Poor Sleep Worsens Arthritis Patients’ Problems

Pain, fatigue, disability and depression tend to be a struggle for patients with Rheumatoid Arthritis. Poor quality of sleep makes each of the symptoms worse, a study in the February issue of the Journal of Clinical Sleep Medicine reports.

Authors of the study believe treating sleep problems would greatly improve the health and quality of life of patients with Rheumatoid Arthritis. They proposed a treatment that combines prescription sleep drugs with cognitive-behavioral therapy. The Sleep Education Blog reports medications are a helpful short-term solution to sleeplessness; cognitive-behavioral therapy is the most effective way of treating solution insomnia.

Rheumatoid Arthritis is an inflammatory disease that causes pain, swelling stiffness and loss of function in the joints. The disease affects about 1.3 million Americans, many of whom cannot carry out daily activities such as dressing, walking, grooming and writing.

The study involved 162 patients who were diagnosed with Rheumatoid Arthritis at least two years prior to the study. Patients had an average age of about 58 years, and more than three-quarters were female. At the start of the study, the subjects answered questions about sleep quality, depression, fatigue, disability and pain as well as their medical history.

Results show more than half of the patients were poor sleepers. Through analysis, researchers linked poor sleep to higher levels of depression, increased fatigue, greater pain severity and greater functional disability.

The authors of the study determined that pain and fatigue from Rheumatoid Arthritis may in turn cause sleep problems. A third of the patients reported sleep problems due to pain.

The results are similar to findings from an October study that examined patients with non-inflammatory forms of arthritis. That study found near 23 percent of patients with other forms of arthritis have sleep-related complaints.

Sleep Complaints Common for Arthritis Sufferers

More than 10 million Americans with arthritis have regular sleep disturbances. National survey data shows an especially high rate among arthritis patients – nearly 23 percent. Only about 16 percent of people without arthritis have sleep-related complaints.

The study published in the October issue of Arthritis Care & Research analyzed findings from the 2007 National Health Interview Survey. More than 23,134 American adults answered a variety of health-related questions. Topics ranged from diet and exercise, to substance use, sleep and chronic health problems.

Nearly 1 in 5 survey respondents said they had been diagnosed with arthritis. The study did not differentiate the two types of arthritis, inflammatory and non-inflammatory. Non-inflammatory arthritis is more common and is most often caused by aging and injury.

Patients with uncontrolled pain, depression and anxiety had the highest risk, the study found. Complaints included inability to fall asleep, interrupted sleep and daytime fatigue. The authors suggest pain and joint mobility limitations related to arthritis may predict sleep problems, rather than just a diagnosis.

Sleep disturbances are often neglected as symptoms of arthritis, the study concluded. The authors contend that doctors should ask arthritis patients about sleep problems, and provide treatment.

Osteoarthritis: CBT for Insomnia Improves Sleep & Pain

A study in the Aug. 15 issue of the Journal of Clinical Sleep Medicine involved 51 older adults with osteoarthritis and insomnia.

Twenty-three people received cognitive behavioral therapy for insomnia; they had an average age of 69 years. Each of the eight weekly CBT sessions lasted two hours; class sizes ranged from four to eight people.

CBT uses a variety of methods to help you develop positive attitudes and habits that promote a healthy pattern of sleep. One common technique is relaxation training.

Results show that CBT improved self-reported sleep quality in people with osteoarthritis and insomnia. After treatment they fell asleep faster; they also spent less time awake during the night. Overall their sleep was much more efficient.

CBT also had a long-term effect; they were still sleeping better at a one-year follow-up. They also were sleeping more than 30 minutes longer each night.

Another finding was that people with osteoarthritis reported less pain after CBT for insomnia. The pain reduction was strongest during the month after the CBT sessions ended; a mild reduction in pain was reported one year later.

“Improvement of sleep may lead to improvement in co-existing medical or psychiatric illnesses, such as osteoarthritis or depression,” lead author Michael V. Vitiello, PhD, told the AASM. “These additional benefits can be seen in the long term.”

The NIAMS reports that osteoarthritis is the most common type of arthritis. It involves the loss of cartilage around the joints. It affects an estimated 27 million people in the U.S.; most often it occurs in older adults.

Last week the Sleep Education Blog reported that studies have linked sleep and pain sensitivity. Treatments that improve sleep quantity and quality may make a person less sensitive to pain.

This can be helpful for people with a chronic pain condition. But it is unlikely to solve the problem of pain for them.

“Pain may be an outcome that has only a limited range to change,” wrote Patricia L. Haynes, PhD, in a commentary that followed the study. “The pain is not going to go away.”

Learn more about insomnia due to medical condition on SleepEducation.com.

Sleep Apnea and Gout: A Painful Connection?

A letter posted in the online Medscape Journal of Medicine on Jan. 5 suggests that there is a clear link between obstructive sleep apnea and gout.

What is gout? It is a painful condition that affects the joints. It occurs when high levels of uric acid build up in the blood.

Uric acid is produced when food is digested. Normally it is dissolved in the blood. Then it goes through the kidneys. Finally it passes out of the body through urine.

But excess uric acid forms salt crystals called monosodium urate. These crystals collect in or around the joints. These chalky deposits are called tophi.

This causes inflammatory arthritis. The result is intense pain and swelling. Lumps also can appear under the skin around the joints.

Often gout will first affect the big toe. It can also affect other joints such as the ankles, knees, fingers and elbows.

The letter describes research that links sleep apnea to gout. Sleep apnea involves repeated breathing pauses. These pauses cause drastic changes in your oxygen levels.

The low oxygen levels cause a cellular reaction that ends in the generation of excess uric acid. According to the author, this explains why episodes of gout often occur at night.

The author recommends that everyone who has gout should be screened for sleep apnea.