Herbie Murray
Sleep is necessary for our overall physical and mental health. For the average adult, doctors recommend sleeping at least 7 hours each night to feel well-rested and promote optimal health. However, people with psoriatic arthritis (PsA) often experience sleep disturbances, with nearly 80% of adults with the condition suffering from some degree of fatigue.
A 2023 review noted that anywhere from 30-85% of people with PsA experience problems with sleep. Sleep apnea, chronic insomnia, and restless leg syndrome are all sleep disorders that people with PsA are at a higher risk of experiencing.
While there is no evidence that people with psoriasis are more likely to experience insomnia, getting treatment for psoriasis or PsA can help people who have insomnia sleep better.
| Characteristics | Values |
|---|---|
| Number of hours of sleep needed | 7-9 hours |
| Sleep issues | 30-85% of people with psoriatic arthritis experience sleep issues |
| Sleep issues causes | Severe pain or swelling of joints, high levels of inflammation, limited physical function, sleep apnea, restless leg syndrome, insomnia |
| Sleep issues consequences | Fatigue, weight gain, obesity, increased risk of joint pain and inflammation |
| Sleep issues treatments | Adjusting medication, lifestyle changes, moisturising, drinking water, meditation, heat or cold therapy, comfortable clothing, regular exercise, healthy diet, improving sleep hygiene |
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What You'll Learn
Sleep disorders and psoriatic arthritis
Prevalence of Sleep Disorders in PsA
Several studies have found a high prevalence of sleep disorders in people with PsA. A 2020 study reported that 38% of people with PsA experienced sleep disturbances. Another small study in 2018 found that about 67.7% of participants with PsA had poor sleep quality. A more recent review in 2023 suggested that anywhere from 30-85% of people with PsA struggle with sleep issues.
Risk Factors for Sleep Disorders in PsA
People with PsA have a higher-than-average risk of developing sleep apnea, a condition where breathing temporarily stops multiple times during sleep. A 2016 study revealed that 36-82% of people with PsA also had obstructive sleep apnea, compared to just 2-4% in the general population. Other risk factors for sleep disorders in PsA include severe joint pain and swelling, high levels of inflammation, and limited physical function.
Impact of Sleep Disorders on PsA
The impact of sleep disorders on people with PsA can be significant. Poor sleep quality can worsen joint pain and may even increase inflammation. Additionally, fatigue caused by sleep disturbances can negatively affect physical health, work productivity, and overall quality of life. Sleep disorders can also lead to anxiety and depression, further impacting an individual's well-being.
Strategies for Improving Sleep in PsA
Treating PsA and any underlying sleep disorders is crucial for improving sleep quality. This may involve following a treatment plan, taking medications, and making lifestyle changes. Relaxation techniques, such as guided imagery or meditation, can also help reduce stress and improve sleep. Adopting better sleep habits, such as avoiding electronics before bed and maintaining a consistent sleep schedule, can also positively impact sleep quality.
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Sleep apnea and psoriatic arthritis
Sleep apnea is a condition where someone involuntarily stops breathing multiple times while sleeping because their airway closes. It is diagnosed through an overnight sleep study, typically conducted at a sleep lab. A technician attaches electrodes to the patient's head and body to monitor brain waves, eye movements, oxygen levels, and breathing.
People with psoriasis and psoriatic arthritis (PsA) are more likely to suffer from sleep apnea. A study published in the International Journal of Dermatology in 2016 found that people with psoriasis were so likely to have sleep apnea that the authors suggested patients be screened for it. Another study found that between 36% and 82% of people with psoriasis may also have sleep apnea, compared to just 2-4% of the general population.
Sleep apnea can cause daytime fatigue, and if left untreated, it increases the risk of high blood pressure, heart disease, and stroke. Losing weight and getting enough exercise can help treat sleep apnea.
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Restless legs syndrome and psoriatic arthritis
Restless legs syndrome (RLS) is a neurological disease characterised by an irresistible urge to move one's legs due to an uncomfortable, aching, throbbing, crawling, or creeping sensation. Symptoms tend to worsen in the evenings and at night, making it a potential cause of sleep deprivation.
RLS is estimated to affect around 7-10% of the general population, with a higher prevalence among females. It can develop at any age, but those most severely affected tend to be middle-aged or older. While the exact cause of RLS is unclear, it is often associated with metabolic disorders such as diabetes, obesity, and hypertension.
Several studies have investigated the link between RLS and psoriasis, a condition closely associated with metabolic disturbances. These studies found a higher prevalence of RLS among patients with psoriasis compared to healthy controls, suggesting a correlation between the two conditions.
One study, which included 50 patients with psoriatic arthritis (PSA), 50 patients with psoriasis, and 50 healthy controls, found a significantly higher rate of RLS among PSA patients (64.0%) compared to the other groups. The study also concluded that the presence of RLS in PSA patients was associated with impairments in sleep and quality of life, fatigue, and depression.
Another study of 300 patients with psoriasis and 300 healthy controls reported similar findings, with 17% of patients with psoriasis experiencing RLS symptoms compared to only 4% of the control group.
The exact mechanism underlying the association between RLS and PSA is not fully understood, but it may be related to the disease-related stress and inflammation associated with PSA. Additionally, RLS may be influenced by metabolic factors, as PSA patients often have higher body mass indexes (BMIs) and inflammatory blood markers.
The treatment for RLS can include lifestyle changes or medication such as ropinirole. Identifying and addressing RLS in PSA patients is crucial, as it can help improve their sleep quality and overall well-being.
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Chronic insomnia and psoriatic arthritis
Chronic insomnia is not clearly linked to psoriatic arthritis (PsA). However, a 2022 study found that 43.33% of people with PsA had insomnia symptoms, and this was more common among those with higher baseline disease activity.
PsA is a chronic condition that affects the joints and can cause inflammation in other parts of the body. It often develops in people with psoriasis, an autoimmune condition that affects the skin.
Strategies to Improve Sleep
Treating PsA and any underlying sleep disorders can help people with PsA get more rest. A person may also benefit from changing their lifestyle and sleep habits. Here are some strategies to improve sleep:
- Stick to a sleep schedule: Go to bed and wake up at the same time every day.
- Keep a sleep diary: Include information about naps and how tired you feel.
- Exercise regularly: Even 10 minutes of walking daily can improve sleep, though longer and more intense sessions are best.
- Avoid caffeine and other stimulants close to bedtime.
- Avoid using electronic devices before bed: The blue light emitted by these devices can disrupt sleep.
- Make your bedroom sleep-friendly: Keep your bedroom cool, dark, quiet, and free of distractions.
- Use the bed only for sleeping: Avoid reading or watching TV in bed.
- Manage stress: Try relaxation techniques such as meditation and guided imagery.
How Psoriatic Arthritis Affects Sleep
PsA can negatively impact sleep quality and duration. A 2023 study found that 30–85% of people with PsA reported sleep issues. Factors that increase the risk of sleep disturbances include:
- Severe pain or swelling of joints
- High levels of inflammation in the body
- Limited physical function
Sleep Disorders and Psoriatic Arthritis
People with PsA are also at a higher risk of developing sleep disorders such as sleep apnea and restless leg syndrome. Sleep apnea affects 36–82% of people with PsA, while a 2019 study found that 64% of people with PsA experienced restless leg syndrome.
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Strategies to improve sleep for those with psoriatic arthritis
- Ask your doctor about sleep apnea: Sleep apnea affects how you breathe at night and is more common in people with psoriatic arthritis. It may not produce any obvious symptoms, so it's worth discussing with your doctor if you experience insomnia.
- Wear comfortable clothing: Loose-fitting cotton or silk pyjamas can help keep itchy skin in check and prevent further irritation.
- Use temperature therapy: Try a warm shower, a hot water bottle, or an ice pack before bed to relax your joints and relieve pain.
- Moisturise before bed: Keeping your skin calm and well-moisturised can help prevent itchiness from keeping you awake.
- Drink water throughout the day: Water helps keep you hydrated and lubricates and cushions your joints, so make sure you're drinking enough.
- Meditate before bed: Stress can make your psoriatic arthritis worse and keep you up at night, so try meditation exercises to help you relax.
- Avoid long, hot showers or baths: Hot water can irritate your skin, so opt for warm water and limit your showers to 10 minutes or less.
- Unplug your electronics: Using electronics before bed can be detrimental to your sleep quality, so set an electronic curfew and power down your devices at least 30 minutes before bedtime.
- Exercise regularly: Exercise helps keep joints strong and functioning properly, which can relieve symptoms of joint pain and stiffness, making it easier to fall asleep.
- Eat a healthy diet: A balanced diet can help prevent excessive inflammation and control your weight, which can help manage symptoms and improve sleep quality.
- Improve your sleep hygiene: Develop good sleep habits by avoiding large meals and caffeine before bed, going to bed at the same time each night, and making your room dark, cool, and comfortable.
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