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Health and Wellbeing

How to Sleep Well with Arthritis

Dr Nerina Ramlakhan

Dr Nerina Ramlakhan

5th March, 2024

Arthritis Pain

If you are living with a chronic condition like arthritis, getting a good night’s sleep can be difficult. Pain can make it nearly impossible to get a good night’s rest and, at the same time, not getting enough restorative sleep can also cause you to experience more pain.

In this article, I will explain how to sleep well with arthritis, or any other chronic pain condition you may be dealing with. Offering you practical tools for optimising rest and sleep to enable healing and vitality.

Pain and sleep

Trying to sleep when you are in pain is not easy. The pain stops you from sleeping and then you wake up feeling even more tired and emotional because pain is emotional when it affects your sleep. Although the brain does not process emotional pain and physical pain identically, research on neural pathways suggests there is a substantial overlap between the experience of feeling both types of pain. As physical pain escalates, so do emotions – this is far from ideal but normal. Some people even find themselves panicking at night and symptoms escalate and stop them from sleeping. They might even start to dread going to bed.

There is a biochemical reason why pain can feel worse during the night. Levels of the anti-inflammatory, pain-relieving stress hormone, and cortisol tend to fall during the night which therefore increases joint inflammation and pain symptoms. The body also produces higher levels of cytokines or inflammatory molecules. In the long term, the increased production of cytokines aims to enable healing, but in the short term, this could increase pain levels. Levels of the sleep hormone melatonin increase at night to help us sleep, but this also causes increased production of cytokines adding to the increase in pain perception.

Pain, stress, and sleep are all interconnected. If your pain is bad, your stress may increase, and your sleep may decrease. If your stress levels are high, your pain may increase, and your sleep may decrease. In other words, when one is affected, the others may be affected as well. On the brighter side, when your stress decreases, your pain may decrease – and your sleep may improve! So, getting yourself to a place where you are better at managing these things can significantly impact how you feel overall.

How to sleep when you’re dealing with pain

If you want to know how to sleep well with arthritis or any other chronic pain condition, make sure that you are following good sleeping habits. This includes minimising caffeine and alcohol during the day and evening as both suppress the body's natural health capacity and your ability to sleep restoratively. This is the time when my 5 non-negotiables are even more important.

Here are some additional tools to consider that can help with the pain:

Epsom salts

Have an Epsom salt bath in the evening. Soak in bath water containing a good mug full of Epsom salts for at least 20 minutes to help relax the muscles and mind. The magnesium salts in the Epsom Salts can help to relieve pain.

Cold water immersion

Don’t be afraid of the cold. Cold water immersion can reduce inflammation and pain. You might not want to go to extremes but maybe consider ice packs or a 60-second cold shower.

Showerhead releasing cold water

Avoid over-resting or napping

Avoid over-resting or napping during the day. Rest breaks are important for pain management, but over-napping will stop you from sleeping at night.

Relaxing podcasts

If pain and wakefulness persist, keep some relaxing podcasts or relaxing music on standby that you can listen to that help soothe anxiety and restlessness. You might want to choose a podcast you’ve listened to repeatedly so that it doesn’t overstimulate your curious mind at night.

Avoid strong and addictive sleep medications

I know that not sleeping might make you feel desperate but try the herbal sleep tea blends. I find the Pukka and Twinings range particularly good.

Keep moving

Motion is lotion. Find small but safe ways to keep mobile and make it joyful and fun if you can. Walking, aqua aerobics, swimming and dancing will help to keep your joints lubricated and stop them from stiffening up.

Elderly Lady Swimming

Keep positive

Life can be stressful and if you are tired and in pain, things can seem even worse. Research shows that maintaining an optimistic outlook can help you sleep better and reduce your perception of pain. Cultivating gratitude and a realistically positive outlook can be helpful and here’s how you go about doing it: try to take time regularly throughout the day to think about what you are grateful for in your life – even small things like a nice cup of tea, or a smile from a stranger or a nice text message from a friend. Keep noticing these small moments of positivity and you will start to find more of them in your days. A powerful practice is to write them down in a notebook before you go to sleep. Even taking 5 minutes to do this can make a difference to your stress levels. Finally, try to end your day on a positive note and avoid listening to or watching the news before you go to bed. 

Seek support

As I’ve described, pain can be emotional; it can affect your mental health. Seek support from good friends and your GP if you feel your mental health is being impacted.

Support shown by holding hands

Techniques for falling asleep or getting back to sleep

When you are in pain (emotional or physical), the body goes into survival mode and you feel unsafe. Your brain believes that it’s simply not safe to sleep. Being able to access a place of deep inner safety - the parasympathetic nervous system - will accelerate your healing and help you to get restorative rest. But how do you do this when your body and mind are screaming ‘I am unsafe!’? Here are a few simple techniques on how to sleep well with arthritis or any other chronic pain condition for you to try: 

Breathe your way to inner safety

  • If you wake up during the night, avoid looking at the time which can fuel anxiety and increase wakefulness.  Bring your attention to your breathing, place one hand over your heart and the other over your belly, and watch the rise and fall of your breathing INNNN and OUTTTTT.  Encourage your breathing to drop into your belly by prolonging your out breaths.
  • Practice box breathing - breathing in ideally through the nose on 4 counts, hold the breath on 4 counts, exhale on 4 counts, hold the exhale on 4 counts.

Havening technique

A military psychiatrist developed this technique to help war veterans suffering from PTSD. The technique is now used widely in mental health clinics and the NHS. Here’s a simple clip from Paul McKenna that shows you how to do a version of the technique. I also describe exactly how to do this for your sleep in my book Finding Inner Safety (Wiley, 2023).

Love yourself to sleep meditation

I recorded this simple on audible a few years ago but here’s a simple version of how to do it. Focus your attention on your left foot, repeat SILENTLY AND SOFTLY to yourself:








Continue going, working your way up to the top of your head and then back down, ending up on your right foot. If you lose your train of thought (because you’re falling asleep), go back to the starting point – I LOVE MY LEFT FOOT.

I hope that applying these simple but practical tools will help you not only get the restorative sleep that you need, but in the longer term, alleviate and heal your symptoms.

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