Nonradiographic axial spondyloarthritis (nr-axSpA) is a form of inflammatory arthritis that affects your spine and sacroiliac (SI) joints, where your spine connects to your hips. It’s characterized by lower back pain that’s sometimes described as a dull ache, which is often accompanied by stiffness and tends to get worse with inactivity and better with movement.
Because it’s often at its worst when you’re sitting or lying still, pain from nr-axSpA can interfere with your sleep. “A lot of patients with [nr-axSpA] have sleep disturbances compared with the healthy population,” says John Miller, MD, an instructor of medicine in the division of rheumatology at Johns Hopkins Medicine in Baltimore. That includes “issues with getting to sleep, staying asleep, and the depth of sleep when a patient is asleep.”
Sleep problems in nr-axSpA “can have a huge negative impact in terms of quality of life,” Dr. Miller notes. The good news is that there are steps you can take to potentially improve your ability to fall and stay asleep, although not every solution works for everyone. It may take some exploration of the specific causes of your sleep problems, and some trial and error in exploring remedies, before you’re resting easy again.
Here are some hints that may help you get a good night’s sleep with nr-axSpA.
Effective nr-axSpA Treatment for Better Sleep
It’s common to see sleep disturbances in people with nr-axSpA that hasn’t yet been diagnosed and treated, according to Jean Liew, MD, an instructor and spondyloarthritis researcher in the division of rheumatology at the University of Washington in Seattle.
People with nr-axSpA who wake up with back pain tend to see it improve somewhat with movement, says Dr. Liew, “whereas mechanical pain is more likely to get worse with more movement, get worse throughout the day.” In fact, she says, that’s often a clue to look into inflammatory back pain and a diagnosis of either nr-axSpA or ankylosing spondylitis (AS).
Once your nr-axSpA is diagnosed, your doctor will probably prescribe a drug to treat it. But treatment guidelines from the American College of Rheumatology also emphasize that exercise is a key part of treating nr-axSpA.
“There’s pretty good data that exercise can help with sleep,” as well as with pain relief in nr-axSpA more generally, says Miller. That usually means seeing a physical therapist soon after your diagnosis, and then following a prescribed exercise regimen that continues after your sessions have ended.
Exercise and appropriate treatment with drugs go hand-in-hand in keeping your nr-axSpA well-controlled, which can lead to a beneficial cycle involving sleep. “If you treat the disease aggressively, and if the patient is active and maintaining a healthy lifestyle, it can help with sleep,” Miller emphasizes. And in his experience, “I think people who are sleeping less perceive pain differently, and less sleep can also lead to less activity and worse food decisions,” which can, in turn, worsen symptoms and support a vicious cycle of pain and sleep problems.
That’s why, Miller says, “if you’re treating sleep-related issues, I think addressing inflammation needs to be a part of that.” In practice, this can mean talking to your doctor about making sure your drug treatment is as effective as possible.
In a research review published in February 2017 in the journal Rheumatology International, the authors found that both exercise and biologic drugs called TNF inhibitors were effective at reducing poor sleep in people with nr-axSpA or AS.
Troubleshooting to Improve Sleep With nr-axSpA
Beyond effective overall treatment of your nr-axSpA, there may be steps you can take to specifically improve your sleep. These include:
- Adjusting the timing of nonsteroidal anti-inflammatory drugs (NSAIDs)
- Applying heat to your back or other affected areas before bed
- Experimenting with sleeping arrangements
- Looking into psychological factors affecting sleep
- Talking to your doctor about using medication for sleep
“We’re trying to figure out what drugs might have a better ability to let you sleep through the night,” says Liew. That could mean taking a longer-acting NSAID, “rather than one you have to keep dosing every 12 or 8 hours.” But no matter how long-acting the drug you take is, you can talk to your doctor about taking it “so that it has its greatest effect right around the time you wake up in the morning,” Liew suggests — when you’re more likely to be woken up by pain than earlier in the night.
You should feel free to experiment with applying heating pads or a hot-water bottle to your back or any other area of pain or stiffness before bed, says Miller. “Generally, heat is a good thing” for short-term relief, but he cautions that “it’s not recommended to sleep with those overnight, because you can get burns from heating pads and warm compresses.”
It also can’t hurt to try to make your sleeping arrangements as comfortable as possible. That might mean trying out new pillows, getting a new mattress topper or pad, or making your bedroom cooler or darker. And you can experiment with sleeping positions — including using pillows for support under your back or stomach, or between or under your legs — to see if this helps you sleep through the night.
RELATED: What to Do When You Can’t Sleep: All About Insomnia Treatments
While pain from inflammation is a major factor in sleep disturbances in people with nr-axSpA, it’s not the only possible cause. “It’s not uncommon to see anxiety or depression,” Miller notes. “Some people wake up with racing thoughts or can’t fall asleep because of that.” If you think stress, anxiety, or depression is playing a role in your sleep problems, talk to your doctor about possible remedies. You may be able to find ways to cope with these problems on your own, or you may benefit from referral to a mental health professional.
Finally, sleep medication may be appropriate for some people, but shouldn’t be viewed as an easy solution in the context of nr-axSpA. “Taking sleep-related drugs really doesn’t take care of the issue of pain,” says Liew. “When you do wake up, you’re going to wake up with pain even if you’ve got medicated sleep.”
In addition, many sleep medicines have troubling side effects, including increasing the risk of falling during the day or if you get up at night, Miller notes. Since some people with nr-axSpA already have some instability in their walking due to pain and stiffness, a drug that makes this problem worse may not be a good choice.
In the end, the best approach to treating problems with sleep in nr-axSpA is to look at what specific aspects of your condition are causing them, says Liew. “It’s really about making [sleep] an important outcome, and seeing what we can do with the treatments we’re already using to improve it.”