The Arthritis Newsletter

Summer 2015


By Marilyn Mulldoon


How sleep restores the body and why that is of critical importance in the health of arthritis patients.


Oh, for the halcyon days of infancy when we slept 16-18 hours daily. No stress, no timetables, no worries. Every human being must sleep. It is so vital to our survival and physical/mental health that it was even covered by Interrogation Policy – Geneva Conventions 1949 and War Crimes Act. Sleep deprivation/interruption used to break down prisoners is classified as a form of torture. Everyone requires sleep but let’s take a look at patients suffering from autoimmune diseases and see if our needs are different from otherwise healthy individuals.


Simplified, “cytokines” are small, secreted non-antibody proteins released by cells on contact with a specific antigen and serve as “messengers” between cells. Cytokines regulate various inflammatory responses and involve a diverse association of interleukins, interferons and growth factors.


There is a circadian rhythm to the immune system and it is influenced by and influences sleep. T-cell blood counts and levels of pro-inflammatory cytokines are high during the night while leukocytes and the anti-inflammatory cytokine IL-10 goes up during daytime. Inflammatory disease increases cytokine levels and causes fatigue. For short term illness this is good – makes the patient want to sleep – however, with patients suffering chronic inflammation, the immune system keeps them tired for protracted periods. It is now believed that this may explain symptoms of fibromyalgia and chronic fatigue syndrome. Sleeping problems are now considered reliable warning signs for a variety of autoimmune diseases.


As we age, sleep changes. It was once erroneously believed that seniors didn’t need much sleep. We now understand that seniors require exactly the same deep, restful sleep as young adults (7 – 8 1/2 hrs.) Seniors face hormone changes (e.g. melatonin/serotonin levels) while some struggle with snoring/sleep apnea, restless leg syndrome, bladder issues, physical pain, etc. Pregnant women share a number of these symptoms as well. Menopausal women struggle with sleep interruption. These matters may become serious and must be addressed with your medical team to resolve issues precluding deep, restorative sleep.


What exactly is going on in that blissful state of being asleep? To begin with, we grow and heal when asleep. Even adults experience a surge of growth hormone during their first deep sleep period of the night. The brain is able to re-order without the interruption it would be by daily interference. It exercises important neuronal connections that might deteriorate due to lack of activity.


The brain gets an opportunity to reorganize data to help find solutions to problems. It organizes and archives memories and processes new information. The cardiovascular system relaxes somewhat – research had found patients with normal or high blood pressure (BP) enjoy 20-30% reduction in BP and 10-20% reduction in heart rate. The metabolic rate and energy consumption is lowered. The allostatic load (wear and tear on the body) takes a toll and sleep is respite time. The body has a chance to replace chemicals and repair muscles, other tissues and aging/dead cells. Sleep helps us cope with stress, gives energy and improves immunity. Notwithstanding there is a multitude of housekeeping/maintenance tasks taking place, after a good night’s sleep one wakes up feeling refreshed in more ways.


On the other hand, let’s understand what goes awry when we don’t get adequate sleep: impaired immunity, weight gain and obesity, cognitive decline, mood and mental health problems, systemic inflammation, increased risk of death. Yes, it’s true. The Arthritis Research Centre has published studies on inflammation being an important factor in possible heart attack and stroke in autoimmune patients. (rheumatoid arthritis and Lupus  – 60% higher likelihood, Sjogren’s – 40%). People can survive longer without food than they will without sleep. Even missing one hour of sleep will leave us with a deficit the next day and increased inflammation levels. Autoimmune patients must get their rest, but more importantly, a good deep sleep.


Today’s world is hectic. More people than ever before are suffering from chronic sleep loss due to many factors including but not limited to: caffeine, nicotine, drugs that mimic/counteract neurotransmitters (e.g. cocaine), schedule changes disrupting circadian rhythms, inner ear problems, hunger, pain, high carbon dioxide levels, exercising too late in the evening, etc. Electronic devices are everywhere – TV, computer screens, hand-held devices (phones, games) all give off blue light that affects circadian rhythms. Games with never-ending task combinations stimulating the brain together with light shining directly into the eyes are a surefire combination to thwart falling asleep at an appropriate hour.


Sleep study is a relatively new field of research. “Sleep hygiene” is a phrase outlining practices and procedures for improved sleep quality.



Listed below are a few sleep hygiene tips:


– Don’t go to bed with a full stomach – leave time to allow for adequate digestion and proper hormonal signalling.


– Accommodate a comfortable, dark sleeping space – consider black out drapes or sleeping masks, earplugs to block noise. Keep room well-ventilated, linens fresh and bed clean.


– No stimulants before bed – caffeine or sugar. Blood sugar issues contribute to problems both falling and staying asleep


– No technology in bedroom – no phones, no TV, no computers or anything w/bright – Evening rituals (individuals vary) – dim lights early, soothing bath, gentle music


– Keeping bedroom as a place for sleep only


– Retiring to bed at the same time every night and rising at the same time daily


– Utilizing C-PAP machines for sleep apnea. Strips, cones, mouth guards etc. for snoring


– Getting sufficient exercise daily but not too late in the evening



* Hamlet – Act III, Sc. 1 – Wm. Shakespeare

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