Rheumatoid Arthritis and Sleep

Pain and inflammation from rheumatoid arthritis can negatively impact your sleep.

There’s even a medical name for it: painsomnia. It is a major problem for many people with RA. In fact, research shows that up to 70 percent of people with RA struggle with sleep issues, such as being able to fall asleep or stay asleep throughout the night. Unfortunately, a vicious cycle can start when RA pain prevents you from getting enough good-quality sleep. Poor sleep can make you more sensitive to pain, which in turn makes it harder to sleep well. Poor sleep also contributes to daytime tiredness, fatigue, brain fog, all of which can affect your pain and ability to sleep. You’re also less likely to exercise when you’re tired, and exercise is key to help improve arthritis symptoms. Tiredness is also linked to greater depression in arthritis patients, which again is linked to worsening pain.

An empty bed decorated by light streaming through a window.A bedroom shelf with an alarm clock and some dried plants in a vase.

Why Does Pain 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. Lower levels of cortisol may lead to more inflammation and more pain. Staying still in one position during sleep may also cause joints to stiffen up. Pain sensitivity also may be lower at night when fewer distracting sensations such as sounds and sights are present to draw attention. People with RA also may have a sleep disorder like obstructive sleep apnea, restless legs syndrome, or insomnia.

Tips for Getting Better Sleep

Getting your RA under control with the right medication will likely help your sleep improve. Talk to your doctor about your symptoms and what specifically is keeping you awake.

Here are tips to help you get a better night’s sleep:

Practice good sleep hygiene

Go to bed within two hours of the same time each night and wake up within two hours of the same time each morning. Limit electronics or screen time before bed. Don’t consume alcohol or caffeine close to bedtime. Don’t eat food too close to bedtime.

Exercise during the day

Physical activity is associated with better sleep. Try exercising earlier in the day to avoid too much stimulation before bed.

Try meditation or deep breathing

Use a mental technique to help you relax before bed.

Create a relaxing pre-bed routine

Try light stretching before bed, read a book, find something that relaxes you before you go to bed.

Consider CBT

Cognitive behavior therapy for insomnia (CBT-I) is a well-known treatment for sleeplessness. This targeted treatment, which usually consists of six to eight sessions, is aimed at changing the thoughts and behaviors that may be interfering with your ability to fall asleep and get good quality rest. Relaxation techniques, education about habits that help (or hurt) sleep, and specific strategies (like limiting your time in bed so you’re only there when you’re really sleepy) are all part of the process.

Use hot or cold therapy

A warm bath before bed may help calm sore joints. Sleeping on a heated mattress pad may help you avoid night stiffness. Alternatively, you can try an ice pack on swollen areas.

Make sure your bed is comfortable for you

Use pillows to prop yourself in a comfortable way. Test out different mattresses to find what’s supportive for you.

Consider herbal remedies

Talk to your doctor about trying melatonin or herbal teas with calming properties prior to bedtime.

Optimize light exposure

Bright light exposure in the morning and spending time in darker rooms at night before sleep can help reset light- and time-responsive body systems (Circadian rhythms) that are critical for sleeping effectively. 

Re-examine your medication routine with your doctor

Medications you take to treat your arthritis can have a direct or indirect impact on sleep. Talk to your doctor about your medication and if a different dosing schedule could help minimize the impact on your sleep.

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More RA and Sleep Resources

Here are some additional articles to help you get better slumber with RA.

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