Sleep Issues and Insomnia with Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2020 | Last updated: February 2021

AxSpA spectrum conditions can affect various parts of your life, including sleep. Good, restorative sleep is important for health and overall well-being, and when you’re not getting sleep for whatever reason, it can affect you in many different ways. Without sleep, your body doesn’t have the chance to repair itself and rest properly, which means it may impact your experience of pain or stiffness the next day.1 This can create a vicious cycle, creating never-ending fatigue and other symptoms.

Poor sleep has been reported by approximately 30 to 90 percent of people living with AxSpA spectrum conditions.2 Inflammation, pain, and stiffness can make it hard to get comfortable and difficult to fall asleep.

There are things you can do to help manage sleep issues and increase the chances of having a better night’s sleep.

Take a look at your mattress

With AxSpA spectrum conditions, it’s not just your spine and hips that are affected; you also have to think about your neck, shoulders, and other joints.2 Your mattress may be making matters worse. It’s worth considering whether your mattress evenly distributes your weight, provides adequate support for your spine and doesn’t cause it to bend, and if it has a supportive box spring or foundation.1 If your mattress is too soft, it might not be providing enough support; if your mattress is too firm, it won’t be comfortable and mold to your body.

Think about how you sleep

How you sleep, or your sleep positioning, may be making things worse or exacerbating any pain or discomfort you might be having. To start, when you wake up in the morning, take a minute to notice how you are positioned – is your spine well-supported? Is your neck bent at all?

You might want to try sleeping on your back without a pillow for part of the night, or for a few nights, to see if this helps at all with pain and stiffness.1 This can help align your back and relieve pressure on the spine.1 If you need a pillow, a thin one is recommended; a thick one can make your neck bend in an unnatural position and impact your posture during sleep.1

Sleeping on your stomach is not recommended with AxSpA spectrum conditions, as this puts more stress on your neck and back.1 This can increase pain and inflammation in the long run.

Practicing good sleep hygiene

Sleep hygiene consists of the habits you do to promote quality of sleep.1 These behaviors can help you establish a routine to help you sleep better and minimize sleep issues. Some things you can do include:1

  • Avoid caffeine later in the day and at night
  • Make sure your bedroom is dark
  • Get regular physical exercise
  • Only use your bed and bedroom for sleep and sex (ie, don’t do work in bed, don’t watch television in bed)
  • To avoid heartburn at night, refrain from spicy, hot, fried, or citrus foods at night

Talk with your doctor

If nothing helps with sleep, or if you find that your pain or discomfort aren’t relieved by doing any of these interventions, you may need another treatment option. Your doctor can talk with your about your symptoms, your sleep habits, and what’s going on that is preventing you from getting the sleep you need. They will be able to determine whether a sleep aid or pain medication might be helpful, or if there are any non-drug options that can be of benefit.

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