Ankylosing Spondylitis and Sleep Disorders: Exploring the Links
In a significant finding, current research has shown a strong connection between insomnia and ankylosing spondylitis (AS), an inflammatory arthritis that can have broad effects on the entire body [1]. This link is primarily attributed to disease activity, pain, inflammation, and related psychological factors like depression and anxiety [1].
The impact of poor sleep quality on AS patients is profound. A study highlights that increased disease activity scores, impaired functional status, and higher levels of inflammation markers such as C-reactive protein correlate closely with sleep disturbances [1]. Active disease status and comorbid conditions like fibromyalgia further worsen sleep disturbances, affecting sleep efficiency, total sleep time, and circadian rhythms [3].
Addressing insomnia in individuals with AS involves a multi-faceted approach. Medical treatment often includes the use of anti-inflammatory therapies such as anti-tumor necrosis factor (TNF) antibodies, which have been shown to reduce sleep disturbances by controlling inflammation and disease activity [1].
Lifestyle adjustments also play a crucial role. Incorporating regular stretching and physical exercise tailored to AS patients can significantly improve sleep quality by reducing stiffness and pain [2]. Creating a sleep-friendly environment, establishing consistent bedtime routines, and finding comfortable sleeping positions adapted for back pain associated with AS help improve rest [2].
Engaging healthcare providers, support groups, and family contributes to better coping with sleep challenges [2]. A person living with AS, who may also be dealing with depression, anxiety, or both, may find that they experience insomnia. It is essential to talk with a doctor if insomnia persists [2].
Biological research suggests a complex role of inflammation and immune factors in regulating sleep. Therapies that modulate immune function may indirectly improve sleep quality in AS [4]. For instance, a 2015 study indicates that people with AS have a 30.9% higher risk of developing obstructive sleep apnea than people without AS [5].
In summary, insomnia in ankylosing spondylitis is largely driven by inflammation and disease symptoms but can be managed effectively by a combination of disease-targeting treatments and non-pharmacological strategies focused on improving sleep environment and routines [1][2][3][4]. Adopting good sleep hygiene practices, avoiding caffeine, and establishing a fixed bedtime routine can help minimize the likelihood of insomnia. Stress can worsen insomnia, so it is essential to manage stress levels effectively.
It is important to note that the body of research looking specifically at AS and insomnia is generally sparse, with sleep disturbances affecting anywhere from 64.8% to 91.0% of people living with AS [6]. Studies have shown that pain and insomnia can make each other worse [7]. A 2012 study reports that the symptoms of AS affect various aspects of sleep, increasing the time it takes to fall asleep and raising the chance of waking during the night [8].
People living with AS have a much higher chance of developing depression than the general population [9]. Depression and anxiety are common comorbidities in people with AS, which may cause secondary insomnia. Treating and keeping AS under control can help improve the symptoms, including insomnia. A 2019 study proposes that AS increases the risk of new-onset sleep apnea, with people aged 40-50 years being most at risk [9].
In conclusion, managing insomnia in individuals with ankylosing spondylitis requires a holistic approach that considers both the underlying disease and lifestyle factors. By working closely with healthcare providers, implementing behavioural and environmental modifications, and staying informed about the latest research, individuals with AS can improve their sleep quality and overall wellness.
- Ankylosing spondylitis (AS), a chronic inflammatory arthritis, has been linked to increased instances of insomnia, a sleep disorder often exacerbated by disease activity, pain, inflammation, and anxiety.
- Research indicates that sleep disturbances in AS patients correlate closely with increased disease activity scores, impaired functional status, and higher inflammation markers like C-reactive protein.
- The health-and-wellness implications of untreated insomnia in individuals with AS are significant, as poor sleep quality can worsen symptoms, affecting both physical health (spondylitis) and mental health (anxiety, depression).
- Managing insomnia in AS requires a multi-faceted strategy, involving medical treatments such as anti-TNF antibodies and lifestyle modifications like tailored exercise, creating a sleep-friendly environment, and adopting good sleep hygiene practices.
- Engaging support groups, healthcare providers, and family can help individuals with AS better cope with sleep challenges, as depression, anxiety, and other mental-health conditions may exacerbate existing insomnia.
- Comorbid conditions like fibromyalgia and obstructive sleep apnea can further complicate sleep disturbances in AS patients, thus emphasizing the need for a holistic approach to managing sleep issues in this demographic.
