Johns Hopkins’ Rheumatoid Arthritis treatment information page says Rheumatoid Arthritis (RA) patients “often need over ten hours of sleep a night, or eight hours a night and a two-hour nap during the day.” (Gee, do you think so?) Seriously, there’s plenty of evidence that RA fatigue and RA pain is less severe with more sleep.
Discussions between RA’ers often include references to lack of quality or quantity of sleep. However, RA sleep is understudied according to Johns Hopkins. They praise a large survey (over 8,000 RA patients) which found that 25-42% of RA patients attribute sleep disturbance to the RA disease process. A significant result of this research is that anti-tumor necrosis factor (TNF) inhibitors like Enbrel may not improve RA sleep problems. The National Data Bank for Rheumatic Diseases says the data show that RA sleep disturbance “is linked to pain, mood, and disease activity.”
In 2009, the Journal of Sleep and Sleep Disorders Research (article #1007) reported similar findings. Their study of 133 women with RA found “71% of the subjects had poor sleep quality.” About half of the variance in sleep quality was accounted for by pain, depression, and poor adherence to RA medication.
Some other causes of RA sleep problems
In addition to the causes already mentioned, I found 2 significant sleep problems which can affect those with Rheumatoid Arthritis. The first is cardiovascular disease (CVD). As we’ve discussed previously, heart disease is responsible for a large portion of deaths with Rheumatoid Arthritis. A 2009 study reported in the Journal of Rheumatology suggests that CVD may be to blame for some RA sleep problems. Their theory is that RA leads to CVD which contributes to sleep apnea.
Other things which increase the risk of sleep apnea include “reduction of the size of the upper airway by temporomandibular joint destruction, brainstem compression due to rheumatoid arthritis affecting the cervical spine, sleep fragmentation, and drug effects.” This is a case study of one patient. However, it looks at ten other studies and raises excellent questions about the causes of sleep apnea and disturbances related to RA.
Don’t tell those detractors who insist that RA cannot affect the spine, but the British Journal of Rheumatology says that “Sleep apnea syndrome (SAS) is a rarely documented, but possibly lethal, complication of the instability of the cervical spine in Rheumatoid Arthritis.” The inflammatory process of RA causes instability of the cervical spine which leads to spinal cord compression or myelopathy. They present details of five patients, saying symptoms are often inconspicuous and not always mentioned spontaneously. “We hope clinicians will become more aware of the existence and the different etiologies of SAS, thus improving early recognition and appropriate treatment. Adequate treatment has proven to increase survival in peripheral SAS and seems to be successful in doing so in central SAS. ”
Rheumatoid Arthritis and sleep requires more research
There are an array of concerns with RA and sleep. Some cannot fall asleep or wake up too early. Some do not sleep deeply enough. Some are awakened by pain, stress related to ability to work or finances or disability issues. Apnea is much studied, so RA and apnea are being examined. I hope these other RA-sleep issues will eventually get some attention, too.
Does RA affect your sleep? What can we do? Tomorrow: Tackling Rheumatoid Arthritis Sleep Problems
Note: I noticed a current study of sleep problems in RA being conducted at UCLA. For information about participating, follow this link. They are examining the activity of cytokines and whether or not TNF blockers have an effect on RA sleep problems.
- Tips for sleeping with RA: Tackling Rheumatoid Arthritis Sleep Problems
- A courageous story of a woman with RA in her spine: Rheumatoid Arthritis and Basilar Invagination
- Those dreamy RA medicine ads: Baloney About Rheumatoid Arthritis
- Sad, but true: Can Rheumatoid Arthritis Affect the Spine?