Arthritis Self-Management

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Getting a Good Night's Sleep

by Wendy McBrair, MS, BSN, CHES

Perfect pillows. It is very important to find a pillow that is comfortable for you, so investigate the material, thickness, and firmness of any pillows you buy. However, you should not sleep with lots of pillows that bend your neck forward, as this will add to poor posture and possibly cause neck pain. If you have neck or back problems, consider a cervical pillow. A cervical pillow supports your neck as well as your head and allows your head, neck, and spine to remain in proper alignment, which can help to decrease pain. If you have lower back pain, lying on your back and placing one or two pillows under your knees so that they are slightly bent can help support your back. Or you can purchase a foam wedge that serves the same purpose. If you have knee problems, you should avoid sleeping with a pillow under your knees so your knees are bent. This may increase knee stiffness and make it more difficult for you to straighten your knees. You might find instead that it helps if you put a pillow under the entire length of the leg. Putting a pillow between your knees as you lie on your side helps maintain back alignment, which can reduce hip and back pain. Again, a special pillow is available for this purpose. Another helpful pillow is the dual position bed wedge, which can be used both for sleeping and, in a different position, for reading or watching TV. You can find specialized pillows at medical supply stores and on the Internet.

Bed equipment. Some people with arthritis or fibromyalgia are bothered by heavy covers that press down on their feet at night. An adjustable blanket support can keep covers off sore feet and ankles and make it easier to turn and change position without disrupting your sleep. These supports can attach easily to the sides or foot of a bed. Sheets made of satin or another smooth material can also make it easier and less painful to turn over in bed. Partial side railings that anchor by sliding under the mattress to keep them in place are made to adjust in four positions. You can use the railings to help you turn over more easily during the night.

Other strategies. The best environment for sleep is one that is cool, dark, and quiet. This is sometimes easier said than done. For instance, you may live where there is noise outside your bedroom, such as traffic, or you may sleep with a partner who tosses and turns or snores loudly. Earplugs or sleep machines can help with outside commotion and with noisy sleeping partners. (Sleep machines create “white noise” that drowns out other sounds.) A person can reduce snoring if he or she loses weight or avoids alcohol in the evening — alcohol contributes to snoring by relaxing the muscles in the throat. Some people like to use special tape on the nose to enlarge the nasal passages during sleep (though there is little hard evidence that this works). If your nasal passages are swollen because of allergies, ask your doctor whether it’s OK for you to take allergy medicine to reduce the swelling and thus help reduce snoring. And sometimes snoring is a symptom of a sleep disorder known as sleep apnea, discussed later in the article.

Another good strategy for getting good sleep is to go to bed at the same time and wake up at the same time every day (including weekends). Using your bed only for sleeping (instead of reading and watching TV) and for sex can also help. But if you are awoken by your partner’s noise or movement and can’t find any other way of dealing with the problem, consider moving to another room.

Some people have no trouble going to sleep but wake up in the middle of the night and can’t get back to sleep. If you are waking up to empty your bladder, try stopping your intake of fluids a few hours before bed — for example, by 7 PM. If you wake up and are upset or worrying, you can try to stop the upsetting thoughts by using a technique called progressive muscle relaxation, in which you relax each muscle in your body, one at a time. To do this, first tighten all the muscles in your face for several seconds and then release them. Work from top to bottom, tightening and relaxing the muscles in each area of your body until you reach your feet. Concentrate on the relaxation process rather than on the fact that you are upset because you are awake.

Foods and medicines

The medicines you take and the foods you eat can cause sleep problems or make them worse. Prednisone and other corticosteroid drugs, which people with inflammatory arthritis often take, can cause sleeplessness. Other medicines — such as decongestants and some blood pressure drugs — can cause sleep problems, too. If you think a drug may be causing your sleep problems, check with your doctor or pharmacist. Caffeine, nicotine, and amphetamines cause sleep problems, as they are all stimulants. Some people try reducing their intake of caffeine from coffee, tea, energy drinks, or sodas to one cup or glass a day, preferably before 5 PM. Others have to stop altogether. (Also note that some headache relievers, such as Excedrin, may contain caffeine.) You should also avoid alcohol before bed if sleep is a problem, because alcohol does more than make you snore — it can suppress deep sleep and REM sleep. And remember Mom’s warm milk. Heated milk at bedtime helps some people relax and get to sleep faster.

Last Reviewed on March 9, 2011

Wendy McBrair spent 30 years as a health-care professional in the fields of rheumatology and orthopedics, where she specialized in patient and community service, patient education, and advocacy.

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