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It’s a vicious cycle. Your osteoarthritis pain keeps you up all night as you struggle to find a comfortable position, and the lack of sleep makes your pain worse the next day and so on and so forth.

If you are one of the 27 million people with OA, it can be hard to sleep soundly, but there are 10 tried-and-true things you can do to take back your sleep -- and ease your joint pain.

  • Consider medication. Some antidepressants improve sleep and help relieve pain, says David Pisetsky, MD. He is the chief of rheumatology at Duke University Medical Center, Durham, N.C. “These may be an option,” he says. “Talk to your doctor to see if you are a candidate.”
  • Rule out sleep apnea. Obesity is a risk factor for OA, and it also sets the stage for sleep apnea or pauses in breathing while asleep. Treating the apnea may help with sleep quality, which will in turn, reduce pain, Pisetsky says.
  • Change sleep positions. “The ideal sleep position depends on which joints ache,” Pisetsky says. “It is hard to tell people to get into a certain position at night.” Sleep expert Michael J. Breus, PhD, adds: “It is usually best to sleep on your back, assuming you don’t have back pain.”
  • Choose the correct sleeping surface. What you sleep on is as important as how you sleep, Breus says. “People usually say their mattress is hard as a rock and stiff as a board and nothing could be worse if you have OA,” he tells WebMD. “You need a mattress that does a great job of relieving pressure and conforming to your body shape.” It should be firm, but not hard. Mattress toppers can also help accomplish this.
  • Use pillows to ease discomfort. “Placing a pillow under a sore joint can relieve pain and support the joint,” Breus says. Say you are a back sleeper with knee OA; place a pillow under your knees to take the pressure off of them.
  • Take a PM pain reliever. Many over-the-counter pain relievers come in PM or nighttime formulations that help you sleep.” Take it an hour before bed so you have the maximum blood levels when trying to go to sleep,” suggests Martin Jan Bergman, MD. He is clinical associate professor of medicine, rheumatology, Drexel University College of Medicine, Philadelphia, PA; chief of rheumatology, Taylor Hospital, Ridley Park, Penn.
  • Ice aching joints. When it comes to relieving joint pain, ice seems to work better than heat at the end of the day, Breus says.
  • Take control of your OA. Are you doing everything you can to manage your joint pain? The best way to improve your sleep is to treat your OA pain effectively, says Bergman. There are many treatments available to help curb pain, including over-the-counter pain relievers, prescription non-steroidal anti-inflammatory drugs, steroid injections, as well as physical therapy programs to help relieve pain.
  • Exercise every day. It may be the last thing you feel like doing, but exercise is one of the best things you can do for your OA pain and your sleep. “Exercise as much as you can,” Bergman says. “It will preserve function and make you a little bit more tired around bedtime.” Just make sure you don’t do this too close to bedtime, as it can have opposite effects and get you revved up. It is also wise to avoid joint-pounding, high-impact exercises, such as jogging on paved roads.
  • Practice good sleep hygiene. Many of the same sleep hygiene tips recommended for the general public also apply to people with OA. These include:
  • Setting regular sleep and wake times
  • Avoiding caffeine (coffee, tea, soft drinks, chocolate) late in the day
  • Creating a dark and cool bedroom environment that is conducive to sleep
  • Avoiding reading or watching TV in bed.
  • Using the bed only for sleeping and sex
  • Avoiding large meals before bed
  • Doing something relaxing before bed

If these measures don’t help alleviate your pain and allow you to get a good night’s sleep, talk to your doctor about other measures that can help you sleep better. Joint replacement surgery may be an option for people with severe OA. “If you have pain at night and pain at rest, that is a red flag and one of the indications for joint replacement surgery,” Bergman says.