Sleep is an odd paradigm for people with rheumatoid arthritis (RA) who often feel they either sleep too much, or not enough.
Sometimes, both are true.
Fatigue and insomnia often go hand in hand.
Some participants in online communities report that fatigue is more debilitating than the pain associated with RA.
Another issue that many people with RA and chronic pain complain about is “painsomnia.”
Although painsomnia is not proper medical terminology, it is a real phenomenon.
Chronic pain can affect sleep quality and sleep patterns. This can affect quality of life, energy levels, physical and mental health, and overall well-being.
Pain, sleep, exercise
Recent research out of the University of Warwick in the United Kingdom, shows that the way people with chronic pain think about pain and sleep can often lead to insomnia — or painsomnia — and, sometimes, inadequate management of pain and related symptoms.
These researchers showed that conditions like back pain, fibromyalgia, and various forms of arthritis can be exacerbated by negative thoughts about insomnia and pain.
They indicate that cognitive behavioral therapy is an asset to people who are negatively impacted by the vicious cycle of pain and insomnia.
For people with RA, therapy is often recommended in helping cope with sleep habits and fatigue, in addition to proper sleep hygiene and possible prescription sleep aids.
Many people with RA and lupus also derive benefits from cognitive behavioral therapy, psychotherapy, hypnotherapy, and even rehab stays to cope with the negative mental and emotional impacts caused by these conditions and the cycle of depression that can often accompany them.
Some studies show that depression is more of a contributing factor to sleep problems than the RA itself.
Exercise is shown to be beneficial in getting a better night’s sleep. It may also reduce pain and stiffness from RA, as well as increase stamina and mobility.
State of mind
But, as the researchers of the U.K. study noted, people with chronic pain need more than exercise, or sleep meds.
The mental-emotional connection to physical health is important in regard to the sleep-pain cycle. It is also important for the overall health and wellness of patients.
Instead of focusing on why people cannot sleep, researchers urge doctors to facilitate communication and teach people how they think and talk about their pain and resulting sleep patterns are equally important as "why" the situation is the way it is.
“Thoughts can have a direct and/or indirect impact on our emotion, behavior, and even physiology. The way how we think about sleep and its interaction with pain can influence the way how we cope with pain and manage sleeplessness,” said Nicole Tang, Ph.D., lead author on the study, in a press statement. “Based on clinical experience, whilst some of these beliefs are healthy and useful, others are rigid and misinformed. The new scale, PBAS, is developed to help us pick up those beliefs that have a potential role in worsening the insomnia and pain experience.”
PBAS is the scale her team created to measure Pain-Related Beliefs and Attitudes About Sleep.
The Journal of Clinical Sleep Medicine published the study and the coinciding impact of the PBAS scale. According to the abstract, researchers concluded, “Pain-related sleep beliefs appear to be an integral part of chronic pain patients' insomnia experience. The PBAS is a valid and reliable instrument for evaluating the role of these beliefs in chronic pain patients.”
These researchers were not the first to address this issue, though. In 2012, it was reported in the Pain journal and other publications that 50 to 75 percent of people with RA have some type of sleep problem, ranging from insomnia to drowsiness.
Another study in the Journal of Sleep concluded, “This study provides the first evidence of an exaggerated increase in symptoms of mood and pain in patients with rheumatoid arthritis after sleep loss, along with an activation of rheumatoid arthritis-related joint pain.”
It is clear by the research that sleep management and mindset are key components to the management of RA pain and other symptoms.
It seems that the paradox is what came first: the pain or the sleep disturbances? This is an issue that continues to be studied.