One of the lesser-talked-about symptoms of osteoarthritis is sleep disturbance. While most people are aware that this degenerative condition damages joints, leading to pain, stiffness and loss of mobility, fewer know about the impact of osteoarthritis on sleep.
How many people with osteoarthritis experience sleep problems?
According to the Arthritis Foundation, a major non-profit organisation that supports research and education for people with arthritis, around 70% of people with osteoarthritis experience problems sleeping. These can range from difficulties going to sleep or staying asleep through to full insomnia.
The link between sleep and pain
Osteoarthritis and sleep problems can become a vicious cycle. Stiff, painful joints can make it difficult to get comfortable in bed so it’s harder to get to sleep. They can wake you up during the night, too. However, sleep deprivation also makes you more vulnerable to pain. So, when you’re not sleeping well the impact of pain is greater, and the more pain you’re experiencing the harder it is to get a good night’s sleep.
Osteoarthritis and mental health
Another factor that contributes to sleep problems in people with osteoarthritis is worry and anxiety. Worrying about being in pain, worrying about not being able to sleep, worrying about having a degenerative condition… all of these can make it harder to get to sleep and stay asleep. And, a lack of sleep increases your experience of pain during the daytime, which can further increase anxiety levels. Once again, it’s easy to get into a vicious cycle.
Sleep disturbance is also linked to increased rates of depression. Having any form of arthritis is known to have a detrimental effect on your mental health, most often manifesting as depression or anxiety. People with arthritis are between two and 10 times more likely than the general population to develop depression [1].
There are a number of reasons for this. Living with chronic pain is physically and emotionally demanding. It causes stress, which alters the chemicals in your brain and nervous system. Stress hormones like cortisol, serotonin and norepinephrine have an impact on your mood, thinking and behaviour and can trigger depression. When someone is depressed, their perception of their health condition can change, making them more likely to experience higher rates of pain, for example.
Impact of sleep deprivation on pain pathways
And the experience of pain itself can become amplified in people who have sleep deprivation related to osteoarthritis. This process is referred to as ‘centralisation’. When pain becomes ‘centralised’, the pain pathways overreact and the central nervous system becomes sensitised.
A study published in the Journal of Neuroscience on 20 March 2019 [2] found that sleep loss increases the experience of pain, although the exact mechanisms are not understood. The researchers showed that acute sleep deprivation amplifies pain reactivity within the primary somatosensory cortex, yet blunts pain reactivity in higher-order valuation and decision-making regions of the striatum and insula cortex. They found, too, that sleep deprivation expands the temperature range for classifying a stimulus as painful, specifically as a result of the lowering of pain thresholds. Outside of the laboratory setting, they revealed that even modest nightly changes in sleep quality produce consequential day-to-day changes in the way people experience pain.
How to manage sleep quality in osteoarthritis
So, when it comes to managing osteoarthritis symptoms, as well as thinking about pain and stiffness, it’s important to give some consideration to sleep quality. Talk to your orthopaedic consultant about the medications you are taking. Check they are sufficient to manage your pain levels and ask whether they are likely to impact your sleep. Look out for possible signs of sleep apnoea, which causes repeated interruptions to your breathing while you sleep and can lead to persistent tiredness as well as morning headaches and problems concentrating.
For more information about osteoarthritis and its symptoms, including its impact on sleep and quality of life, contact us.
Frequently asked questions
What causes osteoarthritis?
Osteoarthritis is caused by the breakdown of cartilage which protects the ends of the bones and helps them glide smoothly over each other when you move your joint. A range of factors contribute to the condition including joint injury, obesity and ageing.
What is meant by ‘good sleep hygiene’?
Good sleep hygiene means taking some simple steps to improve the quality of your sleep, such as improving your daily sleep habits (going to bed and getting up at the same time each day), having an effective wind-down routine (avoiding caffeine from 2pm onwards, putting away smartphones, tablets and laptops as the blue light they emit suppresses the sleep hormone, melatonin), and creating the ideal environment for sleeping (including keeping the bedroom dark and cool and not watching TV or working in bed).
Can exercise help improve sleep?
Gentle exercise during the day can help you feel more physically tired at night, which may help you to sleep better. However, avoid doing anything too strenuous in the evening as this could increase your adrenalin levels and keep you awake.
Sources:
[1] https://www.arthritis.org/health-wellness/healthy-living/emotional-well-being/anxiety-depression/arthritis-and-mental-health
[2] https://pure.johnshopkins.edu/en/publications/the-pain-of-sleep-loss-a-brain-characterization-in-humans/
