Yet little research has been done to document these sleep issues in people with RA, and, importantly, to identify specific sleep disorders people with the illness may be prone to. This information dearth prompted University of California San Francisco (UCSF) researchers to examine a large database of rheumatoid arthritis patients. They looked for rates of sleep apnea, restless legs syndrome, and insufficient sleep, all conditions that small, prior studies indicated might be more common than in the general population. Insufficient sleep is sometimes described as “short sleep” or “sleep deprivation.” As they reported in an article published in Arthritis Care & Research in August, these sleep disorders are indeed more prevalent in people with RA. The researchers hope this data raises awareness about how common and how detrimental sleep disorders can be for people with RA, says Patricia Katz, PhD, a professor of medicine and health policy at UCSF and the study’s lead author. “This study is the first step, showing how common sleep problems are,” she says. RELATED: 8 Great Pain Relievers You Aren’t Using

Poor Sleep Affects Health in Many Ways

A good night’s sleep is important for people with RA because being exhausted during the day can significantly reduce quality of life, says Juan Maya-Villamazar, MD, a rheumatologist at the Rheumatology Center of Palm Beach in Florida and a medical advisor to the online support group CreakyJoints, who was not involved in this research. As the study notes, poor sleep also directly impacts health. “Sleep disturbance and sleep disorders are associated with multiple poor health outcomes relevant to RA in general population studies, including … higher rates of depression, cognitive impairment, systemic inflammation, and cardiovascular events,” the study states.

Pain and Sleep Work Both Ways

People who experience pain at night not surprisingly can have difficulty sleeping. But they may not realize the circular nature of the effect. Not sleeping well can also increase a person’s level of pain, experts have found. For example, a study published in the Journal of Clinical Sleep Medicine found that poor sleep is associated with greater pain severity in people with RA. Pain at night could indicate that RA disease is not well controlled, Dr. Maya-Villamazar says. It’s important to speak to you doctor about any night pain you are experiencing because you may need a different RA treatment plan, he says.

Study Examined Major RA Database

Information in the study was culled from a national databank called Forward, where patients with rheumatic conditions, referred by their rheumatologist, are asked to periodically answer questions about their disease. This is “perhaps the largest cohort of people with RA in which to look at this issue,” Dr. Katz says. Although comprehensive sleep questions weren’t originally included in the databank, Katz’s team requested that they be added, “to get a more complete picture of sleep problems,” she says. The researchers were able to evaluate 4,200 patient responses.

Sleep Disorders Are Prevalent in People With Rheumatoid Arthritis

The researchers found that almost two-thirds of the respondents met the criteria for a sleep disorder. Twenty-one percent had either been diagnosed or had symptoms indicating sleep apnea, while the figure was 30 percent for restless legs syndrome. Some 43 percent reported sleeping fewer than six hours a night, which scientists term “short sleep.” While the researchers didn’t examine why people were sleeping less, Katz speculates that pain or other disease-related issues is a likely culprit. Resting during the day might also play a role. “It is possible that daytime resting or napping, which is often recommended to people with RA to manage fatigue, may lead to less sleep at night,” she says.

Those experiencing sleep disorders typically had the same risk factors as people without RA, especially obesity, Katz says. But researchers also found a significant association between sleep disorders and patient-reported disease activity and pain. “Looking at relationships with clinical measures of disease activity and disease biomarkers would be an interesting next step,” she says. In their paper, the researchers also note that certain medications used for RA, particularly glucocorticoids, can disturb sleep. And it points out that cytokines, substances secreted by immune cells which play important roles in RA also appear to play important roles in regulating sleep.

If Your Doctor Doesn’t Ask About Sleep

Rheumatologist Maya-Villamazar says he always asks his patients about their sleep, and he works with them to improve it if it is poor. But Katz believes sleep doesn’t come up as often as it should in rheumatologist-patient encounters. If your doctor doesn’t ask but you’re having issues like excessive sleepiness or fatigue during the day, snoring at night, or you wake up feeling unrestored, you should definitely bring up the topic with your doctor, says Shelby Harris, PsyD, a behavioral sleep medicine expert and clinical associate professor of neurology and psychiatry at the Albert Einstein College of Medicine in the Bronx, New York, who wrote The Women’s Guide to Overcoming Insomnia. Harris was not involved with the study. It may help to keep a detailed sleep journal that you bring to your appointment, Maya-Villamazar suggests.

How to Know if You Have Restless Legs or Apnea

Signs of restless legs syndrome can include an urge to move your legs or a creepy crawly feeling. These generally improve if you move your legs, get out of bed, or sit on a cold floor, Dr. Harris says. In some people the sensation can also occur in the arms. You might suspect apnea if you snore, pause your breathing, or gasp during sleep — something your bed partner might report. “It doesn’t need to be the super-loud snoring many people associate it with. If you feel sleepy or unrefreshed during the day, awaken with headaches or heartburn, or use the bathroom a lot at night, these are all potential symptoms, Harris says.

Basic Steps to Make Sleep Better

The first step to improving poor sleep is to follow basic sleep hygiene rules, Maya-Villamazar says. Common recommendations include avoiding overstimulation at night (so quit that sci-fi TV show or horror novel a few hours early), using the bed for sleep and sex only, and shunning caffeine, alcohol, and snacks close to bedtime. Since heat often relaxes the body, taking a bath or hot shower, or using an electric blanket for a few minutes before turning out the lights are also recommended as easy sleep remedies. (Plus, heat can make your joints feel better.)

Supplements or Medicines May Help

If this doesn’t sufficiently solve the problem, Maya-Villamazar often recommends the supplement melatonin. Harris says people may also be helped with cognitive behavioral therapy for insomnia — or CBT-I, a special type of CBT for sleep problems, per the Sleep Foundation — which she specializes in. And people with restless legs may have a deficiency in iron or magnesium, so supplementing might do the trick, she says. If these aids aren’t sufficient, Maya-Villamazar prescribes medications like gabapentin or muscle relaxers, or in some cases sleep-inducing medicines like Ambien (zolpidem).

Time to See a Sleep Specialist

If your rheumatologist is unable to solve your sleep issues, you might ask for a referral. “In most cases it is best to see someone board-certified in sleep medicine, often through a sleep center,” Harris says. These centers will further test your sleep, but that doesn’t always mean you have to stay overnight. “Oftentimes they can start with home sleep studies,” she says. If you’re found to have restless legs, in addition to the lifestyle changes and supplementation, medications are available, she says. Mild sleep apnea might be helped with weight loss, changing sleep positions, or using oral appliances designed for the condition, she says. If your apnea is severe enough to require a positive airway pressure (PAP) machine, know that mask technology is constantly changing, making them more comfortable than before, Harris says. These devices are also getting “smarter,” with technology that sends real-time feedback to your phone, she says. “There are lots of treatment options, depending on the issue,” Harris says. But to successfully get help for your sleep disorder, you have to ask for it.