Psoriatic arthritis (PsA) is a type of arthritis that is a combination of arthritis and the skin condition psoriasis. The arthritis symptoms include swollen and sore joints, while psoriasis causes scaly, itchy red patches that appear on the scalp and skin. It is estimated that over 7.5 million Americans have psoriasis, and around 30 percent of these people go on to develop psoriatic arthritis.1 PsA or Psoriatic arthritis can be mild or severe and may involve either one or several joints.2 Psoriatic arthritis can also cause inflammation in other parts of the body, but it primarily affects people who already have psoriasis. Psoriasis is an autoimmune condition that affects the skin.
Symptoms of Psoriatic arthritis tend to be different for each person, and they can be mild to severe. Sometimes your Psoriatic arthritis will enter the remission stage, and you will feel better for some time. Other times, though, your symptoms may get worse, and you may experience a flare-up of your symptoms. The exact symptoms also depend on which type of PsA you have.
Some of the general symptoms of PsA or Psoriatic arthritis include:
- Morning stiffness of the joints
- Swollen and tender joints on either one or both sides of the body
- Swollen fingers and toes
- Flaky scalp
- Scaly skin patches, which tend to get worse when your joint pain flares up
- Painful tendons and muscles
- Nail pitting
- Eye pain
- Eye redness
- Separation of the nail from the nail bed.
Psoriatic Arthritis and Sleep Disturbances
Many people with Psoriatic arthritis also have trouble sleeping. In a 2018 study, it was found that nearly 68 percent of people with Psoriatic arthritis have poor quality sleep.3
Another bigger study discovered that almost 60 percent of people with just psoriasis or both psoriasis and PsA experience sleep difficulties.4
Another study in 2017 determined that a whopping 84 percent of people with Psoriatic arthritis have a poor quality of sleep.5
Even though Psoriatic arthritis does not directly cause insomnia or other sleep problems, the symptoms of the disease like itchy, dry skin, and joint pain can make it difficult for you to sleep at night. In some cases, an underlying sleeping disorder can also make it difficult to sleep.
Psoriatic Arthritis and Sleep Apnea
According to a 2016 Danish study, people with Psoriatic arthritis have a greater than average risk of having sleep apnea.6 Sleep apnea is a condition in which a person stops breathing temporarily during their sleep. People with sleep apnea are more likely than others to develop Psoriatic arthritis.
One of the most common symptoms of sleep apnea is chronic and loud snoring. Sometimes, the snoring might be interrupted by a choking sound. Some of the other symptoms of sleep apnea may include:
- Morning headaches
- Mood swings
- Trouble concentrating
- A dry mouth or sore throat in the morning
- Frequently needing to go to the bathroom in the middle of the night.
However, more research is still necessary to understand the exact link between Psoriatic arthritis and sleep apnea.
Psoriatic Arthritis and Chronic Insomnia
According to a review published in Sleep Medicine Reviews, there is no clear proof that people with psoriasis are more susceptible than others to develop insomnia.7 The researchers also found no clear evidence to link Psoriatic arthritis and the risk of insomnia.
However, the researchers did find proof that getting treated for Psoriatic arthritis or psoriasis can help people with insomnia sleep better. In people who have received biologic medications as treatment for PsA or psoriasis, there was reduced joint pain along with lesser fatigue.
Psoriatic Arthritis and Restless Legs Syndrome
Restless legs syndrome can cause an uncomfortable sensation in a person’s legs, and they have an overwhelming urge to move their legs. Restless legs syndrome usually affects a person at night, but they may also notice this symptom at any time when they are resting.
In a recent research done in Turkey, researchers found that 64 percent of people with Psoriatic arthritis experienced restless legs syndrome.8 They also discovered that these people were more prone to having this type of sleep disorder than people who had psoriasis alone.
In a review article on sleeping disorders in people who have psoriasis, the researchers found that nearly 15 to 18 percent of people with psoriasis experience restless legs syndrome.9
Psoriatic Arthritis and Other Sleep Disturbances
Apart from sleep disorders like insomnia, there are many other factors that may impact how well a person with Psoriatic arthritis sleeps. These factors may include:
- Body weight
- The severity of the pain
- Tenderness of the joints
- The extent of inflammation in the body
If you also have depression, anxiety, or other emotional distress.10
If a person has psoriasis, the uncomfortable skin symptoms are likely to disrupt their sleep. For example, experiencing a burning or itching sensation on the skin at night is expected to keep a person awake or keep disrupting their sleep.
Remember that your sleeping routine, bedroom environment, and many other lifestyle factors can also have an impact on the quality of sleep you get.
Tips to Sleep Better with Psoriatic Arthritis
While it can indeed be frustrating to keep on tossing and turning throughout the night, this does not mean that the situation has to be entirely out of your control. Here are some tips to help you get a good night’s sleep while having Psoriatic arthritis.
Getting Help With Diagnosing The Sleep Disorder
You should ask your doctor to diagnose if you have sleep apnea or any other underlying sleeping disorder. As mentioned above, nearly 36 to 82 percent of people with psoriasis and Psoriatic arthritis may have obstructive sleep apnea, as compared to just two to four percent of the general population.7
Many times, sleep apnea or other sleep disorders may not exhibit any obvious symptoms, so you may have a sleeping disorder without knowing about it. If you are frequently experiencing insomnia, you may bring up the possibility of having sleep apnea with your doctor.
Wear Comfortable Clothes
Wearing loose-fitting silk or cotton clothing to bed can help you manage your dry or itchy skin due to psoriasis. This will also prevent you from further irritating your skin if you are tossing and turning about in the night.
You can also consider buying softer bedsheets. Sheets that have a high thread count and are made from high-quality cotton can help reduce the irritation to your skin at night.
Moisturizing Before Going To Bed
One of the easiest things to do before going to bed is to regularly moisturize to keep your skin from being itchy and dry. Applying lotion to your skin before going to sleep can help prevent itchiness, and you will be able to sleep through the night.11
However, when selecting a moisturizer, search for products that are specially designed for dry skin or for people with psoriasis. Your doctor can also prescribe a moisturizer that is primarily for psoriasis. You can also consider natural moisturizers like coconut oil and shea butter.
Try Hot Or Cold Therapy
Before going to bed, you can try temperature therapy to give some relief to your joints. Different types of therapy work better for different people. So you can consider experimenting with hot and cold temperatures to see which one helps you better. You may even prefer to take a warm shower, sit with a hot water bottle, or use an ice pack.
Whatever method you find to be most effective, you can incorporate it into your nightly pre-bedtime routine. This may help you avoid the pain for long enough to get some sleep.
Hydrate Throughout The Day
Apart from moisturizing your skin with lotion, you will want to ensure that you remain hydrated throughout the day by drinking plenty of water. Water will not only keep you hydrated, but it will also help you cushion and lubricate your joints. For people with Psoriatic arthritis, water is a powerful ally.
However, instead of filling up on water just before going to bed, you should try to spread out your intake throughout the day. The last thing you want is to fall asleep only to find yourself needing to use the bathroom.
Avoid Taking Long, Hot Showers Or Baths
Many people like to take a long hot bath or shower before going to bed. However, hot water can actually worsen the irritation of your skin. Restrict your showers to just 10 minutes or even less so ensure that your skin doesn’t get too irritated, especially before bed.12
To prevent your skin from becoming dry, take a shower in warm water rather than hot water. Once you are through with your shower, gently pat dry your skin instead of rubbing it with the towel. You can still continue to have a warm shower before your bedtime, but remember to take these precautions.
Try Meditating Before Bedtime
Stress is a significant factor that aggravates Psoriatic arthritis and also keeps you awake at night. Decrease your stress levels by practicing meditation exercises before going to bed. Meditation will help you decompress your thoughts and wind down for the night.13
When people hear about meditation, they usually associate it with a complex routine. However, it does not have to be complicated. All you need to do is close your eyes and focus on your breathing as you inhale and exhale. Just keep your body still and relaxed as you enjoy the quiet around you.
Unplug the Devices
It is important that you stop using your phone at least sometime before going you head to bed. Using electronic devices before bedtime can have a huge impact on the quality of your sleep.
The drawbacks of using electronics before bedtime are well known, but still, over 95 percent of people say that they use some type of an electronic device in the hour before bedtime.14 So it is best if you set an electronic curfew for yourself. Power down your frequently used devices at least half an hour before you go to bed.
Head To Bed Earlier
If you have Psoriatic arthritis, you should make an effort to avoid getting overtired. Being overly tired can again worsen the symptoms of both arthritis and psoriasis. If you find that you are consistently not able to get sufficient sleep, keep in mind that the resulting fatigue that further weakens your already weakened immune system. This can ultimately lead to a vicious cycle in which your symptoms get worse, and this makes it even more difficult to sleep.15,16
It can be challenging to get out of this cycle, but one thing you should aim for is to decide on an early bedtime and strictly follow it. Even if it takes you some time to fall asleep, your body will still get the time to relax and wind down.
By going to bed at the same time each night, you will be able to stabilize the body’s circadian rhythm, and eventually, it will become easier for you to fall asleep.17
Does Your Medication Regimen Need To Be Changed?
If you have tried all the sleeping tips mentioned here, but you are still unable to get a good night’s sleep due to the symptoms of Psoriatic arthritis, you may talk with your doctor to see if it is time to change or reconsider your medication regimen.
It is a good idea to maintain a log of your symptoms, sleeping habits, and any other observations related to your sleep cycle. Then you can talk to your doctor and let them know about the trouble you are having sleeping. Your doctor may consider putting you on a new or alternative treatment that may relieve your sleep disturbances.
Living with Psoriatic arthritis can be difficult and impact various parts of your life, including your sleep. People with Psoriatic arthritis are known to have trouble sleeping due to their symptoms. In some cases, they may also have an underlying sleep disorder that prevents them from having a good night’s sleep and getting the rest they require.
Researchers have found that Psoriatic arthritis increases the risk of developing sleep disorders like sleep apnea and restless legs syndrome. Practicing good sleeping habits and getting medical treatment for Psoriatic arthritis can help you overcome these sleep troubles. With the proper routine and healthy lifestyle, it is possible to have a good night’s sleep even with psoriatic arthritis.
- Psoriasis.org. 2021. Get the facts about psoriasis and psoriatic arthritis. [online] Available at: <https://www.psoriasis.org/psoriasis-statistics/> [Accessed 13 March 2021].
- Psoriasis.org. 2021. Psoriatic Arthritis: Causes, Symptoms and Treatment. [online] Available at: <https://www.psoriasis.org/about-psoriatic-arthritis/> [Accessed 13 March 2021].
- Krajewska-Włodarczyk, M., Owczarczyk-Saczonek, A. and Placek, W., 2018. Sleep disorders in patients with psoriatic arthritis and psoriasis. Reumatologia, 56(5), p.301.
- Smith, M.P., Ly, K., Thibodeaux, Q., Weerasinghe, T., Beck, K., Shankle, L., Armstrong, A.W., Boas, M., Bridges, A., Doris, F. and Gelfand, J.M., 2019. Factors influencing sleep difficulty and sleep quantity in the citizen pscientist psoriatic cohort. Dermatology and therapy, 9(3), pp.511-523.
- Wong, I.T., Chandran, V., Li, S. and Gladman, D.D., 2017. Sleep disturbance in psoriatic disease: prevalence and associated factors. The Journal of rheumatology, 44(9), pp.1369-1374.
- Egeberg, A., Khalid, U., Gislason, G.H., Mallbris, L., Skov, L. and Hansen, P.R., 2016. Psoriasis and sleep apnea: a Danish nationwide cohort study. Journal of Clinical Sleep Medicine, 12(5), pp.663-671.
- Gupta, M.A., Simpson, F.C. and Gupta, A.K., 2016. Psoriasis and sleep disorders: a systematic review. Sleep medicine reviews, 29, pp.63-75.
- Sandikci, S.C., Colak, S., Baykara, R.A., Öktem, A., Cüre, E., Omma, A. and Kucuk, A., 2019. Evaluation of restless legs syndrome and sleep disorders in patients with psoriatic arthritis. Zeitschrift für Rheumatologie, 78(10), pp.987-995.
- Gupta, M.A., Simpson, F.C. and Gupta, A.K., 2016. Psoriasis and sleep disorders: a systematic review. Sleep medicine reviews, 29, pp.63-75.
- McDonough, E., Ayearst, R., Eder, L., Chandran, V., Rosen, C.F., Thavaneswaran, A. and Gladman, D.D., 2014. Depression and anxiety in psoriatic disease: prevalence and associated factors. The Journal of rheumatology, 41(5), pp.887-896.
- Gelmetti, C., 2009. Therapeutic moisturizers as adjuvant therapy for psoriasis patients. American journal of clinical dermatology, 10(1), pp.7-12.
- Psoriasis.org. 2021. Life with Psoriasis. [online] Available at: <https://www.psoriasis.org/life-with-psoriasis/managing-itch> [Accessed 13 March 2021].
- Misery, L.A.U.R.E.N.T., Shourick, J., Sénéschal, J., Paul, C., de Pouvourville, G., Jullien, D., Mahé, E., Bachelez, H., Aubert, R., Joly, P. and Héas, S., 2020. Use of mind‐body practices by patients with psoriasis: Results from a study on 2,562 patients. Journal of the European Academy of Dermatology and Venereology.
- 2021. [online] Available at: <https://www.sleep.org/articles/how-technology-changing-the-way-we-sleep/> [Accessed 13 March 2021].
- Husted, J.A., Tom, B.D., Schentag, C.T., Farewell, V.T. and Gladman, D.D., 2009. Occurrence and correlates of fatigue in psoriatic arthritis. Annals of the rheumatic diseases, 68(10), pp.1553-1558.
- Gudu, T., Etcheto, A., de Wit, M., Heiberg, T., Maccarone, M., Balanescu, A., Balint, P.V., Niedermayer, D.S., Canete, J.D., Helliwell, P. and Kalyoncu, U., 2016. Fatigue in psoriatic arthritis–a cross-sectional study of 246 patients from 13 countries. Joint Bone Spine, 83(4), pp.439-443.
- Lange, T., Dimitrov, S. and Born, J., 2010. Effects of sleep and circadian rhythm on the human immune system. Annals of the New York Academy of Sciences, 1193(1), pp.48-59.
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