Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by inflammation and joint involvement. Most adults with RA experience sleep disturbances, including longer times before falling asleep, numerous awakenings during the night, and early morning wakening, resulting in excessive daytime sleepiness and fatigue. This article will review what is known about sleep disturbances and the biologic basis in adults with RA, the influence of ovarian hormone levels in women with RA, how medications may influence sleep in RA, and complementary and alternative therapies that may be useful in reducing sleep disturbances.
Rheumatoid arthritis (RA) is one of the most common forms of arthritis, affecting about 1% of the population or 2.5 million Americans. 1 Not only is RA more common in women than men, with women representing 71% of all cases, it often strikes women during the reproductive years (25-40 years). 2 RA is a systemic autoimmune disease characterized by joint inflammation that can destroy bone and cartilage if left untreated. 1 Adults with RA may have periods of remission, but must manage symptoms and disease flares throughout their lives because the disease is inflammatory and not yet curable. One of the most difficult aspects of living with RA is managing symptoms of pain, sleep disturbances, fatigue, and depression. 3-8 When disease flares occur, symptoms are significantly increased. 9
The prevalence of sleep disturbances in adults with RA ranges from 54% to 70%. 9-12 In a 2-wave longitudinal study over 24 months, Nicassio and Wallston 13 found that 60% of participants stated that RA interfered with their sleep to a mild or moderate degree, and 14% of participants stated that RA interfered with their sleep to a severe degree. Restless sleep was reported by 57% of the participants.
Sleep studies seem to indicate that sleep fragmentation is more of a problem than changes in sleep stages in adults with RA. Those with RA take longer to fall asleep, have numerous awakenings during the night, experience early morning wakening, and excessive daytime sleepiness. 10,12,14,15 Adults with RA often report that joint pain and tenderness are associated with their sleep disturbances. 8,13,14 In addition, they may experience primary sleep disorders, such as restless leg syndrome (RLS) or periodic leg movements (PLM). 9,16
Sleep disturbances in adults with RA often lead to increased daytime sleepiness and fatigue, which may decrease work productivity or ability to accomplish daily activities. 8,12,14,17,18 This article reviews what is known about sleep disturbances and the biologic basis in adults with RA, the influence of ovarian hormone levels in women with RA, how medications may influence sleep in RA, and complementary and alternative therapies that may be useful in reducing sleep disturbances.