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RA and the Inability to Sleep

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RA Patients Struggle with Insomnia

More than 80% of RA patients say fatigue is a huge problem. Part of the reason for that fatigue is the inability to obtain quality sleep. Sleep problems in people with chronic illness like RA are associated with a variety of problems, including lower quality of life, psychological issues, cognitive decline, as well as higher morbidity and mortality.

According to a study by the NIH, sleep disorders are common with RA patients, and I am the poster girl for insomnia! For many years, I have struggled to get to sleep and/or stay asleep.

My Personal Battle with Sleep

When I finally gave up the battle and discussed this with my PCP, he first prescribed Tramadol, a fairly mild (compared to many others) pain medication. It gave me hallucinations and I walked in my sleep. Next was Trazadone, another popular drug for several ailments. It made my head fuzzy, but I didn’t sleep. Gabapentin really hit me hard. It was clear that what works for many people would not do it for me. He then prescribed a popular sleep aid. For 4 blessed months, I took that little pill at bedtime and slept like a baby.

One morning, I awoke to find a red rash all over my lower legs and feet. The rash didn’t hurt or itch but eventually, it spread to my arms. My PCP suspected rheumatoid vasculitis. Fortunately, my rheumatologist disagreed,.and he sent me to a dermatologist. But before that appointment, I discovered the rash disappeared when I stopped taking the sleeping pill. One problem solved, but another returned!

I lay awake and tossed and turned for hours! For a few months, I self-medicated with a dose of Tylenol PM capsules every night or a dose of Nyquil. It takes a couple hours for both of those to kick in and then I would sleep for 3-4 hours before waking to toss and turn once more. Not long ago, I decided to go cold turkey and stop taking anything to sleep. After a couple of weeks, sleep 4-5 hours only each night, last night I slept for 9 hours! Granted, it was broken up a couple of times by a night own cat wanting to play but wow! I can’t remember the last time I slept so long!

If rheumatoid arthritis causes sleeping problems for you, know that you are not alone!

RA Can Cause Sleep Problems

You may find that the lack of sleep increases your RA pain. Along with the lack of sleep, patients with sleep deprivation may struggle with depression, anxiety and the inability to function well during the day. In fact, some RA medications can contribute to the inability to fall asleep or stay asleep. Steroids can cause insomnia. Hydroxychloroquine can cause a person to feel nervous, twitchy and unable to sleep.

What and When You Eat May Affect Your Sleep

Most people know to avoid caffeine at night, as it can keep some people awake. But did you know that many people don’t consume enough liquids? All the healthy food in the world won’t help if your body becomes dehydrated. Avoid sugar as much as possible – especially, at night.

Pain and Insomnia

It would be nice if rheumatologists would address the issue between pain and the inability to sleep, but I haven’t run across one that did in my 45 + years with the disease.

Pain usually occurs when nerves are stimulated to an intense degree. This activates your brain and keeps you awake. In order to achieve the right amount of healthy sleep, you must undergo each stage of sleep – light sleep, deep sleep, and rapid-eye-movement sleep. That isn’t possible if pain keeps waking you.

Logic says that pain medication is the answer. However, many pain meds actually keep you awake. Hydroxychloroquine and steroid drugs are just a few examples. Leflunomide is another and directions say to take it earlier in the day.

What’s an Insomniac to Do?

First, determine the actual cause of your insomnia. From stress and anxiety to medications to pain, and even poor sleeping conditions, you must know the cause of your inability to sleep in order to fix it. Obviously, pain should be addressed first. Discuss this with your rheumatologist and find ways to treat the pain.

Prepare Your Room for Sleep

Your bed MUST be comfortable for you. While most sleep experts say a firm mattress is the only way to go, people with rheumatoid arthritis often find firm mattresses create more pain. I want support, but I don’t want to lie down on a hard mattress. Solutions for this problem abound. From memory foam toppers to pricey innerspring mattress made with memory foam as the top layer, you can probably find the perfect comfort solution for you and your joints.

Years ago, we chose a Sleep Number mattress, and it has held up well. These are adjustable and offer a comfortable option for many people. Today, there many brands of mattresses on the market that should solve this issue for you.

Remove Electronics from your Bedroom!

This means no phones, no television, no laptops or tablets at all! Part of the light spectrum most active in our sleep cycle is the blue light that is produced by electronics’ screens. Any electronic with this light won’t help you sleep.

Exercise is Crucial to Sleep.

It may seem odd, but your body needs daily exercise earlier in the day in order to sleep well at night. Determine an exercise plan that works for your body and pain level, and try not to allow anything to interfere with it each day. As we RA patients are often told, motion is lotion!

No Alcohol Close to Bedtime.

Just as with caffeine, confine any alcohol intake to 5-6 hours before bedtime. Alcohol may interfere with your sleep cycle. Alcohol may also interfere with some RA medications.

No Naps!

If you feel sleepy during the day, take a walk outside. Fresh air may help you wake up. You want to be ready for sleep when you go to bed at night.

Keep Your Rheumatologist in the Loop!

Your doctor should know what medications you take but also what methods you use to encourage sleep. He or she may have suggestions to help.

Avoid Eating Close to Bedtime.

If you must eat something, make it a light snack. I have diabetes and find a light snack, such as a glass of iced tea and a low-cal cheese stick around 9 p.m. helps keep my glucose regulated.

Your Body Requires Sleep to Function Well.

Sleep is crucial to our overall health! We must find a way to deal with the pain from RA and still get enough sleep to keep our bodies functioning well. The inability to sleep creates more pain, and it becomes a vicious circle. Practice healthy habits that contribute to sleep, and include your physician in your plan anytime you need help.

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