Osteoarthritis is a degenerative disease that involves certain joints and bones in various regions of your body. It can be very painful and discomforting, as well as debilitating. One way that it really disrupts life is by interrupting one's ability to sleep. 

Sleep can be vital in the healing and rehabilitation process. However, the pain from OA can cause many barriers to getting that sleep. Continue reading for more information on the relationship between OA and sleep, and how you can get good rest if you do have OA.  

What is Osteoarthritis? 

Osteoarthritis is the most common form of arthritis and affects millions of people around the world. It happens when the protective cartilage that cushions the ends of the bones begin to wear down over time. Osteoarthritis can damage any joint, but its effects are most prevalent around the hands, knees, hips and spine - weight bearing and very active joints. 

The main symptoms of OA are pain, stiffness, tenderness, loss of flexibility, grating sensation, bone spurs and swelling. These signs and symptoms are gradual, and worsen overtime. When you have stiffness that just won't go away, then it may be time to go and visit your doctor for an official diagnosis. 

OA is caused by natural wear and tear of your joints. Cartilage, which is a slipper tissue that allows almost frictionless movement between your bones, begins to deteriorate so that bones rub on each other. This can cause further damage to other tissues holding your bones together like muscles and tendons.  

Risk factors for developing OA include older age, being a woman, obesity, joint injuries, and repeated stress on the joint (former athletes). The mainstay of treatments include acetaminophen, NSAIDs and Duloxetine. Various types of therapies can provide relief as well. 

OA and Sleep 

It is not uncommon for OA to keep you up at night. About 70% of those with RA also have sleep problems. These problems range from not being able to fall asleep or stay asleep, to waking up much earlier than desired. Worse case scenarios are that full blown insomnia could ensue, which means absolutely no sleep is happening. 

The pain of OA can be the main reason why it's hard to get enough hours of sleep. Sleeping with chronic pain can be fairly difficult due to the physical discomfort and the emotional stress it can bring.

Unfortunately, sleep can be a huge benefit in the treatment and management of OA. Sleep reduces stress levels and also stabilizes the sympathetic nervous system. The sympathetic nervous system is your flight or fight activation when you encounter a stressor.

Pain is a stressor, and therefore, this system is activated. It tenses muscles and prepares the body for a fight. This can lead to prolonged pain and discomfort, as well as put the body in a state that is not conducive for sleep. Sleep stabilizes this system by reducing blood pressure, temperature, and fully relaxing all of the muscles in the body.

The pain keeping you awake at night is problematic, but not as problematic as a lack of sleep making you more vulnerable to pain. 

Pain catastrophizing 

When individuals are stressed or worried, it can ruin their sleep leading to tossing and turning all night. This stress, for individuals with OA, can revolve around their pain and the anxiety about another sleepless night. This is called pain catastrophizing. 

There are two forms of pain catastrophizing: assuming that something bad will happen and expecting that it will be as bad as possible. So, this involves lying in bed, anticipating the pain and thinking that it is going to be the worst pain that you've ever experienced. This mental anticipation can lead a long, sleepless night of rolling around and frustration. 

Poor sleep can lead to sleep deprivation which makes dealing with the pain the next day that much harder. Sleep deprivation can also take a toll on your mental health and contribute further to anxieties and depressive feelings you may be experiencing relating to your pain and quality of life.

Centralized Pain 

OA pain can become centralized meaning that the pain pathways become over-excited and pain is amplified beyond what would be normal for the amount of damage found in the joints. 

OA becomes centralized in some people because of their sleep patterns. Sleep deprivation can actually promote central nervous system sensitization. A study done at Johns Hopkins University showed that sleep deprivation, specifically sleep fractionation, can  overwhelmingly lead to increased sensitivity to pain. 

Problematic sleep patterns can predate their chronic pain, even before an official diagnosis. Those with erratic sleep patterns may put themselves on a slippery slope towards significant chronic pain and illness. 

Depression and Disability 

Depression and disability accompany OA, as they do with many chronic illnesses. The perceived helplessness truly does lead to feelings of despair and hopelessness. This can further contribute to feelings of disability which are already increased by the high levels of pain. 

Sleep can contribute to both depression and disability, as sleep deprivation increases depression and disability. Therefore, treating sleep problems may actually prove to be better options than trying to treat the depression and disability through other routes. 

How to get better sleep 

Getting better sleep with OA means managing pain, stress and anxiety. By improving your sleep, you may improve many of the symptoms you're having related to OA. So, how is this done? 

First, a proper pain management regiment needs to be initiated. Prolonged use of medication may lead to other issues such as stomach ulcers, so it's best to heavily rely on behavioral pain modifications. This can include going to therapy, exercising, meditating, manipulation, or other non conventional therapies such as acupuncture. 

After initiating a proper pain management routine, mentally getting prepared for sleep is the next step. Anxieties around bedtime are the most likely culprit for keeping you awake. Practice some calming activities before bed, like stretching, meditating, spending time with loved ones, a nice warm bath, and a steaming cup of chamomile tea.

Do these same routines every night, and anything else that helps you feel absolutely relaxed, so you can train your body and brain that at bedtime, it's time to destress. 

Go into bedtime with a positive attitude about getting sleep. Half the battle is getting over the previous night of rough, fragmented sleep, and convincing yourself that you are going to get good sleep. It's a new night, you've done your relaxation routine, and it's time to go to bed. Practice having this attitude everyday and watch how your mindset about sleep changes. 

Make sure when you do go to bed, that it's optimized for sleeping. This means it's completely dark, quiet and cool. Add some extra accessories for comfort, such as a pillow or extra blanket. Anything that can provide some relief to the pain points may be helpful. 

Last, but not least, talk to a slepe health professional who can help you sleep through the pain. Please click the orange button below to take a free online sleep test and get in contact with one of our sleep health professionals. 

https://www.arthritis.org/health-wellness/healthy-living/managing-pain/fatigue-sleep/osteoarthritis-and-sleep