Sleep Disorders & Rheumatic Disease

Sleep Management Tools

Dr. Lee

When trying to help patients with rheumatic diseases with their sleep struggles, there are a lot of ways a physician can approach it, said Yvonne Lee, MD, MMSc, associate professor of medicine at the Northwestern University Feinberg School of Medicine. Treating the inflammatory disease activity, minimizing medications that can disrupt sleep, treating patients’ comorbidities and treating the sleep problem itself are all worth consideration, she said.

“Sleep is obviously a very multi-factorial problem, and so when we come to think about managing sleep, it often requires a very individualized and often multi-modal strategies,” she said.

Studies of drugs like certolizumab and tofacitinib have found that treatment helped lead to improved sleep quality. But the association between an improvement in disease activity itself, and the quality of sleep, was only low to moderate, she said.⁴

“I think there is a relationship but there are also other mechanisms here,” Dr. Lee said.

Studies of glucocorticoids and sleep have found mostly a linear relationship—as the dose goes up, sleep disturbance goes up, she said. But when it comes to the duration of use, researchers have seen a threshold effect—duration only seems to matter among patients taking the equivalent of at least 7.5 mg of prednisone daily.⁵

Managing comorbidities can be important, she said. Depression might be particularly important—studies have found that elevated disease activity is associated with greater sleep disturbance among non-depressed patients, but that sleep disturbance remained constant despite differences in disease activity among depressed patients, Dr. Lee said.⁶

In terms of managing sleep itself, Dr. Lee said, “I really, really want to emphasize the importance of non-pharmacologic sleep strategies here. This really should be the foundation of how we manage sleep.”

Many of these approaches are fairly well known—consistent sleep times, staying off phones shortly before sleep and increasing exercise.

Research on cognitive behavioral therapy (CBT) and sleep has seen mixed results. In one study involving six face-to-face sessions on topics such as sleep hygiene and stimulus control, there was no difference on sleep efficiency measured by polysomnography.⁷

But patient-reported insomnia did improve to a clinically significant degree, Dr. Lee said. Comments by patients give a sense of how the sleep-education component of CBT can have a positive effect, she said.

“The patients really talked about how they kind of knew some of these things before, but having someone talk to them about it and drive it home was really important.”