Hello, and welcome to the first Medicine Matters podcast in a series on quality of life. Today, we will be talking to Victoria Ruffing, Director of Patient Education at the Johns Hopkins Arthritis Center in the USA about sleep. Victoria will be discussing the causes of sleep problems that can occur in patients with rheumatic and musculoskeletal diseases, the impact these may have on patients’ symptoms and quality of life, as well as strategies that patients can use to help improve their sleep.
First of all, Victoria, what type of sleep problems can be experienced by patients with rheumatic and musculoskeletal diseases, and why?
One thing that we should talk about right off the bat is obstructive sleep apnea. This is actually commonly associated with people with rheumatoid arthritis, and I would imagine other inflammatory diseases, and it has to do with the amount of inflammation. So, I would consider that all patients that are really having trouble with sleep consider getting a sleep study to be able to diagnose obstructive sleep apnea and possibly restless leg syndrome. That can help avoid some other comorbidities, and we may have the answer to your sleep problem right away.
Now, the other things that can sort of be reasons behind not getting a restful sleep could be depression, and so we know that depression is high and people who are depressed, about 70% of those depressed people will have poor sleep. So, addressing any depressive-type symptoms or issues is gonna be important. This is even more common in women than in men, some depressive symptoms.
The other thing may be pain. Patients go to bed and their pain is not quite under control, therefore they have a little bit of a problem settling down, or pain may wake them up. If you're having pain issues you might wanna talk with your physician about an over the counter type medication, a non-steroidal type anti-inflammatory or other pain medication to take at bedtime. But you wanna really take that, I shouldn't say at bedtime, you wanna take that about an hour to two hours before bedtime, so that you've got your pain control at its highest level before you try to get into bed and go to sleep.
Another thing that we have to think about are the medications that the patient's taking. So some medications could contribute to having this problem of sleeplessness. One of them would be steroids. So a patient that's on prednisone, if they could take that early in the day rather than late in the day, that would probably be better, because prednisone can make people sort of like a little agitated and not able to settle down really well.
So, what impact can this sleep disturbance have on a patient's disease symptoms and their daily activities?
People can feel a little confused, they can have problems concentrating, they can have difficulty coping with pain. So we know that people who don't sleep seem to have higher level of pain, or a higher level of the inability to cope with pain. So, that would be another issue that would happen when people are having a restless sleep.
The other thing that's equally important is that people find they have the inability to complete any of their leisure activities. So, it's, the quality of life really altogether can lessen because a patient may find all they can do is get to work and get home, and then sort of that would be the end of it. So there's no dinners out with the family, there's no playing with the grandchildren, there's no going to a book club, or whatever your leisure activity might be, could certainly be curtailed because you just don't have the energy to be able to attend these.
Are there any actions that patients can take to improve their sleep?
So, one thing you might do is, just take a look at your bedroom. Is this bedroom a place where you can get quality sleep. So, is it too warm? Is it too cold? You wanna look at these kinds of things like adjusting the temperature in your room. Is it too noisy? Is it too bright? Things like blackout curtains may be helpful so that you have complete darkness. We know that darkness is really key for getting a good night's sleep.
The other thing you wanna look at in your bedroom is, "Is your bedroom where you sleep?" Or is your bedroom where you do all kinds of things like sort your laundry, watch TV, and you really don't want to do those things in your bedroom. You wanna be able to train yourself that when you go into your bedroom, you're there to sleep, and that's it. If you don't fall asleep right away, if you can't fall asleep within, say, 20 minutes of going to bed, you may wanna get up, go to another room, listen to some music, read, and then try again.
The other thing you wanna evaluate are, is your bed itself. Look at your pillows. Are they comfortable still? Is your mattress still comfortable? You may have been using it for, you know, 15 years, which really kind of exceeds the life of most mattresses. So you wanna take a look at that and see if, see if that can be switched up or, you know, do you need a harder mattress, do you need a softer mattress? And you wanna make sure that your pillows are, if you have any allergies, that your pillows are washed frequently or have an allergen cover on them.
And what can patients do in terms of a bedroom routine?
Some people really try to establish a bedtime routine. So that would mean no electronics, and that would include your phone. So, try to stay off your phone for about an hour before you go to bed. There's some studies that are recent about just the blue light that comes from phones and computers that's stimulating parts of the brain and it really needs a good hour to settle that down.
One thing that helps is to get up in the morning and go to bed at the same time every day. And that would include weekends. So not just during the week but get your body in a routine where you're waking up and going to sleep at the same time.
Another thing is, while it may be very difficult, you should really avoid naps, especially after, say, 2pm. If you find that you're having trouble getting to sleep and you had a nap in the afternoon, then perhaps you wanna try to skip that nap, and sort of force yourself through it, and see if you don't get a better night's sleep without having that nap.
What about what patients eat and drink and other lifestyle considerations – can they play a role?
So you don't wanna really eat anything for about 2-3 hours before you go to sleep. And avoid drinking caffeine. Caffeine should be, can be, limited after like 2pm, and so hopefully you've got all the caffeine out of your system. And beware of places where there's hidden caffeine. People don't think about the amount of caffeine that might be in tea and perhaps they drink iced tea with dinner, they may want to limit that, or switch to a caffeine-free tea.
Alcohol can disturb your sleep so you would like to, you would wanna, limit the amount of alcohol, especially close to bedtime.And the other thing that's gonna be important is exercise. But you don't wanna exercise within 3 hours of going to bed. But regular exercise really does help with getting a good night's sleep.
Finally, what additional tools are available to help patients monitor and improve the quality of their sleep?
Well, it's interesting because, I have just, I just was browsing to see what kind of new things were out there for helping people and there are a million apps. And the apps really have, people that I've talked to that have used these apps really do credit them with getting a better night's sleep. So there's a couple of different kinds of apps that are out there, one of them is called relax melodies, and that plays relaxing sounds, nature sounds. Also you can get some meditation to that they can play over top of the noises sort of to let you get to sleep.
There's two apps that actually measure, sort of measure, your sleep as you go along. And one's called sleep cycle, and one of them is called sleep time. And they, they monitor your phases of sleep and actually the alarm will wake you at the right moment during your sleep.
Another app is called relax and sleep well, and this one has an author that's available, and he will do hypnotherapy and meditation with you, and just sort of help you with getting yourself settled down going to sleep. All of the apps that I mentioned are free, so that's kind of a bonus there, and they were all available for both iPhone and Android.
So, we’ve heard that there are multiple causes of sleep disturbance in patients with rheumatic diseases, and that these can have a significant impact on patients’ quality of life. Victoria also covered the different actions that patients can take, as well as lifestyle considerations and apps to help patients improve their sleep.
Thank you very much to Victoria for sharing her thoughts with us on this topic. You can find links to the apps Victoria mentioned, as well as links other podcasts in this series on quality of life at the bottom of the page.