For those living with rheumatoid arthritis, managing the symptoms and pain is crucial. It helps them keep the condition in check, and remaining pain-free has a positive impact on their mental well-being. However, it’s often noted that pain resulting from rheumatoid arthritis worsens at night, which is also associated with other forms of inflammatory arthritis and ankylosing spondylitis. Increased pain and discomfort disrupt sleep patterns, which in turn affect one’s quality of life. Besides causing increased disease activity (reversible manifestations of a disease), the mental toll it takes could also lead to depression. Hence, understanding the reason behind this occurrence can help in efficiently managing the pain.
Why does rheumatoid arthritis flare up at night?
“At night, the joints are in a state of inactivity,” says Dr Neena Chitnis, consultant rheumatologist, SL Raheja Hospital, Mahim, Mumbai. “Whenever the joints are mobile, pain is less; but when they become inactive, the pain increases. Also, there are fewer distractions at night. During daytime, an individual is engaged in a state of activity that keeps them distracted. As a result, the pain is not registered.”
Another significant reason is the decreased levels of cortisol hormone in the body at night. “Cortisol is anti-inflammatory,” says Dr Chitnis. “So, whenever there is a secretion of cortisol, the pain subsides. Cortisol levels naturally decrease at night, which is the most important chemical reason behind the increased pain.”
Managing rheumatoid arthritis pain
“If the condition is not under control, the pain is going to increase during the night,” says Dr Chitnis. “People can do yoga or meditation before going to bed, but it should be tailored to their requirements and performed under the guidance of a certified yoga teacher. An individual with rheumatoid arthritis should not take up exercise on their own. Activities like reading a book or listening to relaxing music before hitting the bed can help manage sleep disturbances.”
Painkillers can be taken on an emergency basis under the supervision of a medical practitioner. “If painkillers need to be taken daily, it means that the condition is not under control, and the reasons for it should be evaluated. Painkillers or heat packs are temporary solutions,” adds Dr Chitnis.
“Additionally, sleeping pills, prescribed by a medical practitioner, can be taken for a short period if the sleep cycle is disturbed. However, once the cycle returns to normal, the medications must be stopped,” cautions Dr Chitnis. In addition, leading an active lifestyle, having a healthy diet (containing calcium, vitamin D and protein) and regular follow-ups will help manage the symptoms of rheumatoid arthritis.
Rheumatoid arthritis pain: Altering sleeping arrangements can help
Sleeping arrangements can be modified depending on the severity of the condition and the location of the pain. For example, if an individual is suffering from back pain, a firm mattress that supports the back can make a huge difference in sleep quality. Those suffering from neck pain should use a thin pillow rather than a thick one. Additionally, sleeping with a cushion or pillow next to the knees can bring comfort to those with knee pain.
- Rheumatoid arthritis, characterized by pain, often flares up during the night.
- There are fewer distractions at night, due to which the pain perception is higher. In addition, the levels of the anti-inflammatory hormone cortisol decrease at night. As a result, an individual feels more pain.
- Doing yoga or meditation, reading a book and listening to relaxing music before going to bed can help alleviate sleep disturbances.
- Painkillers can be taken on an emergency basis under the guidance of a medical practitioner.