other caffeinated beverages late in the day can interfere with sleep. But many people aren’t aware of other hidden sources of caffeine, including colas and some over-the-counter pain relievers. Always check labels to make sure you’re not getting caffeine. Black tea also contains stimulants that can make some people wide awake when they want to sleep. Herbal teas in the evening are a better choice if you’re having trouble sleeping. Alcohol may help some people fall asleep, but too much can disrupt sleep halfway through the night, leaving you wide awake and tossing.
The inevitable stresses of everyday life can also disrupt sleep. You can’t eliminate them all, of course, but you can put them in their place. “One strategy is to avoid stressful activities or thoughts before bed time,” says Fontaine. “Don’t watch the news if it gets you irritated. Don’t pay bills. Don’t make a list of all the things you have to do tomorrow.” Instead, arrange your schedule to do something relaxing in the hour or two leading up to bedtime. Listen to music. Read a book. Work on a hobby, as long as you find it calming. If you still find yourself fretting, practice some relaxation techniques such as meditation or progressive relaxation.
Be as active as possible during the day. This will strengthen your muscles and joints -- and it can help make you tired enough to go to sleep. Activity has also been shown to ease stress, which promotes a restful sleep. Being active isn’t always easy when you’re suffering from arthritis. Still, activities such as swimming, water aerobics, and moderate walking are doable for many people with arthritis. “The common wisdom is to exercise earlier in the day, since exercise itself can be arousing,” says Fontaine. “But some of our patients like to do a little light activity in the evening -- a walk around the neighborhood, for instance -- to tire themselves out. The best advice is to find what works for you.”
Reserve your bedroom for sleep. That way, you’ll associate getting under the covers with falling asleep. “Avoid watching TV, reading, working on your computer, or doing other stimulating activities in bed,” says Wilfred Pigeon, PhD, is assistant professor of psychiatry at the University of Rochester Sleep and Neurophysiology Research Laboratory and author of Sleep Manual: Training Your Mind and Body to Achieve the Perfect Night’s Sleep. “Make the bedroom as conducive to sleep as possible. Put up heavy curtains or shades to eliminate distracting lights. Use earplugs if sound is a problem.”
What’s the best kind of mattress? Despite ads claiming that certain mattresses will help you sleep better, experts say almost any kind of bed -- soft or firm -- is fine as long as you feel comfortable. “If you suffer from knee pain, try positioning a pillow under or between your knees to take some of the pressure off your joints,” says Kimberly Topp, PhD, professor and chair of the department of physical therapy and rehabilitation services at the University of California, San Francisco. “A small pillow under your neck can help align your spine and avoid neck pain while you sleep. Experiment to find what makes you comfortable.”
It may sound paradoxical, but staying in bed too long can create poor sleep. To treat insomnia, experts often restrict the amount of time people spend in bed. “That way, you help ensure that when you do go to bed, you’re more likely to be sleepy enough to fall asleep,” says Pigeon. “If you find yourself lying in bed for more than 15 minutes unable to sleep, get out of bed and do something that’s not too stimulating until you’re sleepy enough to try going to sleep again.” The reason: you won’t associate the bed with feeling restless. Over time, this strategy will help you associate the bed with sleeping, not tossing and turning.
Sleep medications are useful for people who have acute insomnia. But if you’re suffering from chronic insomnia, which is often true for many people with arthritis, the first line treatment should be better sleep hygiene, says Pigeon. “Medications treat the symptoms. Behavioral medicine can actually cure insomnia,” he says. In fact, some studies show that behavioral medicine may be more effective for many people. In a 2006 study, researchers at the University of Bergen in Norway compared cognitive behavioral therapy with a prescription sleep medication. Volunteers who took part in behavioral therapy were sleeping better six months later than the matched group who took pills. “Sleep medications are often useful for helping people get through a bad patch of insomnia,” says Pigeon. “But when people stop taking them, the insomnia often returns -- unless they learn to practice better sleep habits.”
Basic tips on how to promote good sleeping habits are sometimes called “sleep hygiene.” Together, they can have a dramatic effect on improving sleep quality. In a study published in the Journal of Clinical Sleep Medicine in 2009, older volunteers with osteoarthritis who took part in a program of sleep hygiene reported significantly better sleep and less pain. The benefits were apparent even a year after the program ended.
SOURCES:Kevin Fontaine, PhD, assistant professor of rheumatology at Johns Hopkins University.Wilfred Pigeon, assistant professor of psychiatry at the University of Rochester Sleep and Neurophysiology Research Laboratory and author of Sleep Manual: Training Your Mind and Body to Achieve the Perfect Night’s Sleep. Kimberly Topp, PhD, professor and chair of the department of physical therapy and rehabilitation services at the University of California, San Francisco: firstname.lastname@example.org 415-476-9449Andrew Lui, PT, DPT, assistant clinical professor, University of California, San Francisco.Hawker, GA. Osteoarthritis and Cartilage, November 2010; vol 18: pp 1365-71.Vitiello, M., Journal of Clinical Sleep Medicine, August 2009; vol 5: pp 355–362.Roehrs, T. Sleep Medicine Reviews, August 2001; vol 5: pp 287-297.Sivertsen, B., Journal of the American Medical Association, June 28, 2006; vol 295: pp 2851-2858.
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