“The diagnosis and treatment of these disorders can make a huge impact on sleep and, as a result, quality of life,” Ms. Cralle says.
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Explore This IssueJune 2015
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Because rheumatologists have limited time with their patients, Ms. Cralle recommends they work with a sleep specialist to address any ongoing insomnia issues that their patients may be experiencing.
“We can help rheumatologists determine if the patient’s lack of sleep is causing pain or if pain is causing a lack of sleep and then work to treat whichever came first,” Ms. Cralle says.
The good news is that reduction in sleep disturbance is usually followed by improvement in pain symptoms. Ms. Cralle says that when rheumatologists refer their patients with insomnia to a sleep specialist, they can help them break the cycle of chronic pain and insomnia.
“As chronic pain develops, it’s not unusual for patients to develop bad sleep habits without even realizing it,” Ms. Cralle says. “These can include staying in bed most of the day, and even taking naps throughout the day.”
Ms. Cralle says a sleep specialist can help patients beat insomnia by:
- Inquiring about their sleeping conditions: “Firmer mattresses are not always the best option for patients with chronic pain,” Ms. Cralle says. “A softer mattress or pillow top can still be supportive, yet provide softness for greater comfort for painful joints. Adjustable air beds (adjustable bases and adjustable comfort levels) can also help ease pain, help with getting in and out of bed and allow for different sleep positions for fluctuating pain levels.”
- Reviewing common medications that can disturb sleep: “For those with chronic pain and sleep problems, it’s important to ascertain that their analgesic doesn’t contain caffeine (e.g., Excedrin),” Ms. Cralle says. “In addition, many medications used to treat arthritis (e.g., prednisone) may actively disrupt sleep and should be taken in the morning rather than at night.”
Determining the Causes of Insomnia
“Any patient who complains of both pain and insomnia should have a thorough evaluation by a sleep expert,” Ms. Cralle says. “Don’t just assume the sleep problem is caused by their arthritis or autoimmune disease. There may be an unrelated disorder that is the primary culprit in the sleep disturbance, such as sleep apnea, restless legs syndrome (RLS), depression or anxiety.”
Ms. Cralle adds that RA patients have a higher incidence of RLS than the non-RA population.
“Treatment of RLS may not seem obvious if one is focused exclusively on the pain,” Ms. Cralle says. “For example, checking ferritin levels or the use of dopamine agonists may not be a standard treatment for RA, but could lead to sleep improvement.”