Arthritis and Sleep

Arthritis is a serious disease that causes inflammation in the joints, accompanied by pain, swelling and stiffness. According to an FDA Consumer article from 2000, nearly 42 million Americans suffer from arthritis. That number has only have grown in the past years. But arthritis is also contributing to America’s sleeplessness, because pain and discomfort from all the various types of arthritis severely affect quantity and quality of sleep.

There are over 100 different rheumatoid diseases that fall under the category of arthritis and the condition tends to affect people of advanced age. Arthritis can last a lifetime and the effects are hindering. Arthritis patients usually cannot get a good night’s sleep or perform tasks for work because of the pain and stiffness that results from the condition. Without restful sleep, the quality of life for a person begins to deteriorate. While pain may appear to be the most serious effect of arthritis, sleep loss takes its toll on quality of health and life.

Arthritis and sleep have a two-way relationship where one directly affects the other. People suffering with arthritis need to give more attention to the symptom that is most often overlooked, disrupted sleep. According to the Centers for Disease Control and Prevention, arthritis patients are very susceptible to insomnia, disrupted sleep and sleep disorder because of nighttime pain associated with the disease.

Arthritis Symptoms

The most common symptoms of arthritis include pain, stiffness, discomfort and limited mobility in their response. Fatigue is also recognized as a symptom of many types of arthritis, in the sense of being “worn out” or “lacking energy,” due to lack of sleep. But the fact is that poor quality of sleep and disrupted or fragmented sleep is just as problematic for arthritis patients as joint pain and limited mobility. Without quality sleep, the arthritis patient suffers two-fold, because of pain and because of the effects of little or fragmented sleep.

Pain is a leading cause of insomnia. Difficulty with falling asleep, staying asleep and waking earlier than accustomed are all symptoms of insomnia. When pain makes it difficult to sleep, falling asleep is often a major problem. The changed sleep pattern, weariness and fatigue as well as sore and aching body parts that result from nighttime pain due to arthritis can wreak serious havoc on your personal life and work life. Activities you used to enjoy and tasks you were once able to perform may become very hard, even impossible to do because of chronic fatigue and pain. Lack of sleep also contributes to limited mobility because the body is unable to rest and restore itself.

Fibromyalgia (FM) is a sleep disorder characterized by widespread musculoskeletal aches, pain and stiffness. Arthritis is a cause of FM and creates many sleep and life problems for the sufferer.

Statistics

• Approximately 43 million Americans (or approximately 1 in every 7 people) suffer from some form of arthritis, and many have chronic pain that limits daily activity.
• Osteoarthritis is by far the most common form of arthritis, affecting about 20 million Americans.
• Rheumatoid arthritis, which affects about 2.1 million Americans, is the most crippling form of the disease.
• Up to 60 percent of those with arthritis experience pain during the night, causing disrupted sleep or the inability to fall asleep.
• 23 million people have chronic joint symptoms but have not been diagnosed with arthritis.
• Nearly three out of every five arthritis sufferers are under the age of 65.
• Arthritis is the leading cause of disability in the United States , limiting the activities of more than 16 million adults by causing disabling effects.
• Chronic arthritis affects over 300,000 children.
• It is estimated that 60 million people will be affected by arthritis by the year 2002 by the Centers for Disease Control and Prevention. It is also estimated more than 12 million will be disabled by the condition.

Osteoarthritis

The most common form of arthritis is osteoarthritis. As of 2002, more than 20 million people living in the United States suffered from osteoarthritis. This form of arthritis is also referred to as degenerative joint disease or osteoarthrosis. This condition is most common in people over 65 years old, but may appear much earlier.

Aging is also a factor in developing sleep disorders. Taking naps during random times of the day and fragmented sleep are all symptoms that can correlate to age-related sleep problems. Osteoarthritis is painful and can add to stress and worry especially while trying to fall asleep. For the elderly, sleep is an important but sometimes hard-to-achieve necessity that is only made more difficult by sleep disorders or conditions that can cause sleep problems, such as arthritis.

In osteoarthritis, cartilage deteriorates and breaks down and the bones of the patient rub together. The joint then loses its shape and alignment. The ends of the bones thicken forming bone spurs (bony growths). The knobby bone growths are painful and are most common in the finger but are usually not crippling. Also, bits of cartilage or bone float in the joint space. All of these physical characteristics of arthritis contribute to pain and discomfort.

Any joint can be affected by osteoarthritis most commonly is located in the feet, knees hips and fingers. Factors that contribute to development of osteoarthritis include being overweight, the aging process, joint injury and stresses on the joints from certain jobs and athletic activities. A combination of one or more factors is believed to cause this disease according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
Osteoarthritis is often mild, but in some cases the disease may be very severe and painful.

Osteoarthritis is often mild, but in some cases the disease may be very severe and painful.

Treatment

Short-Term Relief

Just like any other disease or condition, there isn’t a single treatment that will “cure” everyone’s arthritis, but a doctor can help develop a management plan designed to minimize your specific pain and improve the function of your joints. A number of treatments can provide short-term pain relief.

• Medications - Because people with osteoarthritis have very little inflammation, pain relievers such as acetaminophen may be effective. Patients with rheumatoid arthritis generally have pain caused by inflammation and often benefit from Tylenol, the safest non-prescription pain reliever.
  
• Heat and cold - The decision to use either heat or cold for arthritis pain depends on the type of arthritis and should be discussed with your doctor or physical therapist. Moist heat, such as a warm bath or shower, or dry heat, such as a heating pad, placed on the painful area of the joint for about 15 minutes may relieve the pain. An ice pack (or a bag of frozen vegetables) wrapped in a towel and placed on the sore area for about 15 minutes may help to reduce swelling and stop pain. If you have poor circulation, however, you should not use cold packs.
  
• Joint Protection - Use of a splint or brace to allow joints to rest and protect them from injury can be helpful. Your physician or physical therapist can make recommendations.
  
• Transcutaneous Electrical Nerve Stimulation (TENS) - A small TENS device that directs mild electric pulses to nerve endings that lie beneath the skin in the painful area may relieve some arthritis pain. TENS seems to work by blocking pain messages to the brain and by modifying pain perception. However, TENS should only be used on a temporary basis.
  
• Massage - In this pain-relief approach, a massage therapist will lightly stroke and/or knead the painful muscle. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are very sensitive so the therapist must be very familiar with the problems of the disease.

Long-Term Relief

Osteoarthritis and rheumatoid arthritis are chronic forms of the disease that may last an entire lifetime for some people. Learning to cope with the pain is an important factor in controlling the disease and maintaining good quality of life.

• Medications
  
  Biological response modifiers— These new drugs used for the treatment of rheumatoid arthritis reduce inflammation in the joints by blocking the reaction of a substance called tumor necrosis factor, an immune system protein involved in the immune response system.

  Nonsteroidal anti-inflammatory drugs (NSAIDs)—These are a class of drugs including aspirin and ibuprofen that are used to reduce pain and inflammation and may be used for both short-term and long-term relief in people with osteoarthritis and rheumatoid arthritis. NSAIDs also include COX-2 inhibitors that allegedly block an enzyme known to cause an inflammatory response.

  Disease-modifying anti-rheumatic drugs (DMARDs)—These are drugs used to treat people with rheumatoid arthritis who have not responded to NSAIDs. Some of these include the new drug Arava and methotrexate, hydroxychloroquine, penicillamine, and gold injections. These drugs are thought to influence and correct abnormalities of the immune system responsible for a disease like rheumatoid arthritis. Treatment with these medications requires careful monitoring by the physician to avoid side effects.

  Corticosteroids—These are hormones that are very effective in treating arthritis but cause many side effects. Corticosteroids can be taken by mouth or given by injection. Prednisone is the corticosteroid most often given by mouth to reduce the inflammation of rheumatoid arthritis. In both rheumatoid arthritis and osteoarthritis, the doctor also may inject a corticosteroid into the affected joint to stop pain. Because frequent injections may cause damage to the cartilage, they should only be done once or twice a year, or less.

  Other Products— Hyaluronic acid products like Hyalgan and Synvisc mimic a naturally occurring body substance that lubricates the knee joint and permits flexible joint movement without pain. A blood filtering device called the Prosorba Column is used in some health care facilities for filtering out harmful antibodies in people with severe rheumatoid arthritis.

• Weight reduction - Excess pounds put extra stress on weight-bearing joints such as the knees or hips. Studies have shown that overweight women who lost an average of 11 pounds substantially reduced the development of osteoarthritis in their knees. In addition, if osteoarthritis has already affected one knee, weight reduction will reduce the chance of it occurring in the other knee.
   
• Exercise - Swimming, walking, low-impact aerobic exercise, and range-of- motion exercises may reduce joint pain and stiffness. In addition, stretching exercises are helpful. A physical therapist can help plan an exercise program that will give you the most benefit. (The National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse has a separate fact sheet on arthritis and exercise. See the end of this booklet for contact information.)
   
• Surgery - In select patients with arthritis, surgery may be necessary. The surgeon may perform an operation to remove the synovium (synovectomy), realign the joint (osteotomy), or in advanced cases replace the damaged joint with an artificial one (arthroplasty). Total joint replacement has provided not only dramatic relief from pain but also improvement in motion for many people with arthritis.

Arthritis can cause serious problems for people who have the condition, and while mainly prevalent in older people, the disease can strike anyone at any age. Not only is the inflammation painful and the pain a large hindrance in performing tasks for work and enjoying recreational activities, but arthritis seriously affects sleep. Sleep is vital to sustain human life and helps the body recuperate and grow.

A general physician or rheumatologist can help identify the presence of arthritis or other rheumatoid diseases as well as help to create a management plan to alleviate pain from the condition. Practicing healthy sleep habits and consulting a physician if any symptoms characteristic of arthritis are present are two important ways to help your body get the sleep it desperately needs.