How can disturbed sleep affect my health?
If you have poor or disturbed sleep night after night, you may begin to notice your health getting worse. If you have arthritis, symptoms such as pain may disrupt your sleep.
Several of your body's functions are influenced by sleep:
- Your body clock is controlled by your sleep pattern.
- Many different hormones are affected by sleep. For example, steroid hormones are at their highest level when you wake up and lowest before you go to sleep, so taking steroid tablets later in the day can affect your body clock and may disrupt your sleep.
If your body clock is altered by a change in your sleep pattern (for example, if you have jet lag), you may feel generally unwell and experience:
- stomach problems
You may also find it difficult to think clearly, concentrate or carry out normal activities such as driving.
What's a normal sleep pattern?
How much sleep do I need?
Most adults need about 7–8 hours sleep per night, though this varies from person to person. Children tend to sleep more than adults, and older people tend to have lighter sleep.
What are the stages of sleep?
The stages of sleep are commonly referred to as:
- non-rapid eye movement (REM)
- REM or dreaming sleep.
The pattern of your brainwaves differs in each stage.
Non-REM sleep happens in four stages:
- Stages 1 and 2 refer to light sleep.
- Stages 3 and 4 refer to deeper sleep with slow brainwaves.
These phases are repeated several times during the night. Each cycle lasts about 90 minutes, although the proportion of deep sleep and dreaming sleep changes as we get older.
What kind of sleep problems are there?
A severely disturbed sleep pattern can cause all the following problems:
- You may have trouble getting to sleep but then sleep through the night.
- You may wake often during the night or wake up too early.
- You might not remember having disturbed sleep but don’t feel refreshed when you wake up. This is called (non-restorative sleep).
If this continues for a long time, it can cause increased muscle tension and can be linked with muscular pain. Sleep also has a major effect on our mood.
It's normal to wake up once or twice each night, and it's only a problem if you can't get back to sleep again or if you’re not happy with the amount and quality of sleep you’re getting.
Sleep and depression
Depression can result in disturbed sleep but a poor sleep pattern over a period of time often leads to anxiety or depression, or both. It’s sometimes difficult to know whether sleep disturbance is the result of depression or the cause of it.
Sleep and pain
Sleep disturbance may lower the point when you begin to feel pain (your 'pain threshold'). This could lead to:
- increased pain from an already painful condition
- developing pain from a condition that hadn’t been painful before
- pain that was felt only in only part of your body (localised pain) becoming more widespread.
It's also possible that disturbed sleep could cause fibromyalgia, so it's important to try to improve the quality of your sleep.
Sleep and fibromyalgia
If you have fibromyalgia, you may have sleep disturbance and fatigue, along with pain and stiffness. People with the condition often recall having disturbed sleep before the pain and stiffness began.
Although it’s likely that the fatigue is caused by a poor sleep pattern, it’s also possible that pain and stiffness may be caused by sleep disturbance. This is supported by the results of a study that prevented volunteers from going into deep sleep. Within a few days, all the volunteers developed widespread stiffness and muscle pains.
How can arthritis affect my sleep?
All forms of arthritis can affect the way you sleep, especially if your condition causes pain that makes it uncomfortable to lie down.
Back pain, neck pain and sleep
If your pillow or mattress are too soft or too firm, or if they don’t give you enough support, this can make these problems worse.
Osteoarthritis and sleep
Osteoarthritis usually causes pain when you’re moving your joints, but it can sometimes cause problems at night as well. This quite often happens if you have osteoarthritis of the hip. Surgeons often take this into account when considering whether you need a joint replacement operation.
Rheumatoid arthritis and sleep
If you have rheumatoid arthritis you’re more likely to suffer disturbed sleep than people of a similar age who don’t have arthritis.
Sleep disturbance is usually worse when your pain is worse, and it’s linked to increased anxiety and depression as well as morning stiffness and fatigue.
Are restless legs affecting my sleep?
Many people find their sleep is disturbed by restless legs. Restless legs are unusual and sometimes unpleasant sensations which cause a strong urge to move your legs.
Restless legs syndrome (RLS) can occur at any time but is often worse at night.
A related condition called periodic limb movement disorder (PLMD) only occurs at night and causes your arms or legs to jerk or twitch.
You should see your doctor if restless legs are affecting your sleep.
What causes RLS and PLMD?
RLS and PLMD can affect anyone but are quite often linked with long-term conditions. They can also occur as a side-effect of some medications or as a result of not having enough iron or vitamins in your body.
What treatments are there for RLS and PLMD?
Treatment for RLS and PLMD may involve:
- changing your medications
- taking iron or vitamin supplements
- avoiding stimulants such as caffeine and alcohol
- stretching and massaging your leg muscles.
If your symptoms are severe, your doctor may suggest you take a drugs called dopamine agonists, for example ropinirole and pramipexole.
Dopamine agonists increase the levels of a chemical called dopamine in your brain. Dopamine is needed to produce smooth muscle activity and movement and so helps to prevent the involuntary movements that occur in RLS and PLMD.
Snoring and obstructive sleep apnoea syndrome
Snoring is common and can be a symptom or a cause of sleep disturbance. Most people who snore remain perfectly well and don’t feel sleepy during the day, but they may be more sensitive to the effects of alcohol or sedatives.
Obstructive sleep apnoea syndrome
Severe snoring may be a sign of obstructive sleep apnoea syndrome, a condition caused by brief blockages of the upper airway during sleep. You’re more likely to have obstructive sleep apnoea syndrome if you:
- are obese
- have a thick neck
- have diabetes
- often have a blocked nose.
Obstructive sleep apnoea syndrome can cause long-term (chronic) fatigue. It can be diagnosed by measuring the level of oxygen in your blood while you’re sleeping.
What treatments are there for obstructive sleep apnoea syndrome?
Treatment for obstructive sleep apnoea syndrome can include:
- controlling your weight
- avoiding alcohol
- positive airway pressure (which involves wearing a mask during the night)
- surgery to clear a blockage in the upper airway
- drug therapy.
How can I improve my sleep?
Keeping a sleep diary
Keeping a diary of your sleep pattern can help you spot things that disturb your sleep. It can include:
- what time you go to bed and wake up
- whether you got to sleep easily or not
- any causes of disturbance, such as your mood, pain or fatigue
- any caffeinated drinks
- your daytime activities.
Healthcare professionals will usually suggest you think about 'sleep hygiene' – things that you can do to improve your sleep pattern:
- get into a relaxing routine – get up and go to bed (ideally when you’re sleepy) at the same time every day
- make your bedroom dark, quiet and at a comfortable temperature
- exercise regularly, but not within three hours of going to bed
- eat sensibly so you don’t feel hungry during the night, but avoid eating and drinking large amounts just before bedtime
- take a warm bath before you go to bed to help ease stiff or painful joints.
- use your bedroom for stimulating activities, like watching TV, working or eating
- sleep during the day because this can make it more difficult to get to sleep at night
- eat/drink caffeinated products (tea, coffee and chocolate) after midday
- drink alcohol if you experience serious sleep disturbance
- smoke before bedtime or during the night.
If you can’t sleep after about 20 minutes, get up and do something that’s not overstimulating (for example, listening to some soothing music). Only go back to bed when you’re sleepy.
Changing your bed
If your mattress is old or uncomfortable, you should probably consider replacing it. Read more about finding a new mattress.
Some people find it helpful to sleep in a narrow soft foam collar.
Treatments for sleep problems
If your sleep problems continue, speak to your GP, rheumatologist or rheumatology nurse. They'll be able to offer more advice and prescribe medication if you need it.
There are four main groups of drugs that can be helpful. They’re most likely to have an effect when just one factor is causing your sleep disturbance. You may find it useful to take drugs from more than one of these groups.
Taking paracetamol (with or without codeine) just before going to bed can ease pain to allow you to get to sleep, but it’s unlikely to last all night.
Non-drowsy painkillers that include caffeine are unlikely to help you sleep.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Slow-release NSAIDs such as ibuprofen or naproxen reduce pain and stiffness throughout the night. Although these drugs have potential side-effects, they can be very useful.
Sedating antidepressant drugs
Some antidepressants, such as amitriptyline and trazodone, have sedative effects, which means they make you feel sleepy. They may also reduce chronic pain.
These drugs aren’t given as sleeping tablets but may improve your sleep as an added benefit. It’s often advisable to take them a few hours before going to bed so that the effect has worn off by the morning.
Temazepam, zolpidem and zopiclone are given specifically to help you got to sleep, although they may not stop you waking during the night. They’re sometimes called hypnotics.
Doctors often advise against using sedatives in the long term because of the risk of dependence, which means you become addicted to them. There's also a risk of side-effects, but they can be very helpful for short-term use. In some cases long-term use of these drugs may be better than long-term loss of sleep.