Psoriatic Arthritis and Sleep

By Kenna Simmons

People with psoriasis and psoriatic arthritis (PsA) are more likely to have trouble sleeping. The authors of a study published in the International Journal of Dermatology in 2016 found obstructive sleep apnea was so common in people with psoriasis that they suggested patients should be screened for it.

If you’re having trouble sleeping, you already know about the fatigue it causes. You may be feeling effects like trouble concentrating, remembering things or mood changes. Poor sleep increases the risk of weight gain and obesity, which puts extra stress on your joints. As if that weren’t enough, disrupted sleep can worsen joint pain, and some experts think it may increase inflammation, too.

Recognizing the issues that are affecting your sleep can help you find relief.

Symptom Control is Critical

Painful joints or itchy skin may make it hard to fall asleep or stay that way. “Chronic pain is associated with disruptive and un-refreshing sleep,” says John Davis III, MD, rheumatologist at the Mayo Clinic in Rochester, Minnesota. To stop the vicious cycle of pain interrupting sleep – which leads to more pain – act quickly. If you’re having trouble sleeping or experiencing a flare, talk to your rheumatologist and dermatologist. Adjusting your medications and making lifestyle changes may help to relieve symptoms.

You can take action on your own to improve your sleep habits, too. “Unfortunately, we live in a society where we’re plugged in 24/7,” says Camilo Ruiz, DO, medical director at Choice Physicians Sleep Center in Ft. Lauderdale, Florida. He talks with his patients about how much sleep they need – most adults need about seven or eight hours, with anything less than six possibly affecting your health. He also discusses their environment. Do they share the bed with kids or pets? Do they spend most of their day in artificial light?

“Light is an important timekeeper,” Dr. Ruiz says, with darkness helping signal to your body that it’s bedtime, and light signaling that it’s time to wake up. That’s one reason you should put your phone or tablet away before going to bed, since the light from the screen can throw off your body’s clock. See Sleep Tips for Arthritis for more dos and don’ts.

Diagnosing and Treating Sleep Disorders

If your PsA symptoms are in check and you feel good about your sleep habits but are still struggling, it may be time to see a sleep specialist. Start by talking to your rheumatologist. Dr. Davis says he routinely screens his patients for sleep problems and makes referrals to sleep doctors. “It’s not uncommon to identify people [with sleep disorders] because we’re asking about sleep and hearing about daytime [sleepiness] or snoring from sleep partners,” he says. For mild symptoms, he will sometimes recommend an overnight oximetry test, which can be done at home. It involves wearing a device, usually a finger clip, to measure oxygen levels. It can help identify people who need more tests, like an overnight sleep study.

• Sleep apnea. This is a condition where someone briefly stops breathing involuntarily many times during the night because the airway closes. It’s diagnosed with an overnight sleep study usually done at a sleep lab. A technician attaches electrodes to your head and body that monitor everything from brain waves and rapid eye movements to oxygen levels and breathing.
  
  Although you may think you won’t be able to sleep at the lab, most people sleep enough for the test to work. If you’re diagnosed with sleep apnea, your doctor may prescribe a continuous positive airway pressure (CPAP) device that provides air pressure to keep your airway open while you sleep. It can take time to get used to wearing a CPAP, and you may have to try different masks to find the right one. But the benefits are substantial. In addition to daytime fatigue, having untreated sleep apnea raises your risk for high blood pressure, heart disease and stroke. Losing extra weight and getting enough exercise also help treat sleep apnea.
   
• Restless legs syndrome. An uncomfortable sensation in the legs along with an irresistible urge to move them can cause poor sleep. It may show up in a sleep study, but there isn’t a test for it. Your doctor may ask about symptoms and check your iron levels, says Dr. Ruiz. “If the levels are low, we’ll prescribe a supplement,” he says. “There are also medications we can prescribe to treat this condition.”
   
• Anxiety. For some people, trouble sleeping turns into its own habit – you start to worry about not getting enough rest, and the anxiety keeps you up. That’s why experts say you should get up if you can’t sleep, do something quiet for a bit (like read a book or listen to soft music – but no screen time) and then go back to bed when you feel sleepy. People who have anxiety about their sleeplessness can benefit from retraining their negative thoughts about sleep using cognitive behavioral techniques. A sleep specialist can help.
   
• Medications for insomnia. There are medications that can help insomnia. Dr. Ruiz often starts with over-the-counter melatonin, a hormone that signals the body it’s time to go to bed soon. “If patients don’t improve, we can move on to [prescription medications],” he says. But they carry risks of dependency if used for more than a few weeks. “These are things we have to discuss, whether they feel comfortable taking these medications for a period of time,” he says.

The healthiest solution is to find the reason for your sleepless nights and fix the problems that are keeping you up.