Is the pain of RA keeping you awake? Consider these tried-and-true sleep remedies.

Rheumatoid arthritis, an autoimmune disease in which the immune system mistakes the body’s own cells for foreign invaders, often leads to debilitating joint pain. Joint pain due to rheumatoid arthritis can be so intense that it prevents people from sleeping.

Not surprisingly, people who sleep well are better able to recover from the activities of the previous day, explains Christopher R. Morris, MD, a rheumatologist in private practice in Kingsport, Tenn. But if a person sleeps poorly, “the muscles can’t fully relax. If they’re fatigued, they hurt, if they hurt, they get fatigued, and they hurt more.”

Patricia Torres, of Seattle, knows full well what this feels like. Diagnosed with rheumatoid arthritis in 2006, Torres, a mother of three, says she is tired “all the time. It’s autoimmune fatigue — I have dreams about sleeping.” On a bad night, she’ll wake up three or four times, “and it’s waking up from pain. I wake up yelling.”

Rheumatoid arthritis pain doesn’t just wake people from sleep, it also makes it difficult to get out of bed in the morning. As Patience White, MD, vice president of public health for the Arthritis Foundation, points out, another issue with the disease is that lack of physical activity actually makes the joint pain worse. “Mobility helps stiffness gets better — it gets better during the day, then [the pain] comes back at night.”

Rheumatoid arthritis patients who don't get enough good-quality sleep can also get caught in a vicious circle — a study published in the Journal of Clinical Sleep Medicine found that poor sleep worsened pain and increased functional disability in patients with RA.

Sleep Medications and Findings for RA

According to Dr. Morris, research suggests that a number of factors contribute to chronic pain in rheumatoid arthritis — including underlying depression. In his practice, patients who experience trouble sleeping due to their joint pain are often prescribed antidepressants. Selective serotonin reuptake inhibitors (SSRIs), a family of antidepressant medications, can help offset chronic pain, both directly and indirectly, by affecting a patient’s perception of pain and by addressing symptoms of depression that many rheumatoid arthritis patients experience. “I think patients feel better, they have more energy, they are able to function better mdash; a lot of them will stay on [SSRIs] chronically,” Morris notes.

Dr. White agrees that underlying depression “is a major issue [that] plays into sleep.”

White also suggests that patients speak with their doctors about taking rheumatoid arthritis medications in the evening to help soothe joint pain and enhance sleep. Keep in mind though that certain medications such as prednisone, a corticosteroid, can be “uppers” and actually disrupt sleep further, she warns.

A look at other research shows that:

• Abatacept (Orencia), a medication designed to manage symptoms among those with moderate to severe rheumatoid arthritis, can help improve quality of sleep.
• Multiple strategies are often necessary to address chronic pain in rheumatoid arthritis since so many different factors are involved — including ongoing joint inflammation and poor sleep.

Torres, author of the blog Flare and Back Again says she has a flare about once a month. On a good day, she’ll go to bed at 10:30 p.m. or so and wake up at 6 a.m. On a bad day, she may be in bed at 5 p.m. — and just stay there. “There is no consistency,” she notes.

10 Ways to Sleep Better With RA

Some ideas to minimize pain and improve sleep with rheumatoid arthritis include:

1. Take a hot shower. Torres says the combination of heat and water can act as a mini-hydrotherapy session for your muscles and joints.
2. Keep the heat on. Invest in a heated water bed, or get an electric blanket, advises White.
3. Ice it up. Ice can help soothe sore joints.
4. Avoid distractions. No pets and no television in your bedroom, urges Morris. White concurs: Your room should be for sleep only.
5. Elevate your legs. Torres says she finds it helpful to slide a pillow under her knees to raise her legs and alleviate the pressure on her joints.
6. Practice guided meditation. Torres recommends meditating quietly and focusing on relaxing images to help “get the mind in the right spot to sleep.”
7. Take a sleeping aid. Morris adds if you want to try sleep aids, then try medications that help with “sleep architecture” instead of over-the-counter medicines. Talk to your doctor about prescription drugs, such as muscle relaxers, eszopiclone (Lunesta) or zolpidem tartrate (Ambien).
8. Avoid bedtime snacks. Don’t eat anything for a few hours before bedtime, Morris advises. Eating causes blood to be diverted to digestion which can interfere with sleep.
9. Buy a new mattress. Both Morris and White say patients should get a mattress that is as comfortable as possible. White even suggests buying a whole-body pillow.
10. Be careful of what you watch and read. Reading a book or watching television or a movie before bed is fine, but you might want to avoid something stimulating, like a crime drama or the late news.

One of the best ways that Torres has found to improve her quality of sleep is through lifestyle changes. In fact, she manages her rheumatoid arthritis through diet and exercise. She adheres to a gluten-free diet, swims regularly, and practices yoga. Currently, she isn’t taking any prescription medications and her symptoms have not progressed. She says she is sleeping better since she changed her lifestyle.

While lifestyle changes can certainly help offset symptoms, Morris warns that “rheumatoid arthritis [does] permanent, irreversible damage — [going natural] doesn’t stop the disease.”