Sleep, Pain, and Ankylosing Spondylitis
Updated: Jul 5, 2021
August 3rd, 2020
Getting ‘good’ sleep is a constant struggle for those of us with Ankylosing Spondylitis. What qualifies as ‘good’ sleep is also relative. I remember a time when I was younger, after a day long and busy day, when I’d lay down at night and my body would tingle with relief as I drifted off into a hard, restful sleep. Sometimes I’d lay down and my body would ache in a good way as my muscles eased into a restorative rest after a day of physical activity.
I long for that kind of sleep now. Maybe my memories are glossed over by a thick layer of nostalgia. Maybe I never really slept hard like my dogs do, limbs twitching through seismic snores that shake the entire bed. Either way, I know that sleep came easier when I was younger--I fell asleep quicker and stayed asleep longer.
My Sleep Trouble with Ankylosing Spondylitis
I was diagnosed with Ankylosing Spondylitis in 2016, but my sleep troubles date back further than that. As a teenager, I can remember having some difficulty falling asleep. The problem, then, was a lack of comfort due to back pain. I’m a side-sleeper and always have been, but even as a teenager I’d have to spend several minutes laying on my back with my knees bent to ease my lower back pain and stiffness.
That trick doesn’t work anymore. Now, I spend much of my night squirming in bed, moving from side to back to side, catching some comfort when I can. If I lay for too long on my back, my lumbar spine begins to throb with pain, prompting me to move. If I lay for too long on my side, my neck, hips and shoulders begin to ache (I also have peripheral arthritis, which is fairly common with AS) and my body feels like it’s collapsing in on itself.
Then there’s the morning stiffness. Regardless of how well I sleep the night before, I always wake with a nagging, dull soreness in my lower back. Luckily, this inflammatory morning stiffness is eased by a hot shower and, unless I’m experiencing a disease flare-up, doesn’t usually last more than an hour.
Sleepless Nights and Painful Days
With AS, lack of movement leads to increased stiffness and pain. If you follow that idea through to its logical conclusion, sleep without movement creates more pain and stiffness. But then, how do you get good sleep if movement is required to stave off pain and stiffness? I have yet to discover a solution.
Fatigue from inflammation feels like a heaviness, like I’m walking around dragging double my body weight behind me, and with little energy to do so.
But there’s another issue at hand here: how lack-of-sleep affects pain and inflammation levels during the day. After all, sleep is your body’s way of regenerating, and so without “enough sleep, your body doesn’t have adequate time to repair itself.” From there, the problem becomes a cascade of pain, fatigue, and inflammation. Bad sleep one night leads to more pain and inflammation the following day. Increased pain and inflammation during the day can then make it harder to fall asleep and stay asleep the next night, and so on.
When I don’t get enough sleep at night my body immediately lets me know with more than just tiredness. Instead, I can feel the joints throughout my body aching, some of them swelling from excess inflammation. Without enough sleep I often spend the day in a state of fatigue, which is markedly different from normal tiredness that can be relieved with a midday nap. Fatigue from inflammation feels like a heaviness, like I’m walking around dragging double my body weight behind me, and with little energy to do so. Usually that fatigue needs to simply be waited-out.
Tricks for Better Sleep with Ankylosing Spondylitis
I’ve tried many tricks and techniques to get a better night’s sleep with AS. Unfortunately, while some tricks work better than others, there’s no one miracle remedy that has solved all my sleeping problems. With that said, here are a few tricks I’ve found to help in certain situations:
Exercise and Yoga
As I’ve discussed before, there’s a fine line between enough and too much exercise, and that depends on the person and their disease activity. Low-impact exercise, such as walking or swimming, gets joints moving without straining them too much or increasing pain and stiffness. Yoga is especially useful because it stretches the muscles, loosens joints, and therefore helps maintain mobility. Exercise right before bed may be counterproductive, but if you do yoga in the evenings you might end with ‘legs up the wall,’ a position that helps relax the body and increase circulation.
When I’m suffering from increased back and joint stiffness, nothing eases it quite like a hot bath. Taking a hot bath (or even shower) before bed can not only ease stiff joints, but may also relax the body by dropping its core temperature. In fact, there’s research that shows the human body actually slightly drops its temperature in order to fall into a good, deep sleep. By taking a hot bath an hour before bed, you may be initiating this drop in temperature and therefore promoting good sleep.
The majority of my rheumatologists treat sleep troubles with prescription medications. I can understand the appeal of using medication to induce good sleep, but I’d rather use prescription sleep aids sparingly. Muscle relaxers are useful to induce sleep when I’m in so much pain that falling asleep just doesn’t seem possible. I’ve also tried supplements such as melatonin, but when pain in the problem melatonin isn't the solution. Cannabis (if you’re in a state where it’s legal for medical purposes) can be effective because it eases the pain and relaxes the body into sleep, especially if you choose indica strains and strains that contain CBD.
There are certainly other remedies for better sleep with AS, but when pain and stiffness are brought on by inactivity, then sleep is always going to suffer. I recommend trying several techniques to find out what works best for you. Maybe a combination of a few tricks will help. And maybe what works for you now won’t work five years down the road, as your pain and your disease evolves.