Insomnia

Given the recent discussions about lack of sleep, I thought it might be appropriate to address this issue. It seems to be a common problem for people with RA.

There’s a general insomnia article at WebMD, and another brief article that mentions some of the ways in which poor sleep can harm health. Combine these, and the results of insomnia sound remarkably like fibro. In addition to the obvious fatigue that accompanies chronic lack of sleep, insomnia can cause muscles to ache. It affects memory. It can cause headaches and elevated blood pressure. It magnifies the sensation of pain (which makes your RA feel even worse). Interestingly enough (although not a key with fibro), insomnia can make weight control difficult and lead to obesity. Given the seriousness of these things, it would seem that sleep should be a key issue to be addressed. I suspect that those in the autoimmune community we would have fewer FMS diagnoses if the topic of sleep were addressed just as early and aggressively as RA.

Address Pain
Ignoring pain, or trying to “just live with it because there’s always pain with RA” is a bad approach. If your RA is well controlled, pain should not be an issue. Work with a rheumatologist who keeps current with treatment recommendations – particularly about pain management. If you’re in too much pain to sleep, then the pain needs to be addressed. If your rheumatologist doesn’t want to address the pain, a phone call to your PCP is appropriate.

If you have additional complications – in addition to generalized RA pain – these, too, need to be treated. RA can cause tendonitis and bursitis, and when the affected joints are shoulders and hips, it’s difficult to find a comfortable position. Sleep gets interrupted. This can be fixed. If you tell your doctor, “My hips hurt so much that I can’t sleep,” your doctor hears how serious the problem is to you. I have found that cortisone shots followed by physical therapy can really help with these problems. Remember, though, that it’s not enough to just drive to the PT office; you have to actually do the prescribed exercises at home, too.

Get Comfortable
I’ve discovered that a double-layer of foam egg-crate pads on top of my bed mattress was very helpful until the PT exercises worked their magic.

Foam pad = less pain

One tip for getting comfortable is to create a good sleep environment:
Darken the room.
Eliminate noises that might keep you awake – if noises can’t be eliminated, some people do well by covering those sounds with white-noise: nature sounds on the radio, the soft hum of a fan…
Modulate the temperature of your room, too – not too hot or too cold – and the right number of covers on the bed.
Don’t read, watch television, or eat in bed. The bed is for sleeping.

 
Exercise
Sure, everyone knows that we’re supposed to exercise. Lots of people don’t though. What’s important to this particular discussion is that you will sleep better if you exercise than if you don’t. Exercise should be done at least three hours before bedtime. I find that stretches first thing in the morning help me to limber up to face the day.

An added bonus is that exercising is a good method of pain control. You don’t need to run a marathon. The Arthritis Foundation’s book Living Well with Rheumatoid Arthritis includes a chapter with stretches & exercises that should be doable by people with RA.

Sleep Routine
Think about how we teach babies and toddlers about bedtime. If bedtime is the same time every day, follows the same routine, and is non-negotiable, kids easily learn to get into bed and fall asleep at night. We don’t let toddlers get up and roam about the house if they wake up; we tell them to lay there until they fall back to sleep.

As adults, we can do the same thing to train our bodies into a routine. Find an evening routine and stick to it. Give the kids a bath, read a bedtime story, pray with them, and tuck them into bed. Then do your own routine, climb into bed, and go to sleep.

If you awaken in the middle of the night, stay in bed and do not look at the clock. Getting up to check your email, read a book, eat a snack, etc., done often enough, will re-set your internal clock. If you firmly tell yourself (just like you’d tell your toddler) “Now it is time to sleep,” your internal clock will eventually adjust and learn that there’s no point in waking up.

(credit)

 
Other Tips
Drink lots of water during the day, but don’t drink anything too close to bedtime. You don’t want to awaken in the middle of the night to use the bathroom.

Don’t nap. When we don’t sleep well at night, we’re tired during the daytime and it’s tempting to catch a few ZZZZs. But if you nap during the daytime, then you won’t be as tired at night, and the cycle will just get worse. (Unless you have a baby who nurses at night, in which case I highly recommend napping with your baby during the daytime.)

Deal with allergens. Breathing difficulties can significantly impact sleep. If you have hayfever, don’t sleep with the window open. If you’re allergic to the cat, don’t let it in your bedroom. I find that extra Vitamin C during allergy season is particularly helpful. If needed, take an antihistamine.

If faithfully trying all of the above things doesn’t work, one method of re-setting your internal clock is given in the book named below (the above worked for me, so I didn’ t have to get this drastic). It will take a couple weeks. If your ideal bedtime is 9:30, on the first night, stay up until 11:30. Follow your bedtime routine later than normal, at and 11:30, climb into bed. Set your alarm clock two hours late, too. Stay in bed until the alarm goes off and then get out of bed. NO NAPS!!! The second day day, postpone bed/awakening time another two hours: you’ll be going to bed at 1:30 a.m. The third day, don’t go to bed until 3:30 in the morning (obviously, this will require some accomodation from everyone in the household – it’s only a couple weeks, not forever). The fourth day, you’ll go to bed at 5:30 a.m. The fifth day, you’ll be awake all night long, not going to bed until 7:30 a.m. Every day, posptone bedtime for two hours, and change your bedside alarm clock. By the tweveth day, you’ll be back to going to bed at 9:30 p.m. Obviously, this can’t be attempted if you’re working outside the home. The chance to correct a long-term sleep problem should be worth taking some time off of work; if you’re already working with your doctor about your insomnia, you might even be able to get a letter so that the two weeks needed to try this are covered under FMLA.

Final tip: If insomnia continues to plague you, more ideas can be found in a book directed toward children’s sleep problems. Check your public library. I don’t believe this book is appropriate for babies, but there are great ideas for helping adults and older kids sleep better:

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