For patients who follow good sleep hygiene and still experience sleep disturbance, evidence suggests several strategies for relief, according to Dr. Irwin.
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The gold standard for addressing sleep disturbance is cognitive behavioral therapy intervention (CBT-I), as recommended by the American Academy of Sleep Medicine. This approach has the strongest evidence supporting success, he says. However, a rheumatologist would need to refer their patient to a psychologist for this therapy.
Emerging evidence shows that community-based treatments that use mindfulness may also be effective. Example: Dr. Irwin and his colleagues found a movement meditation, tai chi, can be equally effective as CBT-I. However, tai chi is a series of low-impact meditative movements and may not be the best approach for RA patients experiencing joint inflammation, Dr. Irwin notes.
A separate published study co-authored by Dr. Irwin shows that mindfulness meditation is promising for reducing sleep disturbance. He suggests more research for alternative sleep support is needed, particularly for RA patients who are more susceptible to inflammatory response from their disease.3
One approach Dr. Irwin does not recommend is pharmacological sleep aids, especially in older adults. “Sleep aids are contraindicated in older adults and in older patients with rheumatologic conditions because these pharmaceuticals can impair function during the day and increase the risk for falls if patients get up in the night.” He is also concerned that these pharmaceuticals may wane in efficacy and mask underlying issues with sleep behaviors.
Carina Stanton is a freelance science journalist based in Denver.
- Irwin MR, Olmstead R, Carrillo C, et al. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. Sleep. 2012 Apr 1;35(4):537–543. doi: 10.5665/sleep.1742.
- Irwin MR, Olmstead R, Carroll JE. Sleep disturbance, sleep duration and inflammation: A systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol Psychiatry. 2016 Jul 1;80(1):40–52. doi: 10.1016/j.biopsych.2015.05.014. Epub 2015 Jun 1.
- Black DS, O’Reilly GA, Olmstead R, et al. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial. JAMA Intern Med. 2015 Apr;175(4):494-501. doi: 10.1001/jamainternmed.2014.8081.