Sleep impairment in rheumatoid arthritis – understanding the negative impact and treatment strategies

This study reviewed sleep impairment and its treatment strategies for patients with rheumatoid arthritis (RA).

Sleep quality and duration is important for overall health. Evidence suggests that sleep impairment can contribute to many diseases including rheumatoid arthritis (RA). Patients with RA may experience insomnia (inability to sleep), increased wakening and tiredness after sleep (non-restorative sleep). This can lead to fatigue and has a negative impact on quality of life.

Sleep impairment (SIP) may also increase disease activity in RA. It can lead to an increase in inflammation and may increase a patient’s perception of pain. It is important to know the causes of SIP in patients with RA in order to treat it.

This study reviewed evidence on SIP in RA.

SIP can be caused by RA symptoms. SIP may also lead to worsening of RA symptoms. Patients with sleep disorders (e.g. sleep apnea, insomnia) are at a greater risk of developing RA. A type of immune cell called T regulatory (T-regs) cells are more active during sleep. If a patient with RA does not get enough sleep then T-regs may not regulate the immune system properly. This could lead to increased production of inflammatory chemicals (interleukins, tumor necrosis factor) and worse disease activity. Sleep can also be disturbed by symptoms including pain and stiffness.

The cause of SIP in RA is unclear. Some factors that might influence it are age, gender, pain, mood, disease activity, medications, and mental health. Pain has the most significant effect on sleep in RA patients. Pain can also affect mood and that impact sleep. Depressive mood is associated with sleep deprivation in RA. SIP can reduce the quality of life of patients with RA.

To treat SIP, RA disease treatment should be assessed first. Reducing disease activity and managing pain should improve sleep. Certain medications may be more useful than others. Patients should be assessed for other conditions that may contribute to SIP. These include mood disorders and fibromyalgia (a condition that involves widespread muscle and bone pain). To improve sleep, patients should be educated about good sleep hygiene habits. These include stress management, regular exercise and limiting intake of substances that affect sleep (e.g. caffeine, nicotine).

This study reviewed sleep impairment and some treatment strategies for patients with rheumatoid arthritis.

If you have any concerns regarding sleep impairment, please discuss this with your physician.