Many people with painful arthritis also have insomnia: The pain disrupts the ability to get sufficient rest. Regular night awakenings or sleeping too lightly can result in non-restorative sleep, which can cause significant fatigue during the day and make pain worse.
Pain can affect sleep in three ways:
- Having difficulty falling asleep (called difficulty falling asleep or DFA)
- Having difficulty staying asleep, especially in achieving deep sleep (called difficulty maintaining sleep of DMS)
- Waking earlier than desired (called early morning awakening or EMA)
Both acute and chronic pain can disrupt sleep, but sleep disrupted by chronic pain is especially troublesome because long-term sleep deprivation contributes to poor health. In addition, acute pain is temporary and may be less worrisome—and therefore less likely to disrupt sleep—than chronic pain, such as that the pain associated with osteoarthritis and rheumatoid arthritis.
Assessing Underlying Causes of Insomnia
Determining the cause of insomnia is important and can be done through careful assessment and evaluation.
Insomnia is initially evaluated using subjective clinical symptoms. During a doctor appointment, a patient may report sleep problems (DFA, DMS, EMA) or daytime drowsiness.
Another way to assess subjective symptoms is through the use of a “sleep diary.” Patients record such things as how refreshed they feel each morning, how many times they awoke during the night, reason for awakenings (e.g. pain, thoughts, needing to urinate, nightmare, or anything else), and daytime energy level. This simple sleep diary method can give a patient and doctor a lot of important information.
If the sleep diary does not provide adequate information about the individual’s sleep problem, a doctor may order a sleep study. In a sleep study, a person spends the night in a sleep laboratory while being monitored for such things as stages of sleep, breathing patterns, and number of awakenings. Sleep studies may be done when more serious medical problems are suspected (discussed below).
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Chronic Pain and Other Causes of Insomnia
If chronic pain is the root cause of sleeplessness, it should be properly treated. A physician can help determine a course of treatment, which may include medication, physical therapy, and/or relaxation and “sleep hygiene” techniques. In some cases, it is necessary to seek help from a pain specialist to specifically address the sensation of pain.
Even though patients often assume that their chronic arthritis pain is the only reason they cannot sleep, there may be other causes. Some of these other causes can be quite serious. Two common medical problems that interfere with quality sleep are sleep apnea and restless legs syndrome:
Sleep apnea is a serious condition that causes breathing to stop or become shallow dozens or even hundreds of times a night. This disrupted breathing causes reduced air flow and poor sleep quality. The condition is usually diagnosed by a sleep study. Treatment often involves losing weight, quitting smoking, or wearing a sleep mask designed to promote proper breathing during sleep called a positive airway pressure (PAP) device.
Restless legs syndrome (RLS) causes a person to have uncomfortable sensations in the legs with an urge to move them. This is often described as a pins-and-needles, itching, or “creepy crawling” feeling. This syndrome may also cause involuntary jerking of the limbs during sleep or—often—when one is just about to fall asleep. RLS symptoms can interfere with the ability to fall and stay asleep.
For many patients, treating any underlying causes of sleep disruption will resolve the problem; however, some patients may also have to manage their chronic arthritis pain, as well as make adjustments to their sleep-related habits.