Sleep and Pain
The vicious cycle that could make your arthritis worse.
As many as 80% of people with arthritis have trouble sleeping. With achy, stiff and sometimes swollen joints, getting comfy, dozing off and staying asleep can be a tall order.
Most individuals attribute their restless nights as an unfortunate side effect of arthritis pain. But new research is finding that the relationship actually works both ways – poor sleep can make your joint pain worse, and even increase the likelihood that you may become disabled or depressed.
“Patients often attribute sleep problems to pain. While pain can certainly contribute to sleep problems, the more we learn about sleep, pain and inflammation, the more we find the relationships are likely to be multidirectional,” says Yvonne Lee, MD, Assistant Professor of Medicine at Brigham and Women's Hospital in Boston. “Different problems start first in different people, but once one of these issues occurs, they lead to the others and can come full circle.”
Poor Sleep Linked to Pain, Disability and Depression
A 2015 study published in Arthritis Care and Research found that individuals with osteoarthritis pain who have sleep problems were more likely to experience depression and even become disabled over time.
The study involved 367 adults with osteoarthritis of the knee. Participants responded to questionnaires about sleep disturbances, pain, functional limitations and depressive symptoms. A year later, 288 participants answered the same series of questions.
Nearly 70% of the participants reported having sleep disturbances including having difficulty falling asleep, waking up in the middle of the night, or rising too early in the morning. Results showed that sleep problems predicted increases in depression and disability at the follow-up questionnaire.
“Research continues to show that not sleeping at night exacerbates pain the next day, but what is most concerning is that there is something about sleep disruption that predisposes folks with arthritis to become more disabled over time,” says lead study author Patricia Parmelee, PhD, Director of the Alabama Research Institute on Aging, University of Alabama at Tuscaloosa. “This is a scary finding that suggests we really need to treat the sleep problems so they do not contribute to the progression of the disease.”
Dr. Lee found a link between pain and sleep among people with rheumatoid arthritis (RA) in her research. Published in 2009 in Arthritis Research & Therapy, she found that sleep problems were associated with decreased pain thresholds in women with RA at numerous body sites when pressure was applied. The sites included both joints that are commonly affected by RA and non-joint sites that are not affected by the disease.
What Causes Sleep to Affect Pain
The big question is why does disrupted sleep affect pain? The culprit, Dr. Lee says, may be deficits in the way the central nervous system (CNS) processes pain.
Dr. Lee explains that their findings suggest the CNS pathways (the spinal cord and brain) that regulate pain may be abnormal in people who are not sleeping well.
A 2013 study in Arthritis and Rheumatism compared CNS pain pathways in 58 women with rheumatoid arthritis and 54 healthy women without chronic pain. The research showed the pathways that inhibit pain were not as robust in people with RA compared to the controls.
“Our analysis suggested that these abnormalities in pain processing may partially be explained by the observation that RA patients had greater sleep problems than the controls,” says Dr. Lee.
Similar findings have also been uncovered in healthy individuals. Research presented in 2016 at the American Pain Society’s 35th Annual Scientific Meeting examined 35 men and women without any history of sleep disorders. Participants who were purposefully deprived of sleep were less likely to tolerate putting their hand in a cold-water bath when compared with those who had eight hours of consistent sleep.
Another theory, Dr. Lee says, is that sleep problems may lead to increased inflammation throughout the body.
“Studies in healthy individuals have found that sleep deprivation is associated with an increase in inflammatory markers measured in the blood,” she explains. “It is possible that an acute inflammatory response to sleep deprivation could lead to more long-term problems, such as the development of chronic inflammatory conditions, in certain individuals. More research is needed in this area.”
How You Can Sleep Better
Since pain, sleep and inflammation are inextricably linked, Dr. Parmelee says treating insomnia is an important step in managing arthritis. A restful night’s sleep often starts with developing good sleep hygiene, such as avoiding electronic devices and caffeine, and adhering to a strict bedtime schedule. Learn more strategies that can help you sleep soundly.
“We are a sleep-deprived nation. When arthritis is in your face with pain, we tend to focus on treating the symptoms and less on our overall health picture,” says Dr. Parmelee. “A good night’s sleep is central to taking care of yourself so you can better cope with the disease.”