Sleep

Creating a good sleep environment 

• A good wind-down routine before bedtime, as well as going to bed at the same sort of time each night can help your body to get into a better sleep cycle. 
• Try to make your bedroom a restful environment, avoiding leisure pursuits such as television and computer games while in bed or shortly before going to bed. 
• Make sure that the bed, pillows and duvet are comfortable for you. If you find that use of a memory foam mattress helps you to sleep at home, you can also get a memory foam mattress ‘topper’ which you could take with you if staying at someone else’s house or on holiday. They can also be a cheaper alternative to buying a memory foam mattress. Memory foam pillows are also available, and some people find this very comfortable. 
• Make sure that your bedroom is generally comfortable, for example, that the temperature is right and the room is dark enough. Some people find that heavier curtains, with a ‘blackout’ quality, can help with this, especially in the summer when it stays lighter for longer. 
• If noise and/or light distract you from getting a good night’s sleep, you can try earplugs, eye masks or other methods to try to block anything that creates unnecessary light or sound. 

Preparing yourself for a good night’s sleep 

• A warm bath before bedtime to relax the joints and muscles can help you to get a good night’s sleep, but if a bath is not possible, a warm shower or soaking joints (such as hands and feet) in warm water can help. 
• Caffeine should be avoided close to bedtime, as it can stay in the body for a long period and make it difficult to sleep. If you want a hot drink before bed, milky drinks and herbal teas are therefore preferable to caffeinated drinks. Alcohol can also cause sleep disruption, so should also be avoided or taken in moderation. Eating food shortly before going to bed can also disrupt sleep. 
• If thoughts or anxieties keep you awake at night, some people find it helpful to keep a notepad and pen by their bed to write down anything that is concerning them, so that it can be tackled the next day. 
• Depression is a recognised symptom of rheumatoid arthritis and can also be a cause of sleep problems. If you are worried about depression, you should speak to your GP. However, if your GP prescribes antidepressants, this does not necessarily mean that you are being treated for depression, as low dose antidepressants can also be prescribed to treat sleep disturbance. 
• It is easier to get a good night’s sleep if you have not over-exerted yourself during the day, so pacing yourself is important.
• Some general lifestyle changes, such as taking regular exercise and establishing a regular sleeping pattern, can help in the long-term. 
• Avoid catnaps when possible and try to establish a regular routine and consistent time for going to bed and getting up.
• Avoid screen time before bed. The blue light that emits from devices (including TVs) suppresses the natural production of melatonin – the hormone you need to feel sleepy.

Relaxing exercises

The following relaxation exercises can help you to relief stress from the day.

Hold each position for 2 minutes. Inhale deeply and exhale slowly. Relax.

Coping with pain at night 

• A lot of people find pain more difficult to deal with at night. If pain sometimes prevents you from sleeping, taking painkillers before going to bed can help, especially if they work by slow release and their effects will last through the night. 
• Occupy your mind with sums, or visualisations of nice scenery; anything to keep your mind off any pain and anxiety you may be feeling. A wide range of books, CDs, YouTube videos and apps are available to teach you visualisation techniques and other forms of relaxation, such as meditation. Thinking about not being able to sleep can make it harder to get to sleep, but any method of relaxation or distraction can help with this. 

Sleeping positions

Your mattress should be comfortable for you. Your neck should be in a neutral position, as shown below.

Other useful tips 

• If you wake up after 3 hours of sleep, then use the 20-minute rule. i.e. if you do not get back to sleep within 20 minutes, go and rest in a quiet, dark area until you feel sleepy and can go back to bed. 
• It does not matter if there is sometimes a break between periods of rest and sleep. Even if you cannot sleep, rest can also be beneficial, whether it’s at night or during the day. 
• If you have trouble getting to sleep, you might find ambient sound, such as ‘white noise’ helps. There are a variety of apps with these kinds of sounds, which you can play at night to help you to sleep.

Try different methods to help you to sleep. As with so many things, what works for one person might not work for another, but keep trying until you find the routine that helps you. 
 
Problems with sleep can greatly affect the quality of life, so if you are having consistent problems with sleep, bring this up with your healthcare team. GPs, rheumatologists, occupational therapists and physiotherapists could be able to help you depending on the cause of the sleep problems. For example, an occupational therapist might be able to supply you with splints to wear at night, or a physiotherapist could help you with an exercise plan, or other strategies. A GP could give information on controlling pain and depression, and your rheumatology team can help by getting your rheumatoid arthritis under better control. 

Further reading: 

The Sleep Charity website 
NRAS article: To sleep or not to sleep
NRAS article: Managing the Pain of RA 
NRAS article on depression 
NRAS article on the role of the occupational therapist 
NRAS article on the role of the physiotherapist 

Updated: 27/03/2023

Next review: 27/12/2025

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