Managing RA Pain for Better Sleep

Medically Reviewed by Michael W. Smith, MD on March 31, 2020
3 min read

Sleep is a commodity that’s in short supply. By one estimate, more than a third of American adults don’t get the recommended seven or more hours nightly. For people with rheumatoid arthritis (RA), rest is even harder to come by. Studies show that up to 70% of people with RA struggle to fall asleep or stay that way throughout the night.

Joint pain is the most obvious reason for disrupted sleep, but it’s not the only explanation. More than half of people with RA also have a sleep disorder like obstructive sleep apnea, restless legs syndrome (RLS), or insomnia. Inflammation from RA, as well as inflammatory substances called cytokines, disrupt sleep regulation and quality.

A lack of sleep leaves you groggy the next day, but that’s not all. When you’re exhausted, your body’s production of stress hormones ramps up, which leads to more flares -- and more pain. Poor sleep can also compromise your ability to manage your disease.

“There is this bidirectional relationship between RA and sleep. A lot of mechanisms associated with RA can affect sleep, but we also know and have shown that sleep can affect pain, fatigue, and quality of life in patients,” says Faith Luyster, PhD, an assistant professor in the University of Pittsburgh School of Nursing. She also studies the effects of sleep disorders on people with chronic conditions like RA.

Getting on the right arthritis treatment will help ease the pain that steals your slumber. Some studies have shown that biologics and other disease-modifying drugs have a positive effect on sleep quality. Also, make sure your doctor is addressing your sleep issues directly.

“We all have times in our life when we sleep poorly for various reasons,” Luyster says. “But if it gets to the point where it’s chronic in that it’s starting to interfere with your daily life, your job, your school, and your relationships, that indicates you may need to seek a diagnosis and then potentially treatment.”

Your primary care doctor or rheumatologist may refer you to a sleep specialist for testing. A sleep study in a lab or at home can pinpoint whether you have a disorder like RLS or sleep apnea.

If you don’t have a treatable sleep disorder, look to your sleep routine for solutions. Get into a consistent schedule by going to sleep at the same time each night and waking up at the same time each day. Keep your bedroom optimal for sleep -- cool, quiet, and dark.

To ward off late-night joint pain, take pain medication before you go to bed. Ask your doctor to recommend the right dose. “Ideally, you would like it to work throughout sleep and not stop halfway through,” Luyster says.


Rest easier with these sleep pointers from Luyster:

1. Buy the Right Bed

A mattress and pillow made from memory foam or another cushioning material may be more comfortable on sore joints.

2. Exercise, But Not Too Late

Regular workouts can both help you sleep better and relieve RA pain, but if you do your routine too close to bedtime, it could keep you awake.

3. Reserve Your Bed for Sleep and Sex

Don’t watch TV or use your devices.

4. Try Cognitive Behavioral Therapy

Research suggests it improves both sleep and pain in people with arthritis.

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