A study published in December 2019 in the journal Frontiers in Medicine found that people with ankylosing spondylitis were at nearly 3 times greater risk of developing obstructive sleep apnea, a condition in which airflow is blocked during sleep, causing snoring at night and daytime sleepiness. And a study published in the International Journal of Rheumatic Diseases found that nearly 60 percent of subjects with ankylosing spondylitis experienced impaired sleep. Chronic pain can increase the amount of time it takes to fall asleep (known as sleep latency), reduce the total amount of time you spend sleeping (sleep duration), and trigger frequent arousals during the night (sleep quality), according to Nathaniel Watson, MD, codirector of the University of Washington Medicine’s Sleep Center in Seattle. “People with ankylosing spondylitis are often struggling with not just one but all three of these sleep issues,” he says. Poor sleep not only leaves you feeling tired and unhappy but can also worsen your ankylosing spondylitis pain. “We know that an untreated sleep disorder that’s causing sleep fragmentation and sleep disruptions affects the way the brain interprets pain, leading to reduced tolerance and making pain feel worse,” explains Dr. Watson. Sleep loss is associated with increased inflammation, too. The good news: It is possible for people with ankylosing spondylitis to break the cycle of poor sleep and worsening pain and get the z’s they need. These relatively simple tweaks to your daily and nighttime routines can help you sleep longer and more deeply at night, and experience less pain and fatigue during the day. Exercise regularly. “Physical activity, and stretching in particular, is one of the most helpful tools for combating ankylosing spondylitis pain,” says Robert Bolash, MD, an assistant professor in the department of pain management at the Cleveland Clinic in Ohio. It can also help contribute to a feeling of tiredness in the evening and promote better sleep. Some people find that working out too close to bedtime can actually interfere with sleep. If that’s the case for you, try exercising soon after you wake up to help relieve morning pain and stiffness associated with ankylosing spondylitis. It’s all about finding out what works best for you. Watch the clock. Healthy sleep works in cycles; painsomnia knocks this cycle out of sync and makes sleeping more erratic and increasingly more elusive, notes Watson. To get back on a healthy sleep schedule, go to bed and get up at the same time each day, even on weekends. A consistent routine for winding down — such as brushing your teeth, washing your face, and reading or listening to relaxing music — can also help you stay on schedule by signaling the body that it’s time for sleep. Then turn the clock around. Checking the time in the middle of the night is never productive. “It just gets you thinking about why it’s so early when you thought you slept more or worrying about the fact that you have to get up in two hours and you’ve barely slept,” explains Watson. “This gets the brain activated and perpetuates sleeplessness.” Ease p.m. pain with heat. Warmth can help reduce inflammatory-type musculoskeletal pain, which tends to worsen at night, says Dr. Bolash. Try taking a warm bath or shower or applying a heating pad, hot-water bottle, or wheat bag (which you can heat in the microwave) to affected joints before bed. Check your mattress. A mattress that’s either too hard or too soft can lead to poor sleep posture and worsening pain and stiffness, notes Bolash. A semifirm mattress is ideal for people with ankylosing spondylitis because it helps maintain the natural curvature of the spine. “You want enough support so that when you lie on your side, your spine is straight, and enough give that when you’re on your back, your spine can maintain its natural S-curve,” he explains. If a new mattress isn’t in the budget, consider a mattress topper that will help give you extra support. Keep the room below 68 degrees F. Some sleep researchers identify the ideal sleep temperature as somewhere between 66 and 70 degrees F, but many experts recommend keeping your bedroom on the cooler side for optimal sleep conditions, according to the National Sleep Foundation. “Your body temperature drops when you fall asleep, so approximating the same temperature drop in the room can help shorten the amount of time it takes to fall asleep,” explains Watson. Relax with an app. Tech takes the heat for keeping us up until all hours, but your smartphone or tablet can also serve as an invaluable sleep aid. Numerous free and low-cost apps can guide you through progressive muscle relaxation, a series of breathing exercises, or a calming meditation. “Incorporating one of these into your evening routine can help you wind down, ease your ankylosing spondylitis pain, and help you sleep better,” says Bolash. Don’t force the issue. If you find yourself ruminating and unable to sleep for more than 10 to 15 minutes, get up and do something nonstimulating in another room, such as reading, a crossword puzzle, or some gentle stretching (especially if you’re in pain), until you feel sleepy. “Remember that sleep is not something that you do,” notes Watson. “It’s something that happens given the right circumstances.” Consider CBT-I. Cognitive behavioral therapy for insomnia (CBT-I) focuses on helping people change the negative thoughts and behaviors that interfere with sleep. “This type of therapy has been shown to be as, if not more, effective as sleep medications over the long term,” says Watson. Ask your doctor to refer you to a sleep specialist who is trained in CBT-I or consider signing up for an online CBT-I program.
