Insomnia and Arthritis Often Go Hand in Hand

From the WebMD Archives

Feb. 16, 2000 (Atlanta) -- Sleep disruption causes older adults with arthritis to seek more treatment than any other arthritis-related problem, according to a report in the February issue of the journal Archives of FamilyMedicine. But researchers say that poor sleep quality is often neglected.

Because little is known about what causes older adults to seek arthritis treatment, researchers surveyed over 900 men and women age 65 or older. The large sample, drawn from the National Survey of Self-Care and Aging, included subjects from urban and rural communities across the country. Each subject, contacted by phone after an initial interview three years before, reported that arthritis symptoms had limited their activity in the previous 12 months.

The data showed that arthritis caused sleep disruption in almost one-third of those surveyed. Also, sleep disruption caused the respondents to seek more medical, complementary, and self-care treatment than any other arthritis-related problem. In fact, those with sleep problems were almost four times as likely to see a physician. The lead author says sleep disruption is quite common.

"The importance of sleep disturbance as a public health problem has recently been recognized by the World Health Organization," says Joanne Jordan, MD, MPH, research associate professor at the University of North Carolina School of Medicine in Chapel Hill. "And older adults are even more likely to have sleep difficulties than the general population." Despite its prevalence, Jordan tells WebMD that sleep disturbance is often overlooked, and others agree.

"Many older adults with arthritis don't feel rested in the morning because of frequent nighttime wakening," says Lisa Granville, MD, assistant director of geriatrics and associate professor of medicine at University of Miami. "And this non-restorative sleep interferes with our threshold for pain. But these symptoms are often viewed as a normal part of aging, and many older patients don't discuss them with their doctors." Granville tells WebMD that sleep disruption can often be improved without medication.

"Sleep medication can cause dependence and adverse side effects, so we focus on education and pain control," says Granville. "Decreasing caffeine and alcohol helps tremendously. Waking up and turning in at about the same time each day helps a lot, too. And just taking acetaminophen more regularly can significantly improve pain control and sleep quality." Granville says doctors should consider pain as the fifth vital sign.

"Arthritis is the most common disability in older adults and sleep disturbance is present in at least half of those over 65. And often, the two conditions co-exist, says Jordan. "But with our research design, we can't be sure that the sleep disturbances reported were actually caused by arthritis. Even so, physicians should recognize that improved pain control often improves sleep and vice versa." The suffering of one older adult reinforces Jordan's findings.

"After I reached the age of 80, my old body seemed to fall apart," says Wilma Howard of Selma, N.C. "I used anything for pain relief from prayer to WD-40 to gin-soaked raisins. But I finally went to my physician for pain medication and something to help me sleep," says Howard. "I know that once the pain is gone and I can sleep, my old self will be back to normal again."