Joint pain from OA can keep you and your bedmate from catching enough zzzs – but not for the reasons you might expect. Find out why, and get some tips for a better night’s slumber.
By Stephanie Watson
Does joint pain keep you up at night? At least half of people with osteoarthritis (OA) have trouble falling asleep or staying asleep throughout the night. In fact, research shows that people with hip and knee OA are more likely to have insomnia and daytime sleepiness than those without osteoarthritis.
The OA-Sleep Connection
The relationship between OA and sleep might seem obvious—your arthritis pain makes it hard for you to fall asleep, or it wakes you up in the middle of the night. Pain is definitely an important part of the equation, but researchers are finding that the connection is more complex–and reciprocal. Rather than OA causing insomnia, the two conditions are thought to coexist.
A 2012 study published in the journal SLEEP looked at sleep quality in people who were in chronic pain, including those with osteoarthritis. Here’s what researchers found:
The amount of pain that people were in before they went to bed had little to do with how well they slept. A person’s sleep quality predicted how much pain they were in the next day. People who slept poorly had more pain the following day.
How might insomnia lead to more joint pain? Researchers think a lack of sleep may trigger inflammatory pathways that exacerbate arthritis pain. Poor sleep can also make you more sensitive to the feeling of pain, says Michael V. Vitiello, PhD, professor of psychiatry and behavioral sciences at the University of Washington in Seattle. “It’s not that the disturbed sleep makes you achy per se, but the disturbed sleep changes your perception of pain,” he says.
Bothering Your Bed Partner
When osteoarthritis interrupts your sleep, chances are it disrupts your partner’s sleep, too. Lynn Martire, PhD, associate professor of human development and family studies at Penn State University, studied sleep patterns in the spouses of 138 patients with knee OA. She found that when a patient with OA had knee pain at the end of the day, his or her spouse did not sleep as well that night and felt less refreshed the following day.
While the obvious assumption might be that the partner with OA tossed and turned all night, keeping their spouse awake, that wasn’t what Martire found. “We were not able to identify the mechanisms by which a person’s pain affects his or her spouse’s sleep. This is an important goal for future research,” Martire says. She did find that spouses got less sleep when they were in a close relationship, which suggests that empathy for their partner’s pain might play some role in sleep quality.
Studying OA and Sleep
Researchers at the University of Alabama at Birmingham (UAB) have embarked on a study to learn more about the relationship between sleep and pain in people with OA. They will use overnight sleep studies to look at the associations between sleep-inhibiting behaviors, sleep, and pain among people with OA of the knee.
“We hypothesize that people with osteoarthritis may engage in behaviors that are not conducive to sleep, which in turn may affect their perception of pain,” says study investigator Megan Ruiter Petrov, PhD, a postdoctoral fellow now at the Arizona State University College of Nursing and Health Innovation. Examples of such behaviors include keeping an irregular sleep schedule, napping during the day, watching TV or eating too much before bed or keeping the bedroom noisy or uncomfortable.
“There are certainly multiple factors involved in the relationship between poor sleep and pain, but sleep behaviors are one of the factors we’re interested in, because they can be modified,” Ruiter Petrov says.
The UAB study is enrolling African Americans and non-Hispanic white people ages 45 to 85 years old with and without osteoarthritis of the knee. You must also be enrolled in the Understanding Pain and Limitations of Osteoarthritic Disease (UPLOAD) study to participate in the sleep study. For more information contact 205-934-9614 or Adriana@uab.edu.
Researchers hope their studies will help shed light on new ways to treat sleep to modify pain, rather than treating the source of pain, which can be difficult.
Ways to Improve Your Sleep
To relieve pain and improve your sleep, you could turn to medicine. However, sleep aids and pain medicines can have side effects. Consider trying some simple sleep hygiene strategies first:
Do not eat a heavy meal before bed. Do not drink caffeinated beverages or alcohol before bed. Do not watch TV in the bedroom. Keep your bedroom comfortably cool, quiet and dark.
If you still can’t sleep, ask your doctor about cognitive behavioral therapy (CBT). In a 2013 study published in the Journal of the American Geriatrics Society, Vitiello and his colleagues reported that CBT reduced insomnia and improved sleep efficiency in older adults with OA.
During CBT, you will learn about the factors that can interrupt your sleep, such as taking too many daytime naps. Then you try to change those behaviors to improve your sleep quality; for example, only going to bed when you’re tired or staying up later than usual to induce sleepiness.
To find an accredited sleep center near you, visit: http://www.sleepeducation.com/find-a-center
For a certified behavioral sleep medicine provider in your area, visit: http://www.behavioralsleep.org/findspecialist.aspx