Table of ContentsView AllTable of ContentsAS and SleepTypes of Sleep IssuesTreatmentsTips to Improve SleepWhen to Seek Medical Care
Table of ContentsView All
View All
Table of Contents
AS and Sleep
Types of Sleep Issues
Treatments
Tips to Improve Sleep
When to Seek Medical Care
Ankylosing spondylitis(AS) and sleep often go hand in hand; sleep disturbances can exacerbate (worsen) AS symptoms like pain, stiffness, and depression, and AS symptoms can make it challenging to get a good night’s sleep.
Between 0.2% and 1% of people living in the United States have ankylosing spondylitis,and up to 91% of people living with the condition report having sleep problems.Restful sleep is essential for everyone, and it’s especially crucial for maintaining quality of life with a chronic condition like AS.
This article explores the connection between sleep and ankylosing spondylitis and provides tips to help you sleep soundly.
VioletaStoimenova / Getty Images
Does Ankylosing Spondylitis Affect Your Sleep?
Symptoms of ankylosing spondylitis, such as low back pain and stiffness, joint pain, and depression, can all contribute to sleep disturbances.
As a result, people with AS may be stuck in a vicious cycle of feeling more uncomfortable due to poor sleep and being unable to sleep the next night due to pain and discomfort. This can worsen fatigue and brain fog many people with AS experience.
Pain and Stiffness
AS-related back pain and stiffness tend to be aggravated after long periods of rest. Many people with AS wake up in pain sometime during the night, making it difficult to find a comfortable position and fall back asleep.
Depression
AS is associated with an increased risk ofdepression.Several factors may contribute to higher rates of depression in people with AS, as it can affect quality of life. Depression is linked to sleep problems, such as waking more frequently at night and having trouble falling asleep.
Sleep Apnea
Research shows that people with AS are nearly 3 times more likely to develop obstructivesleep apneathan people without it.Sleep apnea is associated with pauses in breathing or periods of shallow breathing throughout the night, resulting in broken sleep and excessive daytime sleepiness.
High Disease Activity
AS disease activity describes the amount of inflammation a person with AS has at any given time.Periods of high disease activity (e.g., increased inflammation markers in the blood) are associated with increased sleep disturbances.
Does Sleep Have Any Effect on Ankylosing Spondylitis?AS-related back pain and stiffness tend to worsen after periods of rest or sleep. If you have AS, you may have noticed the more time you spend in bed, the more stiff and sore you feel the following day.Waking up in the middle of the night with pain also contributes to sleep troubles for people with AS. Research shows that poor sleep is strongly associated with worsened AS symptoms, including low mood, high levels of fatigue, and worsened spinal pain and stiffness.
Does Sleep Have Any Effect on Ankylosing Spondylitis?
AS-related back pain and stiffness tend to worsen after periods of rest or sleep. If you have AS, you may have noticed the more time you spend in bed, the more stiff and sore you feel the following day.Waking up in the middle of the night with pain also contributes to sleep troubles for people with AS. Research shows that poor sleep is strongly associated with worsened AS symptoms, including low mood, high levels of fatigue, and worsened spinal pain and stiffness.
AS-related back pain and stiffness tend to worsen after periods of rest or sleep. If you have AS, you may have noticed the more time you spend in bed, the more stiff and sore you feel the following day.
Waking up in the middle of the night with pain also contributes to sleep troubles for people with AS. Research shows that poor sleep is strongly associated with worsened AS symptoms, including low mood, high levels of fatigue, and worsened spinal pain and stiffness.
If you have ankylosing spondylitis, you may struggle to get a good night’s sleep due to the following:
Treatments of AS-Induced Sleep Issues
If lack of sleep interferes with your ability to function throughout the day, talk with your healthcare provider. They may recommend certain treatments to help you get a better night’s sleep.
Medication
Medications used totreat ankylosing spondylitisreduce pain and inflammation and prevent or slow disease progression. The most commonmedications for ASare nonsteroidal anti-inflammatory drugs (NSAIDs), but biologics, such as tumor necrosis factor(TNF) inhibitors, andcorticosteroids(although not good for long-term use), may be prescribed as well.
Research shows that TNF inhibitors may improve sleep in people with AS.
Exercise
High-intensityexercise, including cardiovascular workouts and strength training, has improved sleep in people with AS. In one study, participants with AS exercised three times a week for three months. Participants reported significant improvements in their sleep as well as improvements in mood and overall quality of life.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT)is the first-line treatment for insomnia. This evidence-based therapy helps you identify negative thoughts and behaviors linked to poor sleep and replace them with habits that promote more restful sleep.
Research shows that CBT improves sleep in people with chronic pain and may be more effective when paired with another intervention, such as exercise.
Continuous Positive Airway Pressure (CPAP) Therapy
Your healthcare provider may recommendCPAP therapyif you’ve been diagnosed with sleep apnea. This involves wearing a face mask connected to a CPAP machine that provides a constant flow of pressurized air to help keep your airway open throughout the night.
CPAP is the gold standard treatment for sleep apnea, and research suggests that this therapy may increase pain tolerance in people with chronic pain.
Relaxation Techniques
Relaxation techniques, such as deep breathing exercises, promote relaxation of your body and mind to help you fall and stay asleep. Other techniques that may help you get a good night’s rest include yoga, meditation, music, tai chi, reading, and taking a warm bath.
You may need to try a few methods before finding the most effective relaxation technique.
Good Sleep Hygiene to Improve Sleep Issues
Sleep hygienerefers to healthy habits and environmental factors that promote a good night’s sleep. These habits may include the following:
When to See Your Healthcare Provider
Most adults need about seven or more hours of sleep each night to feel their best.If you have ankylosing spondylitis and are concerned you are not getting enough sleep, see your healthcare provider if:
Depending on your symptoms, your healthcare provider will recommend appropriate treatments, natural remedies, or lifestyle habits to improve your sleep.
Summary
Ankylosing spondylitis (AS) can cause sleep disturbances, and lack of sleep can worsen AS symptoms, like pain and stiffness. Up to 90% of people with ankylosing spondylitis report having sleep problems.
Treatments, such as medications to reduce pain and inflammation, cognitive behavioral therapy, exercise, and CPAP therapy may help improve sleep in people with AS. Good sleep hygiene practices, such as sticking to a sleep schedule and practicing relaxation techniques before bedtime, may also help improve sleep.
A Word From Verywell
If lack of sleep interferes with your ability to function throughout the day or makes your ankylosing spondylitis symptoms worse, talk with your healthcare provider. They may suggest a medication change or other treatments to help improve your sleep and quality of life.
22 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Mercieca C, van der Horst-Bruinsma IE, Borg AA.Pulmonary, renal and neurological comorbidities in patients with ankylosing spondylitis; implications for clinical practice.Curr Rheumatol Rep. 2014;16(8):434. doi:10.1007/s11926-014-0434-7
Walsh J, Hunter T, Schroeder K, Sandoval D, Bolce R.Trends in diagnostic prevalence and treatment patterns of male and female ankylosing spondylitis patients in the United States, 2006-2016.BMC Rheumatol. 2019;3:39. doi:10.1186/s41927-019-0086-3
Park JY, Howren AM, Zusman EZ, et al.The incidence of depression and anxiety in patients with ankylosing spondylitis: a systematic review and meta-analysis.BMC Rheumatol. 2020;4:12. doi:10.1186/s41927-019-0111-6
Spondylitis Association of America.Fatigue in spondyloarthritis.
National Health Service.Ankylosing spondylitis symptoms.
Park JS, Jan, HD, Hong JY, et al.Impact of ankylosing spondylitis on depression: a nationwide cohort study.Sci Rep. 2019;9(1):6736. doi:10.1038/s41598-019-43155-0
Riemann D, Krone LB, Wulff K, et al.Sleep, insomnia, and depression.Neuropsychopharmacology. 2020;45(1):74-89. doi:10.1038/s41386-019-0411-y
Tsao CH, Huang JY, Huang HH, et al.Ankylosing spondylitis is associated with risk of new-onset obstructive sleep apnea: a nationwide population-based cohort study.Front Med (Lausanne). 2019;6:285. doi:10.3389/fmed.2019.00285
National Heart, Lung and Blood Institute.Sleep apnea.
Arthritis Foundation.Taming disease activity in early ankylosing spondylitis.
Song BW, Jeong H, Kim BY, et al.Bath ankylosing spondylitis disease activity index is associated with the quality of sleep in ankylosing spondylitis patients.J Rheum Dis. 2021;28(3):143-149. doi:10.4078/jrd.2021.28.3.143
National Institute of Neurological Disorders and Stroke.Sleep apnea.
American Academy of Sleep Medicine.Aasm clarifies hypopnea scoring criteria.
Spondylitis Association of America.Medications used to treat ankylosing spondylitis and related diseases.
Karatas G, Bal A, Yuceege M, et al.Evaluation of sleep quality in patients with ankylosing spondylitis and efficacy of anti-tnf-α therapy on sleep problems: a polisomnographic study.Int J Rheum Dis. 2018;21(6):1263-1269. doi:10.1111/1756-185X.13102
Sveaas SH, Dagfinrud H, Berg IJ, et al.High-intensity exercise improves fatigue, sleep, and mood in patients with axial spondyloarthritis: secondary analysis of a randomized controlled trial.Phys Ther. 2020;100(8):1323-1332. doi:10.1093/ptj/pzaa086
Nijs J, Mairesse O, Neu D, et al.Sleep disturbances in chronic pain: neurobiology, assessment, and treatment in physical therapist practice.Phys Ther. 2018;98(5):325-335. doi:10.1093/ptj/pzy020
McCarthy K, Saripella A, Selvanathan, J. et al.Positive airway pressure therapy for chronic pain in patients with obstructive sleep apnea—a systematic review.Sleep Breath. 2022;26(1):47-55. doi:10.1007/s11325-021-02363-7
Centers for Disease Control and Prevention.Are you getting enough sleep?
Leverment S, Clarke E, Wadeley A, et al.Prevalence and factors associated with disturbed sleep in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: a systematic review.Rheumatol Int. 2017;37(2):257-271. doi:10.1007/s00296-016-3589-x
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
