A moon and stars is pictured on the left, followed by a person with Axial spondyloarthritis bent over with pain spikes emanating from their back, located inside rotating arrows, to the right of them is a sun

Managing The Vicious Pain-Sleep Cycle of Spinal Arthritis

You finally lay your head down on the pillow at the end of the day, take a deep breath, close your eyes…and lightning bolts of pain strike along your spine.

How does anyone sleep with axial spondylarthritis (AxSpA)?

It’s a huge struggle. Science repeatedly confirms the link between poor sleep and nighttime pain. Research links pain and stiffness from spinal forms of arthritis to insomnia, insufficient sleep, and excessive daytime sleepiness (EDS).1

This only makes life worse if, over time, sleep deprivation accumulates as sleep debt. Sleep debt worsens all manner of chronic health conditions. Will it ever be possible to close our eyes and drift off to sleep without the disruption of pain? Maybe, with pain management, relaxation, and sleep hygiene as tools.

Pain: The enemy of sleep

During the day, we may notice arthritis pain as part of daily living. We do what we need to do to find relief while soldiering on. However, during moments of rest-—and especially at bedtime—-we notice and experience pain more, and this can disrupt sleep.

Acute pain flare-ups at bedtime are real. But even chronic pain, the kind we feel day in and day out, can worsen as we try to fall asleep. What we may experience isn’t only ordinary pain, but heightened pain sensitivity—-normal pain that’s amplified.

Managing AxSpA pain is key. Powering through it during the day may help while we’re awake, but it’s a different story at night.

Best practices for better sleep

Effective pain management

Whether it’s through exercise, diet, medications, or alternative therapies, we have several solutions for managing AxSpA pain. Are we taking advantage of all of them?

If bedtime’s a nightly struggle, the answer may be no. The Arthritis Foundation offers a brochure that addresses pain self-management.2 They ask five questions to help identify shortcomings in your pain management. Do you:

  1. Cancel plans because of pain?
  2. Consume alcohol to manage pain?
  3. Obsess about pain, 24-7?
  4. Spend a lot of time in bed, even when not sleeping?
  5. Quickly exhaust prescribed or over-the-counter (OTC) drugs?

There’s no shame in talking to your doctor about pain. Formalizing a pain management plan could be your ticket to getting more and better sleep. The Arthritis Foundation Pain Toolkit offers a useful worksheet to get you started.3

If OTC drugs don’t work, the Arthritis Foundation’s pain management quiz is also worth checking out: it highlights links between pain and the way we use OTC medications.4

Relaxation techniques

Arthritis pain can spark bedtime anxiety. You’ll toss and turn, wondering if you’ll ever fall asleep, especially if you’re exhausted and really want and need your rest. Not only that, but once you fall asleep, pain may reawaken you later in the night, causing problems with daytime fatigue.5

It’s a vicious cycle. Pain causes anxiety, which causes sleeplessness, which causes sleep loss, which causes higher pain sensitivity. Every night, the cycle repeats. How can you coax yourself to fall asleep—or to fall back asleep—when pain is a nightly sleep intruder?

Both body and mind need calm for sleep to take place. Most relaxation techniques can be supported through free or inexpensive apps or local classes. These include guided imagery, progressive relaxation, meditation, and yogic breathing. Also, try warm baths, soft music, reading, stretching, and massage at bedtime.

Good sleep hygiene

  • Use pillows wisely. A flat, firm pillow can reduce nightly neck pain.6 Creaky Joints suggests using pregnancy pillows and pillows under the knees for added support.7
  • Sleep position matters. Back sleeping is still considered the best position to reduce back pain as it preserves your natural spinal curve. Stomach sleeping should be avoided as it places strain on the spine.7
  • Watch what and when you eat and drink. Heavy meals, caffeine products, alcohol—-when consumed late in the day or prior to bedtime—-can make it hard to fall asleep.
  • Get daily exercise. Exercise helps support healthy circadian rhythms and joints.5 Especially when done in the morning—-ideally, outdoors or in bright light—-exercise promotes a favorable circadian “reset” which supports better sleep at night.
  • Stick to a consistent bedtime. To establish a strong circadian rhythm, go to bed at night and rise in the morning at the same time. Sleep-wake schedules that change frequently significantly disrupt rhythms.
  • Skip blue spectrum light at bedtime. Handheld electronics—including smartphones—emit blue light. This literally shuts off the brain’s production of the “sleep hormone,” melatonin, delaying sleep onset. Avoid checking email, playing video games, or visiting social media at bedtime. This gives your brain the best chance to elicit sleep.

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