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Is Sleep the Missing Piece of Your Arthritis Management?

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hand drawn branch with leaves

Sleep, the final frontier. But seriously, sometimes it does feel like sleep is a mythical beast that you will never locate. Whether because of the aches and pains or because of a baby or toddler in the house, sleep continues to elude us.

Sleep is important to physical health, mental health, and wellbeing. But putting that kind of pressure on yourself when you crawl into bed is counterproductive. It’s doubly true if you believe that you are a “bad sleeper” – that sort of mindset quickly becomes a self-defeating prophecy.

The good news is that there are many, many strategies that you can follow to improve your sleep experience. Let’s dig into some of them.

Sleep and Pain

First things first, let’s talk about sleep and pain. Obviously, if you are in pain it’s hard to sleep. But a lack of sleep can also increase your experience of pain. I know that one of my biggest triggers for arthritis pain is sleep deprivation. This effect can even be found in healthy people, so imagine how it would affect those of us who are already dealing with pain.

Pain isn’t the only problem caused by sleepless nights. Just think about how cranky a tired toddler gets — just because you’re a grown adult doesn’t mean you won’t get moody when you’re tired. There’s also the compounding effect of being tired on top of the fatigue caused by chronic illness.

We get it, sleep is important in general and for inflammatory arthritis symptom management. So now what? Let’s dig into some strategies to help us get more sleep.

Manage your mindset

If it seems like everything I write comes back to mindset — you’re right. Mindset is the key piece of the puzzle for everything that you do. It isn’t a magic answer — you still need to do the work. But the wrong mindset can make everything so much harder.

Sleep is a great example of that. Do you know that moment when it’s three in the morning and you’re lying awake in bed yet again and you think, “Well, I’m never getting back to sleep.” That is your mindset. The way that you think about sleep affects how you sleep because your sleep is a product of your mind.

When you are stressed, you’re not relaxed. It seems obvious to spell it out like that, but that is exactly the point that I’m trying to make. In order to sleep, you need to be relaxed and reasonably comfortable. If you’re not, then you’re not going to sleep unless you’re massively sleep-deprived and that’s a whole other problem.

You can’t force yourself to go to sleep. “In fact, attempting to force sleep backfires and creates more physical and mental arousal” (Say Good Night to Insomnia, p94). In other words, the harder you try to sleep, the more awake you become. You need to relax and just allow sleep to happen. Which sometimes seems easier said than done, I know.

Managing your mindset is crucial for sleep. Especially if you’ve been struggling with insomnia. Cognitive behavioural therapy techniques are very helpful in improving sleep quality and quantity. In other words, therapy can help you sleep better and longer.

One simple technique to start working on your mindset around sleep is to simply notice the thoughts that you have when you’re going to sleep. Notice whether those thoughts are positive or negative. If you are having negative sleep-related thoughts, the goal would be to try to reframe and reprogram your mindset. The book Say Good Night to Insomnia by Gregg D. Jacobs has some excellent scripts that you can use to start resetting your mindset.

Your sleep environment

If you’ve done any reading about sleep, you’ve heard that you should sleep in a cool, dark room. It is also generally recommended that you don’t do other things in bed besides sleep and physical intimacy. [footnote] I attended a session on sleep at a conference once. The presenter said that the only good reason for staying up past your bedtime is sex. [footnote] Ideally, this would be the case for the entire room, but some of us live in small houses and need to carve an office out of a corner of the bedroom. So at least make the bed a spot dedicated to rest.

If we go back to the issue of mindset, you would also want to avoid having things in your bedroom that are stressful to you. If you find disorganization very stressful, then it would be a great use of your time to make sure that your bedroom is as tidy as possible. You might even incorporate this into your bedtime routine.

Does coffee increase your energy?

hand drawn coffee cup with two hearts above
drawing by Samantha Holmgren

Caffeine can improve your energy and focus in the short term. But it can also mess with your sleep. If you drink too much coffee (aka have too much caffeine), your sleep quality is reduced, it takes longer to fall asleep, and you are more likely to wake up in the night.

How much is too much coffee?

It depends. Some people process caffeine quicker than others. If it is out of your system by the time you go to bed, then it won’t affect your sleep. Additionally, some people are affected by caffeine more than others and could have caffeine right before bed without it affecting them.

The general guideline is to stick to 2 cups of coffee in the morning. However, this is something that I recommend you experiment with. Try drinking less, or finishing earlier in the day. The best way to figure out how caffeine affects you would be to cut it out for a few weeks and then reintroduce it.

Fair warning, however, if you are a heavier coffee drinker, and you quit cold turkey, you may have withdrawal headaches. You might feel better if you slowly decrease your intake by 1/2 to 1 cup a day. However, my husband has done self-experiments with caffeine intake, and he finds it is easier to quit cold turkey and take the headache for a day or two than to drag it out by slowly reducing the intake. So do what you think will work best for you.

Bedtime routines

This is another classic tip. Everyone who has ever struggled with sleep has been told to create a bedtime routine. They say to have a bath or read for an hour before bed. And those are both great suggestions. Except when they are not.

Sometimes, you just don’t have time for that. On the other hand, if you are really struggling with sleep and you typically spend an hour laying in bed trying to sleep, you might as well use that time more intentionally.

Otherwise, your bedtime routine could be a short and simple 5-minute ritual. Play a song that you find soothing. Wash your face using water that is the perfect temperature. Once you get into bed, you can do breathing techniques, visualizations, loving-kindness meditations, or progressive relaxation techniques.

Why not try “beditation”?

Meditating while in bed helps to physically and mentally relax you and get you in a state conducive to sleep – you might even drift off while trying to meditate. Even if you don’t manage to fall asleep, you at least get to spend some time relaxing.

When I struggle to fall asleep, I first do a body scan and try to relax as much tension as I can. Then I do a version of a metta — or loving-kindness — meditation. There are many different versions of this. If you have a meditation app (like Calm, Headspace, or 10% Happier), you could play one and follow along. When I do it, I just repeat the following phrases until I drift off.

May I/you be safe.

May I/you be well.

May I/you know love.

May I/you know joy.

May my/your heart be at peace.

hand drawn branch with leaves
drawing by Samantha Holmgren

I first repeat it a couple of times using “I,” and then I continue by using “you” and allowing different people to drift in and out of my mind, wishing them well. I also sync this up with my breath. The first part (May I/you) on the inhale, the last part on the exhale. It sounds like a lot when I write it out, but this is just how the practice evolved for me after following along with many recorded meditations.

I think the fact that there are multiple “tracks” happening at the same time is part of why it works so well for me (physical – breathing, subvocal – the words, and mental – visualizing people). It completely crowds out any other thoughts.

Honour your circadian rhythm

Everyone falls into one of a few groups when it comes to circadian rhythm. There are those whose body prefers to be up early, possibly before sunrise. Others prefer to be up well past sunset. Most of us are somewhere in the middle. Your very biology might naturally be an “early bird” or “night owl”.

This also does tend to shift over your life. Young children are more likely to be early birds. Teenagers are more likely to be night owls. And as we age past adolescence, our circadian rhythm tends to shift earlier to be either a “middle of the road” type or “early bird”.

If you can adjust your day to account for your biology, do it. This might mean getting up at 5 am even though you don’t start work until 9, to take advantage of your morning energy as you enjoy your hobbies or get in a workout. And then go to bed earlier to match that wake-up time.

Or it might mean sleeping as late as possible before getting up for work so you can enjoy your time after work when you have more energy in the evening.

The trick is to try to maintain a similar routine on your days off. This is especially tricky for those who are not early birds by nature but have to wake up early for work. And if you tend to want to go out to parties or visit friends and stay up late, you’ll naturally be sleeping in to account for that.

The problem with sleeping in

When you sleep in, you tend to stay up later the following night, simply because you haven’t been awake long enough to get sleepy. When I used to be able to sleep in (aka before having a child), I would always make sure I got up before 9 am on Sunday so that I could have a shot at getting to sleep between 10 and 11 because I would have to get up to go to work the next day.

Gregg Jacobs uses the term “prior wakefulness” to refer to how long you have been awake before you try to go to sleep. If you “reduce your normal amount of prior wakefulness” by sleeping in and then try to go to bed at your normal time, you’re going to struggle to fall asleep.

In other words, it might not be (just) job-related stress keeping you up Sunday night, if that is a struggle you are having. If so, consider setting an alarm Sunday morning to set yourself up for a better sleep Sunday night.

To wake up earlier… wake up earlier

I always thought that in order to wake up earlier, I needed to start going to bed earlier. But when I did, I just tossed and turned and ended up falling asleep even later. When I tried just getting up earlier, it also didn’t work – but I never gave it more than a few days before giving up and sleeping in – at least on the weekend.

Reading Say Good Night to Insomnia, I realized that, aside from my sleep thoughts (”I’m not a morning person”), my biggest mistake was sleeping in on the weekend.

To be fair, I haven’t intentionally made the change to avoid sleeping in… I merely had a child. Now I have no choice but to get up and feed her breakfast. I have to say though, I don’t really miss sleeping in that much. I still love laying in bed and enjoying the cozy feeling of my blankets. But I don’t miss sleeping in until 11:00 and having my whole rhythm thrown off.

A note on sources for this article

This essay started with most of the ideas being pulled from my personal and professional experience and the book Say Good Night to Insomnia. I have a few other books on my to-be-read pile about sleep and as I finish those, I will add relevant information above and a brief review below.

Say Good Night to Insomnia

Overall, I enjoyed this book. It was interesting reading, for example, his description of ‘the relaxation response’. Essentially, he described mindfulness and meditation as methods for inducing a relaxation response in the body. However, he never actually says the word ‘meditation’. The version I had was released in 2009 and the book was originally written in 1999, before the recent popular uptake of mindfulness and meditation.

Similarly, he talks about “bright light boxes” aka SAD lamps. The way it is written, this book pre-dates the popularity and availability of SAD lamps. He also recommends a gratitude practice in a very practical way – as opposed to the woo-woo magic way that gratitude practices are often talked about lately.

I found myself making a lot of notes in the marginalia of this book. There were some things I disagreed with, especially the language used around the use of sleeping pills. It feels very “fear-mongering”. I agree that if you can manage sleep disorders without medications that would be preferable, especially in the long term. However, I’ve also met so many people who just needed sleep by any means necessary. Creating fear around medications is not helpful.

Overall, I would recommend reading this book if you have difficulty sleeping or want to learn a few more tricks. He also does a great job at giving your some tools that I recognize as being part of a cognitive behavioural therapy toolkit to help you restructure your thoughts around sleep.

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