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The Link Between Sleep and Psoriatic Arthritis


The truth is, everyone suffering from psoriatic arthritis knows how challenging getting a good night’s sleep is. If you’re living with this condition you are probably experiencing numerous sleep issues from trouble falling asleep, poor-quality sleep, to feeling sleepy constantly.

But, that’s not all! The more your psoriatic arthritis symptoms progress and become severe, the insomnia gets worse. Plus, as a result of spending many sleepless nights, you may also suffer from anxiety and your pain may increase.

Fortunately, there are several lifestyle changes and treatments you can try that can positively affect your sleep and relieve your symptoms.

How to Improve Sleep and Manage Psoriatic Arthritis Pain

Have a Healthy Bedtime Routine

First and foremost, when experiencing sleep issues and suffering from insomnia, you must seriously consider making some changes regarding your room and routine.

For instance, following a strict sleep schedule can really go a long way toward fighting insomnia. Hence, determine the time you will go to bed and wake up and stick to it every day. Also, ensure your bedroom is cool and quiet or perhaps try using a white noise machine.

Furthermore, the light from your gadgets sends signals to your body and brain that it is still day and time to be awake. Therefore, make sure you avoid screen time before going to bed for at least half an hour. Instead, try reading a book, meditating, or taking a warm bath.

Try Medical Treatments for Insomnia

Unfortunately, insomnia isn’t really a rare condition and people all around the world are suffering from sleep issues. And, in case adjusting your sleep environment and routine isn’t enough, you may ask your doctor to recommend either a treatment or medications.

When speaking of treatments, cognitive behavioral therapy (CBT) has proven to be remarkably helpful against insomnia. It is a program that focuses on helping you change the way you respond to difficult situations and improve sleep.

On the other hand, you can also consider medications, i.e. sleeping pills. However, different prescription pills have different risks and benefits. Just make sure you talk to your doctor and ask about the side effects before using them.

Consider Pain-Relieving Treatments

Since your sleeping issues are a result of your psoriatic arthritis pain, you may try to deal with it first. Various pain-relieving treatments can reduce the pain by controlling the inflammation and swelling that cause joint pain, stiffness, and tenderness. Some treatments against psoriatic arthritis pain include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium, are only helpful in case of mild inflammation.
  • Disease-modifying antirheumatic drugs (DMARDs), including methotrexate, leflunomide, and sulfasalazine, can help you slow down the progression of symptoms and prevent permanent joint damage.
  • Targeted synthetic DMARDs, apremilast for example, are extremely effective in blocking the phosphodiesterase 4 (PDE4) enzyme action in inflammatory cells and thus reduce inflammation.
  • Biological DMARDs like tumor necrosis factor-alpha inhibitors including etanercept, infliximab, golimumab, adalimumab, and certolizumab, help relieve pain by affecting the signals between the immune system cells.

Make some Lifestyle Changes

Last but definitely not least, you can also try to make some lifestyle changes to reduce your psoriatic arthritis pain and thus combat insomnia. We all know how our lifestyle choices can have either a positive or negative effect on our health. Therefore, try making the following changes that can help you relieve pain and improve your overall health:

  • Get rid of extra weight to reduce the pressure on your joints and ease the strain. You can do so by following a healthy diet full of whole grains, lean proteins, and lots of fruits and vegetables.
  • Try exercising in case it isn’t too painful. Otherwise, you can try physical or occupational therapy. Regular exercise won’t only help you shed excess weight but also improve the function of your joints.

To conclude, the link between sleep and psoriatic arthritis is very strong. However, by following a bedtime routine, making some lifestyle changes, and trying medical treatments for both insomnia and psoriatic arthritis pain, you can finally have a good and painless night’s sleep.

Guide: COPD + Sleep Apnea

Generally speaking, the two most common pulmonary diseases people suffer from are chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). And, for things to be even more complicated, a person can suffer from these two at the same time which is a phenomenon usually called the Overlap Syndrome which can even lead to chronic health issues like diabetes or heart disease.

The Overlap Syndrome

Unfortunately, a patient suffering from both COPD and OSA has a very weak and damaged respiratory system. While COPD means that the person has difficulties maintaining a healthy balance of carbon dioxide and oxygen during the day, those suffering from OSA experience breathing obstructions once they fall asleep. Hence, people suffering from both these conditions, i.e. the Overlap Syndrome, never catch a break.

The Overlap Syndrome is a relatively new medical term coined at the beginning of the 21st century when pulmonologists found out the following:

  • Patients suffering from COPD or asthma have higher chances to suffer from OSA due to the mechanisms of daytime breathing problems which also occur at night
  • Patients suffering from either COPD or asthma do have evident breathing problems, but not as severe as they could be if they had OSA too.

Plus, people who have either COPD or asthma, but not OSA, are far more likely to suffer from a sleep breathing disorder as a result of the upper airway mechanisms.

How are COPD and OSA Linked?

The truth is, nearly half of people suffering from COPD experience some kind of breathing issues while asleep. Patients with chronic obstructive pulmonary disease have their blood oxygen levels reduced during the day, and once they are asleep, OSA reduces these already low levels which, depending on how severe the condition is, can be lethal.

Furthermore, both COPD and OSA occur because both the lower and the upper airways do not function properly. In other words, the dysfunction of the organs and structures situated between the mouth and the lungs. And, the condition of people who have the Overlap Syndrome can easily get worse or even lead to death, which is not really the case for those who suffer from one condition only.

How is the Overlap Syndrome Diagnosed?

An overnight sleep study is the most common way used to address and diagnose the Overlap Syndrome when people with COPD (or asthma) have sleep complaints. This study involves accurate measurements of blood oxygen and breathing patterns to determine whether a person has the Overlap Syndrome or not. As soon as a sleep-breathing problem is identified, the person should get treatment to manage sleep breathing issues.

How is the Overlap Syndrome Treated?

In order to treat the Overlap Syndrome, specialists try to focus on two main things. The first is the maintenance of normal blood oxygen levels during the day. The second is the prevention of obstructive sleep apnea.

Continuous positive airway pressure (CPAP) has proven to be the most effective therapy for obstructive sleep apnea. The combination of CPAP with supplemental oxygen is also a common therapy. Other treatment includes the use of short- and long-term steroids to relieve COPD symptoms in combination with weight loss for obese patients.

Indeed, the Overlap Syndrome has proven to be challenging to address and treat. Researchers are constantly trying to find new and more efficient ways to manage both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) while the challenges of patients’ lives still linger.

Cognitive Behavioral Therapy Instead of Sleeping Pills

There are a lot of people from all over the world who suffer from insomnia. For these people, effective treatment for their sleep disorder is essential to help them fall asleep easier and stay asleep throughout the night.

However, one of the safest and most effective treatments for insomnia is cognitive behavioral therapy, also called CBT-I. This is a nondrug treatment usually recommended for chronic sleep problems.

CBT-I is a structured program that helps people who deal with sleep problems identify and replace both behavior and thoughts that cause it. It also promotes sleep and helps you overcome the underlying causes of sleep problems.

To determine the best treatment for your sleep disorder, the sleep therapist might recommend you keep a sleep diary for about 2 weeks.

Cognitive Behavioral Therapy for Insomnia

CBT-I consists of 2 parts: cognitive and behavioral. The cognitive part teaches the patient to identify and change the thoughts and beliefs that affect the ability to sleep. It can help control and remove all negative thoughts that keep the patient awake. On the other hand, the behavioral part helps develop good sleeping habits and stay away from behaviors that prevent a person from getting a good night’s sleep.

A patient might be recommended one of the following CBT-I techniques:

  • Sleep restriction: reduces the time you spend in bed. This means that you will feel more sleep-deprived and it will be easier for you to fall asleep at night, Lying in bed when you're awake can become a habit that leads to poor sleep. As soon as your sleep has improved, your time in bed is gradually increased.
  • Stimulus control therapy: helps remove factors that make your mind to resist sleep. This might require you got to bed and wake up at the same time every day and stay away from naps throughout the day.
  • Sleep hygiene: involves changing basic lifestyle habits that make sleep worse, such as smoking or drinking caffeine and alcohol late in the day.
  • Relaxation training: helps calm your mind and body through imagery, meditation, and muscle relaxation.
  • Sleep environment improvement: helps create a cozy sleep environment by making your bedroom dark, quiet, and cool.
  • Biofeedback: allows you to observe biological signs and teaches you how to adjust them. You might be given a biofeedback device to use and how to monitor your daily patterns.

For cognitive-behavioral therapy to be effective, your sleep therapist might recommend combining several of these methods.

Cognitive Behavioral Therapy vs. Pills

Most people when they experience insomnia decide to take some sleep mediations to help them fall asleep. However, using pills for insomnia can and should only be used as a short-term treatment. Some new sleep medications can be used for a longer time. Nevertheless, they are not recommended as an insomnia treatment.

On the other hand, CBT-I is the most suitable treatment for people who have long-term sleep problems. Likewise, it is a great option for people who don’t find medications effective.

Pills relieve the symptoms, while CBT-I addresses the underlying causes of insomnia. Sometimes, even a combination of sleep medication and CBT-I may be the best approach.

Anyone with sleep problems can benefit from cognitive behavioral therapy, including people with primary insomnia and people with physical issues, e.g. mental health disorder or chronic pain. The best thing from CBT-I is that is has no negative effects and the effects seem to last.

Can CPAP Therapy Make Coronavirus Worse?

Being diagnosed with Covid-19 is a terrifying experience on itself, but especially so if you have underlying health conditions, such as sleep apnea. So, many sleep apnea patients who receive a Covid-19 diagnosis are quite worried that their CPAP therapy might make the symptoms worse.

However, no evidence suggests that CPAP therapy aggravates Covid-19 symptoms. That’s why many doctors recommend that sleep apnea patients don’t stop their CPAP therapy even when going through their coronavirus recovery.

Covid-19 Patients Needs Enough Sleep

Regardless of a COVID-19 diagnosis, the person’s overall health depends on getting enough sleep. A number of studies have shown that there is a strong link between sleep and boosted immune function.

Sleep apnea patients have to deal with an obstructed airway which hiders sleep as well as recovery. Thus, people are extremely tired, their immune system is weakened, which makes them more prone to infection.

On the other hand, CPAP therapy helps alleviate sleep apnea symptoms with a continuous flow of pressurized air. As a result, their airways are open which allows them to quickly recover while sleeping.

Even though many people are tempted to stop their CPAP therapy while recovering from Covid-19, this can only increase the risk and make the symptoms even worse.

Important Tips After Covid-19 Positive Test Result

If you have obstructive sleep apnea and your Covid-19 test is positive, you have to take a couple of things and precautionary tips into consideration.

Washing Your Hands

One of the most important things you can do to protect yourself from coronavirus is to wash your hands effectively and regularly. So, make sure you wash your hands with warm water and soap before touching your CPAP equipment.


Positive Covid-19 test means that you should be self-isolating in a room to prevent the spread of the virus. This also means that your CPAP machine should be in the room so you can prevent exposure to other people.

Cleaning CPAP

Keeping your CPAP machine clear is very important if you want to have effective therapy. Make sure you clean and sanitize your machine, mask, and hose which will protect you from spreading the virus.

Replacing Accessories

You should regularly replace your CPAP accessories, including the mask, filters, and the hose. Germs are more likely to develop if your filters are dirty and your mask is old.

Adapting CPAP Machines for Non-Invasive Breathing Assistance

Many doctors have determined that to keep the pandemic under control and improve the recovery rates, they have to modify CPAP machines. Thus, by trying this out to help out breathing, doctors have discovered that modified CPAP machines could be used to treat COVID-19 patients.

Using a CPAP mask is a less intrusive and more comfortable method for patients with milder symptoms. So, CPAP has proven to reduce the likelihood of hospitalization for coronavirus and minimize the need for ventilators for hospitalized Covid-19 patients. Italy and China have been using CPAP machines to treat coronavirus infections.

There is no evidence that shows that people who have sleep apnea are at higher risk of developing coronavirus.

Spirometry for COPD

If you need to assess how well your lungs work, your doctor might recommend you take a test called spirometry. This is an office test measures how much air you inhale and exhale and how quickly you do so.

Spirometry is usually used to diagnose COPD, asthma, other breathing conditions. Moreover, this test can be used to monitor the lungs condition and determine if a certain treatment is actually aiding and improving breathing.

In fact, doctors usually recommend a spirometry test if a patient experiences symptoms that are caused by a chronic lung condition, including emphysema, chronic bronchitis, COPD, asthma, or pulmonary fibrosis.

Patients who have already been diagnosed with a chronic lung disorder might get spirometry prescribed to check periodically whether the meds are working and if the breathing issues are under control.

Additionally, doctors also prescribe this test before a surgery to determine if the condition of the lungs is good enough for the rigors of an operation. Last but not least, spirometry is used to screen for occupational-related lung disorders.

Get Ready for the Test

In order to prepare properly for spirometry always follow the doctor’s instructions very carefully. You might be asked to avoid taking some medications before this test. Likewise, you will need to follow these steps to be as ready as possible for the test:

  • Try not to eat too much before spirometry as it will be difficult for you to take a deep breath
  • Wear comfortable and loose clothing which ease your breathing and won’t cause any discomfort

During the Test

Spirometry is a test that requires you to breathe into a tube attached to a machine. This machine is called a spirometer and that’s where the name of the test comes from.

Before doing the test, you will receive detailed instructions either from the nurse or your doctor. Make sure you listen carefully and always ask questions so that everything is clear to you. Correctly performing the test is essential if you want to get accurate results.

In a nutshell, here is how the exact procedure will go during a spirometry test:

  • You will be seated on a chair
  • The nurse will place a clip on your nose to keep your nostrils closed
  • You will be asked to take a deep breath and breathe out as hard as you can into the tube
  • Your lips must be sealed around the tube to prevent air leakage
  • This will be performed for 3 times so that the results are as accurate as possible, but is there is a lot of variation among the 3 test, you will be asked to repeat the test again

The spirometry test takes no longer than 15 minutes and you might be given an inhaled medication to open your lungs after the test. Then, after 15 minutes, you will be asked to repeat the test so that the results can be compared and it will determine with the inhaled medication, known as bronchodilator, improved your airflow.

Spirometry Test Risks

In general, spirometry is a safe test which comes with no risks. However, some people might experience dizziness or shortness of breath after the test. The good news is that this lasts very shortly. Also note that the test isn’t safe to be performed in patients who have some heart condition or have recently had a heart attack. It is very rare that spirometry will cause some breathing issues.

The Results

There will be 2 key spirometry measurements you should know about:

  • Forced vital capacity (FVC): the largest amount of air that you can forcefully exhale after breathing in as deeply as you can. So, if your FCV reading is lower than the normal range, it will mean that your breathing is restricted.
  • Forced expiratory volume (FEV): shows how much air you can force from your lungs in 1 second. Your doctor used this reading to assess the severity of your breathing problems. Hence, if your FEV-1 readings are lower, it means that you have a more significant and severe obstruction.