Don’t just continue to toss and turn—there are ways to break the pain-stress-fatigue cycle
It’s a bit of an understatement to say that falling (and staying) asleep is a challenge when you have psoriatic arthritis (PsA). Not only can PsA symptoms —like achy joints, a stiff back, or swollen fingers and toes—keep you up, but itchy rashes can do the same, since up to 90% of people with PsA also have the skin condition psoriasis.
There’s a psychological component here too. Your pain flares up. You feel stressed, so your body releases cortisol, a hormone that keeps you alert and awake. The next day you’re exhausted and sleep-deprived, which can worsen your pain. “When this cycle is going, you have increased fatigue and more stress during the day, which can worsen pain perception—both during the day and at night—making it harder to cope with the condition," Annie Miller, LCSW-C, a licensed therapist specializing in sleep and chronic pain at DC Metro Therapy, tells SELF.
The good news—yes there is good news—according to Miller and the other experts SELF interviewed: You can break the cycle. Here’s how to get a better night’s rest if you have PsA.
1. DON’T JUST CONTINUE TO TOSS AND TURN.
If you’re tucked under the covers and can’t take your mind off your stiff neck, aching hip, or itchy skin, try to avoid laying there for an hour in the hope you will eventually doze off—this can cause your brain to associate your bed with pain and sleeplessness (rather than sweet dreams), says Miller.
Instead, get out of bed after 15 to 30 minutes, Miller recommends. Move to another room (or a chair in your bedroom, if you have one) and do a quiet activity—read a book, listen to calming music or a relaxing podcast, or watch a chill TV show.
Resist the urge to crawl back under the sheets until you’re really sleepy—i.e., your eyelids are heavy and you feel yourself nodding off.
2. TREAT ANY SKIN SYMPTOMS BEFORE YOU GET INTO BED.
As noted above, many people with PsA also have psoriasis, which can result in swollen, inflamed patches of skin that can wreak havoc on your rest, Jison Hong, MD, a clinical assistant professor of immunology & rheumatology at Stanford Medicine, tells SELF.
Dr. Hong recommends keeping your skin super moisturised—especially during cold, dry winter months. Use a humidifier in your bedroom and apply a thick, creamy product—say, Vaseline—after showering, Dr. Hong says. Dry skin can make your symptoms worse.
Last, keep your showers to five minutes or less and use warm water (not hot!), per the American Academy of Dermatology (AAD). Dr. Hong says this will reduce the odds of your skin drying out and getting itchy overnight.
3. GET CHECKED FOR SLEEP DISORDERS.
If you consistently feel like you’re not well-rested, also see your primary care physician, rheumatologist, or sleep specialist (if you have one). Certain sleep disorders tend to be more common among folks with PsA compared with those without this type of arthritis.
One is sleep apnea, which basically causes your throat to collapse as you snooze, leading to loud snoring and gasping for air. Not surprisingly, it can make you feel exhausted all the time, even when you spend an adequate amount of time in bed, Dr. Hong says.
It’s an easy-to-miss condition and many people with PsA go undiagnosed, says Dr. Hong. If you do end up having sleep apnoea—monitoring overnight can tell—it’s treatable. Your physician might also consider other sleep disorders, like insomnia and restless leg syndrome—two conditions that are more likely in people with PsA. Those are also treatable, so it’s important to get checked out.
4. RETRAIN YOUR BRAIN TO COPE WITH THE PAIN.
When PsA pain flares, it can be hard to focus on quite literally anything but the aching. To cope, Miller recommends something called somatic tracking, which are mindfulness exercises that help divert your brain from hyper-focusing on pain.
Here’s how it might look in practice with PsA, according to Miller: Say a sharp pain hits your knee. Recognize that it’s there and note how the sensation feels (is the ache dull and mildly radiating, or is it sharp and shooting?). Immediately shift focus to your breath—slowly inhaling and exhaling—to bring your attention to a more positive sensation currently on your body (say, your feet in fuzzy warm socks), Miller advises. Generally speaking, Miller recommends doing these exercises about 30 to 45 minutes before getting into bed, noting it helps people with PsA to get in a calmer headspace for a good night’s sleep.
5. DON’T OVERLOOK THE IMPORTANCE OF SLEEP HYGIENE.
It’s always a good idea to keep up with healthy sleep habits—say, by keeping your bedroom dark, quiet, and cool; avoiding electronics right before bed; and nixing caffeine and alcohol in the evenings, for example—but if you’re struggling with PsA and quality rest, those simple tips are especially crucial.
That said, “good” sleep hygiene might look different from one person to the next—and what primes you to enter a dream state might not work for someone else with PsA. If you feel especially sore in the evenings, a warm bath or heating pad 30 minutes before bed might help you relax. Alternatively, if racing thoughts keep you awake, utilising a meditation app (like Headspace) might be what you need. As SELF has previously reported, just do your best to make your wind-down routine as consistent as possible—you want those habits to flag to your brain that it’s rest time.
Say it with us: Better sleep is possible—anyone struggling to snooze soundly (including you!) can improve it, according to Miller. “If you're in bed and you feel stiff and uncomfortable, you may not want to get out of bed, but I would say try these things—really try to put them into practice and see how it goes and see how it feels,” she says.
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