Psoriatic arthritis and sleep disruptions: Key points to understand
Psoriatic arthritis (PsA) is a chronic condition that affects the joints, often developing in individuals with psoriasis, an autoimmune condition that affects the skin. This disease increases the risk of sleep disorders such as sleep apnea, restless legs syndrome, and chronic insomnia.
The key mechanisms linking PsA to these sleep disorders involve chronic inflammation, pain and discomfort, immune and hormonal disruption, increased risk of sleep apnea, and secondary factors.
Chronic inflammation in PsA involves the accumulation of memory T cells and pro-inflammatory cytokines, which affect systemic and vascular inflammation. This inflammatory milieu contributes to pain, joint stiffness, and possibly altered neurological signalling affecting sleep regulation. Elevated inflammation can worsen sleep quality and increase susceptibility to disorders like insomnia and restless legs syndrome.
Pain and discomfort from joint pain and stiffness in PsA can directly impair the ability to fall and stay asleep, leading to chronic insomnia. Pain can also trigger periodic limb movements or restless legs symptoms, which commonly disrupt sleep.
Immune and hormonal disruption due to inflammatory cytokines elevated in psoriatic disease can dysregulate neurotransmitters like serotonin and disrupt the circadian regulation of sleep-wake cycles, exacerbating both insomnia and mood disorders that further impair sleep.
The increased risk of sleep apnea in PsA is similar to that seen in osteoarthritis patients. Inflammatory arthritis may increase sleep apnea risk by contributing to systemic inflammation, impaired respiratory function during sleep, and reduced muscle function around the airways.
Secondary factors such as hormonal imbalances (e.g., low testosterone linked to psoriasis), mood disorders (anxiety, depression), and circadian rhythm disruptions associated with PsA further compound sleep disturbances.
In a study in Turkey, 64% of people with PsA experienced restless legs syndrome, while another study found that 38% of people with PsA reported sleep disturbances. In another study, about 67.7% of people with PsA had poor quality sleep. A 2022 study found that 43.33% of people with PsA had symptoms of insomnia.
If a person with PsA is still having trouble sleeping, their doctor may refer them to a sleep study. The results of a sleep study may help the doctor diagnose and treat the cause of the person's sleep difficulties.
To improve sleep for people with PsA, the Arthritis Foundation recommends keeping a sleep diary, getting enough regular physical activity, avoiding caffeine or other stimulants close to bedtime, sleeping in a cool, dark, quiet, and distraction-free environment, going to bed and waking up at the same time every day, and using the bed only for sleeping and avoiding reading or watching TV in bed.
More research is needed into the relationship between insomnia and PsA to fully understand the complex interplay between these conditions and to develop effective treatments. It is also best for a person with PsA to avoid smoking, as it can worsen symptoms.
- Psoriatic arthritis (PsA), an autoimmune condition, affects the joints and increases the risk of sleep disorders like sleep apnea, restless legs syndrome, and chronic insomnia.
- The key mechanisms linking PsA to these sleep disorders involve chronic inflammation, pain, discomfort, immune and hormonal disruption, increased risk of sleep apnea, and secondary factors.
- Chronic inflammation in PsA can worsen sleep quality and increase susceptibility to disorders like insomnia and restless legs syndrome.
- Pain and discomfort from joint pain and stiffness in PsA can lead to chronic insomnia and trigger restless legs symptoms.
- Immune and hormonal disruption due to inflammatory cytokines can dysregulate neurotransmitters and disrupt the circadian regulation of sleep-wake cycles.
- The increased risk of sleep apnea in PsA is similar to that seen in osteoarthritis patients, due to inflammatory arthritis's impact on systemic inflammation, respiratory function, and muscle function around the airways.
- Secondary factors such as hormonal imbalances, mood disorders, and circadian rhythm disruptions associated with PsA further compound sleep disturbances.
- In a study in Turkey, 64% of people with PsA experienced restless legs syndrome, while 38% reported sleep disturbances, and about 67.7% had poor quality sleep.
- In another study, 43.33% of people with PsA had symptoms of insomnia.
- If someone with PsA is still having trouble sleeping, their doctor may refer them to a sleep study.
- To improve sleep for people with PsA, the Arthritis Foundation recommends keeping a sleep diary, getting regular physical activity, avoiding stimulants close to bedtime, creating a sleep-conducive environment, maintaining consistent sleep hours, and using the bed only for sleeping.
- More research is needed into the relationship between insomnia and PsA to fully understand the complex interplay between these conditions and to develop effective treatments.
- It is also important for a person with PsA to avoid smoking, as it can worsen symptoms and affect overall health and wellness.
- Besides sleep disorders, individuals with PsA may also experience chronic kidney disease, respiratory conditions, digestive health issues, eye health problems, hearing difficulties, and mental health conditions like anxiety and depression, highlighting the importance of overall medical management and care for those with chronic diseases and skin conditions like psoriasis.
