Osteoarthritis and Sleep
Joint pain can keep you from catching enough zzzs – and make your daytime pain worse. Find out why, and get some tips for a better night’s slumber.
If your osteoarthritis (OA) keeps you up at night, you’re not alone. About 70% of people with OA have some kind of sleep disturbance. Troubles range from having problems falling or staying asleep to waking up earlier than desired.
Why OA keeps you lying awake may seem obvious — your pain prevents you from getting comfortable or it wakes you up in the night. Pain is an important part of the equation, but researchers are finding that pain and insomnia feed off one another.
“It’s less about pain keeping you awake at night than it is about a bad night’s sleep leaving you more vulnerable to pain,” explains Patricia A. Parmelee, PhD, director of the University of Alabama Research Institute on Aging in Tuscaloosa. “It works both ways, but the stronger direction is that sleep problems – whatever their cause – can make your experience of pain worse.”
Anxious and worried thoughts often keep people tossing and turning. And for people with OA, it can be “pain catastrophizing,” says Parmelee. Catastrophizing has two forms: assuming that something bad will happen and expecting that it will be as bad as possible. “You lie in bed thinking about how awful the pain is and think that it’s never going to get any better,” explains Parmelee. “Anxiety and hypervigilance are terrible enemies of getting to sleep and staying asleep.”
Poor sleep makes it harder to cope with the next day’s pain, which can lead to more pain catastrophizing, less sleep, and perhaps a magnification of your pain called central sensitization.
Emerging research shows that the joint pain of OA can become “centralized.” This means that pain pathways become over-excited and pain is amplified beyond what would be typical for the amount of damage found in the joints.
Why OA pain becomes centralized in some people may depend on their sleep patterns. Burel Goodin, PhD, associate professor of psychology at University of Alabama, Birmingham, explains that sleep deprivation can promote central nervous system sensitization.
He describes a pain experiment done with healthy volunteers at Johns Hopkins University. All volunteers were tested for pain sensitivity at the beginning of the experiment. Some had their sleep hours cut by being kept awake past their normal bedtime for a few nights. Others were woken up every hour throughout the night but had the same total sleep time as the delayed sleep group. Although identical pain stimuli were given at the beginning and end of the experiment, all were more sensitive at the end. But those with interrupted sleep became even more sensitive to pain.
Goodin believes, “this clean experimental design shows that sleep deprivation – particularly sleep fractionation -- can lead to central sensitization.”
“For many patients, their problematic sleep patterns predate their chronic pain. Poor sleep behaviors – especially in people with chronic disease – can put them on a slippery slope to further illness and increased pain,” explains Goodin, who specializes in pain-related behavioral medicine.
Depression and Disability
Your sleep troubles may not only be making your pain worse, but a 2015 study by Parmelee and colleagues published in Arthritis Care and Research showed it could also be increasing your depression and disability. “We found that sleep disturbance at the beginning of the study predicted increased depression and disability a year later. Pain did not predict increased depression over time, but sleep disturbance did predict depression.
“We know that sleep problems drive pain, depression and disability in people with OA. This may compromise their independence. We really need to treat the sleep problem – independent of pain and depression,” urges Parmelee.
Getting Better Sleep
A good night’s sleep will improve your pain and ability to manage it. You can get more restful sleep. Review your medications with your doctor or pharmacist to see if they affect sleep. Get checked for physical problems like sleep apnea that may be contributing to sleep problems. Exercise during the day so you feel physically tired at night.
Experts also recommend these sleep hygiene tips:
- Sleep on a regular schedule.
- Avoid caffeine and alcohol in the hours before bed.
- Sleep in a cool, dark room.
- Turn off the TV, computer and phones at least an hour before bed.
- Don’t lie in bed awake for more than about 20 minutes. Get out of bed and do a calm activity until you’re ready to sleep.
If you’ve tried these tricks but still aren’t getting the sleep you need, you may want to try cognitive behavioral therapy for insomnia (CBT-I). A 2017 report published in the journal Sleep found that CBT-I increased total sleep time and reduced pain. Another 2017 report published in the journal Pain found that CBT-I reduced daytime and nighttime pain catastrophizing. The CBT-I program used in these studies included sleep hygiene practices and cognitive therapy for insomnia done by a professional therapist.
Parmelee reminds us, “When you’ve had a good night’s rest you are better able to adapt and not let the pain sap joy from your life or stop you from doing the things you enjoy.”
Updated October 2017