If your sleep problems continue, speak to your GP, rheumatologist or rheumatology nurse. They'll be able to offer more advice and prescribe medication if you need it.
Drug treatments for sleep problems
There are four main groups of drugs that can be helpful. They’re most likely to have an effect when just one factor is causing your sleep disturbance. You may find it useful to take drugs from more than one of these groups:
Taking paracetamol (with or without codeine) just before going to bed can ease pain to allow you to get to sleep, but it’s unlikely to last all night.
Non-drowsy painkillers that include caffeine are unlikely to help you sleep.
Non-steroidal anti-inflammatory drugs (NSAIDs)
Slow-release NSAIDs such as ibuprofen or naproxen reduce pain and stiffness throughout the night. Although these drugs have potential side-effects, they can be very useful.
Sedating antidepressant drugs
Some antidepressants, such as amitriptyline, dosulepin and trazodone, have sedative effects, which means they make you feel sleepy. They may also reduce chronic pain.
These drugs aren’t given as sleeping tablets but may improve your sleep as an added benefit. It’s often advisable to take them a few hours before going to bed so that the effect has worn off by the morning.
Temazepam, zolpidem and zopiclone are given specifically to help you got to sleep, although they may not stop you waking during the night. They’re sometimes called hypnotics.
Doctors often advise against using sedatives in the long term because of the risk of dependence, which means you become addicted to them. There's also a risk of side-effects, but they can be very helpful for short-term use. In some cases long-term use of these drugs may be better than long-term loss of sleep.
Treatments for pain that disturbs sleep
Many people have painful muscle cramps during the night. Your doctor will see if any of your medication could be causing the cramps (for example diuretics or statins). They'll also suggest stretching before you go to bed.
If this doesn’t help, they may prescribe a short course of a drug called quinine sulphate. It can be useful for reducing these pains, though it doesn’t work on other types of pain.
Drugs that are usually prescribed for chronic pain may sometimes have useful effects on sleep, for example pregabalin and gabapentin.
Cognitive behavioural therapy
Therapists and psychologists may be able to offer relaxation tips or cognitive behavioural therapy (CBT). A number of studies have investigated CBT as a treatment for sleep problems in people with chronic pain.
CBT is a psychological treatment based on the assumption that our thought patterns and reactions are learned and can therefore be changed. It aims to help you change any thoughts, feelings or behaviours that may be having a negative impact on sleep. It can be given either in group sessions or to individuals.
CBT uses a number of different techniques:
- Education teaches about sleep and the factors which help or disturb it (including sleep hygiene).
- Sleep restriction aims to improve sleep efficiency (the proportion of time you spend in bed sleeping). This is based on the principle that lying in bed awake for long periods makes sleep problems worse in the long term. Your bed times are changed to better reflect how much sleep you get.
- Stimulus control aims to help you link the bed only with sleep and sex. Common strategies include moving TVs out of your bedroom and not working or reading in bed.
- Cognitive therapy helps you spot and assess any negative thoughts and beliefs about your ability to sleep.
- Relaxation and imagery training can help you distract yourself from stimulating thoughts if you find it difficult to stop thinking about what happened during the day.
Some rheumatology clinics also offer evidence-based self-management groups which deal with fatigue and sleep issues. Ask if your rheumatology team offer this.