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Additional Resources

People with arthritis often accept that sleep disturbances are part of their disease and few talk to their doctors about it. However, we know that a lack of sleep can make arthritis pain and symptoms worse. 

“A person may be treated for depression, but not insomnia, and in those cases, we often see a reoccurrence of depression,” said Dr. Deborah Da Costa, a research scientist at Arthritis Research Canada. “So we’re hoping a program to address sleep in people with arthritis will lead to improvements in sleep, as well as other symptoms.” 

Cognitive behavioural therapy for insomnia (CBTi), which focuses on changing thoughts and behaviours around sleep, has been proven to work for people living with other serious diseases. Our research team is customizing and testing a CBTi program for arthritis. Please review the frequently asked questions, videos and other resources below to learn about this research and more.

Frequently Asked Questions

What is insomnia?

Typically, someone is diagnosed with insomnia when they are experiencing difficulty falling asleep and staying asleep and also feeling unrefreshed. These symptoms need to be occurring every other day for at least two weeks. When people start developing insomnia, the symptoms tend to persist for quite a long time (anywhere between six months to a year). This is what we call chronic insomnia. Studies show that chronic insomnia tends to occur more frequently in people who have chronic conditions, such as arthritis, compared to in the general population where symptoms may subside within a few weeks.

How can insomnia impact someone who has arthritis?

Insomnia is difficult to cope with. It negatively impacts a person’s ability to function, concentrate and focus. It also makes people more irritable. And when someone has arthritis, it can exacerbate symptoms they are already struggling with, such as pain, increased fatigue, depressed mood and difficulty tolerating stressors. Lack of sleep can also reduce overall quality of life. 

How do insomnia rates differ between the general population and people with arthritis?

Up to 70% of people with arthritis experience symptoms of insomnia. In the general population, 20-30% of people experience insomnia. 

How is insomnia treated?

While it has become increasingly recognized that insomnia is something that physicians should be treating and screening for in the context of rheumatic care, it tends to go unrecognized and untreated.

When insomnia is treated, hypnotics are typically prescribed. This is a type of medication that induces sleep and is only intended for short-term use. However, many people rely on it for a prolonged period of time, resulting in side effects. People also become tolerant, so the drug stops helping them sleep.

Cognitive behavioural therapy for insomnia, also known as CBTI, is the first line of treatment for insomnia. 

What is cognitive behavioural therapy for insomnia (CBTi)?

Cognitive behavioural therapy for insomnia (CBTi) is a behavioural type of intervention that does not involve the use of medication. It helps people learn new strategies, behaviours and ways of thinking about sleep that can help promote sleep.

When people develop chronic insomnia, they also develop behaviours that are meant to help them compensate for or cope with insomnia. In reality, those behaviours only make the situation worse. CBTi is about identifying what those behaviours are and replacing them with helpful ones. For example, many people with insomnia take naps, which can be okay depending on time of day and duration. Taking a nap at four o’clock to get through the rest of the evening is not as helpful as taking one earlier in the day and for a shorter period of time (less than an hour). It’s also important not to stay in bed for more than 15-20 minutes if struggling to fall asleep during a nap. Instead, go into a different room and sit on a couch or chair and rest. These are the types of behaviours that can impact someone’s night sleep.

Another part of cognitive behavioural therapy is the cognitive part, which is the thinking part. There are certain ways that we start to think about sleep that are not helpful to inducing sleep. We start to worry that we’re not going to fall asleep, that we’re not going to be able to function the next day, that a lack of sleep will have a negative impact on our work and we might get fired. These types of ruminating thoughts happen when people are lying in bed trying to fall asleep. CBTi can be used to teach people different strategies to change their way of thinking about sleep.

Can CBTi be used to treat insomnia in people with different types of arthritis?

Sleep disturbances impact people with various types of arthritis. As part of our research, we will look at patients with rheumatoid arthritis, lupus, scleroderma and ankylosing spondylitis. We really don’t see that much difference in terms of prevalence of insomnia among these diseases. So, we think CBTi will be applicable to the various forms of arthritis. 

How can I access cognitive behavioural therapy for insomnia in Canada?

The problem is that CBTi is not widely available. There aren’t many experts across Canada who are trained to deliver it. There is a cost involved if accessing CBTi privately. There are also waitlists.

We need a better solution for delivering CBTi. In the last five years, we’ve seen an increase in studies evaluating whether CBTi can be delivered online without a healthcare professional. The studies are very promising in terms of seeing long-lasting improvements in sleep. 

How will your research and CBTi program help people with arthritis?

Ultimately, we hope that this research will provide an evidence-based CBTi program to help patients learn to better manage their sleep problems. It will be a program that will be accessible, delivered online and completely self-guided. We hope to see sleep improve, as well as other symptoms that tend to cluster together around sleep such as fatigue, pain and depressive symptoms.

What is the connection between sleep and mental health in people with arthritis?

Interesting, depression and sleep tend to co-occur. We often see that, even when depressive symptoms improve with treatment, if sleep issues are not addressed, the depressive symptoms tend to re-occur. So, addressing sleep problems may actually be a very important way of addressing some of these other symptoms that people with arthritis experience. 

Videos

Sleep & Insomnia

Arthritis Research Canada trainee, Emilie McGuire, and Cheryl Koehn, Founder and President of Arthritis Consumer Experts, talk sleep and insomnia in people with arthritis.

Arthritis and Fatigue

More than 80% of people with inflammatory arthritis report experiencing severe levels of fatigue. In this episode of Arthritis Wellness Conversations, members of Arthritis Research Canada’s Patient Advisory Board and Research Scientist, Dr. Susan Bartlett, discuss the effects of fatigue for people with arthritis, as well as tips and tricks to help manage fatigue.

Twenty‐Four Hour Activity and Sleep Profiles for Adults Living with Arthritis: Habits Matter

Most people who have arthritis generally understand that exercise, movement, and sleep are important for minimizing pain, not to mention boosting overall health. But we tend to consider them as isolated experiences, rather than as integral activities that together make up our day. Learn about an Arthritis Research Canada study to explore activity and sleep profiles within the arthritis population. 

Research

Adapting and Evaluating an Evidence-Based Online Behavioural Intervention to Manage Insomnia in Patients with Rheumatoid Arthritis

Internet Delivered Cognitive Behavioral Therapy for Insomnia – A Feasibility Study of Uptake and Acceptability for People with Systemic Lupus Erythematosus

Help-Seeking Behaviors and Treatment Preferences for Sleep Problems Among Persons with Lupus

Help-Seeking Behaviors and Treatment Preferences for Sleep Problems Among Persons with Inflammatory Arthritis

A Prospective Study on the Course of Sleep Disturbances in First-Time Fathers During the Transition to Parenthood

Understanding Self-Guided Web-Based Educational Interventions for Patients With Chronic Health Conditions: Systematic Review of Intervention Features and Adherence

Prevalence and Determinants of Insomnia After a Myocardial Infarction

The Association Between Sleep Disturbance, Depressive Symptoms, and Health-Related Quality of Life Among Cardiac Rehabilitation Participants

Polysomnographic Measures of Disturbed Sleep are Associated with Reduced Quality of Life in Multiple Sclerosis

Biopsychosocial Determinants of Physical and Mental Fatigue in Patients with Spondyloarthropathy

Sleep Problems and Depressed Mood Negatively Impact Health-Related Quality of Life During Pregnancy

Fatigue in Post-Poliomyelitis Syndrome: Association with Disease-Related, Behavioral, and Psychosocial Factors

Effects of Home-Based Exercise on Fatigue in Postpartum Depressed Women: Who is More Likely to Benefit and Why?

Determinants of Sleep Problems in Patients with Spondyloarthropathy

Dimensions of Fatigue in Systemic Lupus Erythematosus: Relationship to Disease Status and Behavioral and Psychosocial Factors

Determinants of Sleep Quality in Women with Systemic Lupus Erythematosus

The Impact of Tofacitinib on Fatigue, Sleep, and Health-Related Quality of Life in Patients with Rheumatoid Arthritis: A Post Hoc Analysis of Data from Phase 3 Trials

Patients and Clinicians Define Symptom Levels and Meaningful Change for PROMIS Pain Interference and Fatigue in RA Using Bookmarking

Improvements in Fatigue Lag Behind Disease Remission in Early Rheumatoid Arthritis: Results from the Canadian Early Arthritis Cohort

Fatigue Measurements in Systemic Lupus Erythematosus

Identifying Meaningful and Detectable Change from the Patient Perspective Across Common Fatigue Measures in Rheumatoid Arthritis

Patterns of Fatigue and Predictors of Significant Improvement in the 1st Year of RA: Results from the Canadian Early Arthritis Cohort (CATCH)

Who is at Risk for Persistent Fatigue in the First Year of RA? Characteristics of Patients with Persistent Fatigue in the First Year by Sex in the Canadian Early Arthritis Cohort (CATCH)

Articles

Testing an Online Program for Managing Insomnia in Arthritis

No study to date has looked at whether cognitive behavioural therapy for insomnia (CBTi) works for people living with arthritis who are suffering with insomnia. This research fills an important gap in arthritis care. It will provide new knowledge on the benefits of a non drug method for managing insomnia in people living with arthritis. If found helpful, internet-delivered CBTi will help improve access to treatment of insomnia for people living with arthritis, which means better management of sleep and associated clinical symptoms (e.g. fatigue and pain), better quality of life, and reduced healthcare costs.

 

Read More

Sleep Struggles: A New Approach to Treating Insomnia

After two years of pandemic stress, it’s no surprise that people around the globe are struggling to get the rest they need. For many with arthritis, sleep has always been a big problem and the pandemic is only making things worse.

In fact, up to 70 per cent of Canadians living with arthritis report sleep issues, including difficulty falling asleep, staying asleep, or waking early in the morning. These sleep disturbances, also known as insomnia, can aggravate other arthritis symptoms – like fatigue, pain, and depression. For this reason, scientists at Arthritis Research Canada are looking to cognitive behavioural therapy for insomnia (CBTi) for answers.

 

Read More

Sleep vs. Pain: The Battle for Rest with Arthritis

Is arthritis pain and stiffness keeping you up at night? When you’re struggling with fatigue, the last thing you need to do is toss and turn your way into sleep deprivation.

 

Read More

Some Ideas to Help You Sleep

Many of us with autoimmune and arthritis issues suffer from impaired sleep. Facing difficulty either falling asleep, staying asleep, or getting back to sleep is both common and frustrating. For women, add in hormone related issues (i.e., menopause) and the typical recipe for sleep is disaster. Our APAB members have found there are many helpful tips for improving the overall quality of your sleep.

 

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Sleep/Activity Cycles Key to Tailored Interventions for People with Arthritis

New findings from Arthritis Research Canada reveal that 24-hour activity-sleep cycles could help healthcare providers develop interventions for arthritis patients.

 

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How to Get a Better Night’s Sleep with Arthritis: 18 Tips that Patients Swear By

Painsomnia — the inability to sleep due to pain — is a major problem for people with arthritis. As many as 80 percent of patients will have trouble falling and/or staying asleep, and that’s true for people with osteoarthritis or inflammatory types of arthritis.

 

Read More

Helpful Links

24-Hour Movement Guidelines

Canada’s first ever 24-Hour Movement Guidelines for Adults offer clear direction on what a healthy 24 hours looks like for Canadian adults aged 18-64 years and 65 years or older.

 

Learn More

Are Canadian adults getting enough sleep?

Learn about sleep tips and facts for adults. 

 

Learn More

Sleep on It

By the end of our lives, we will have spent 1/3 of our time sleeping. Sleep is a fundamental human need, but more than half of Canadians report that they cut back on sleep when they need more time to accomplish more during the day. Learn about the importance of sleep, find resources and more.

 

Learn More

Understanding Sleep

Do you ever feel sleepy or “zone out” during the day? Do you find it hard to wake up on Monday mornings? If so, you are familiar with the powerful need for sleep. However, you may not realize that sleep is as essential for your well-being as food and water.

 

Learn More

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