Night pain is usually an indication of the severity of pain. Usually pain will decrease at night as the body diminishes its sensation input for sleep and becomes less active. Typically a patient with arthritis may have occasional night pain when changing position but will be free of serious discomfort for most of the night. While it may seem that sleep is lost during these brief episodes, the body actually gets plenty of rest and no serious problem is present.



Most people overestimate the magnitude of a sleeping problem. Indeed, we have been characterized as a nation of insomniacs. The worry makes it worse. Unless the sleeping time totals less than four hours, the body is very good at substituting quality for quantity. The drive to sleep is overwhelming, and the truly tired person will sleep even under adverse circumstances. Once in a great while a vicious cycle occurs in which pain prevents sleep, fatigue prevents rational approaches to problems during the day, depression aggravates pain, and sleep is even more disturbed by pain and depression the following night. The tips given here re reasonably obvious, but they can help most of these problems.

Have a comfortable bed. Usually a moderately firm mattress of good quality is the best choice. A water bed, which supports the weight of the body evenly and can be kept quite warm, is successful for some people; others can never get used to the thing. Pillows can be used here and there to increase comfort. For example, they can be placed on the sides to limit turning, under the neck, under the low back, or at the foot of the bed to keep covers off the feet. Be careful not to use a pillow under the knees of there is any problem with the knees or hips, as stiffness and contracture can result.

Don't go to bed early to try to ensure enough sleep. Wait until you're tired. You want your body so ready for sleep that it suppresses painful signals from the nerves.

Beware of sedatives and sleeping pills. These give the wrong kind of sleep, cause rebound depression, tend to be habit-forming, and only very rarely help solve sleeping problems.

Beware also of painkilling drugs. These do not affect the arthritis or pain but only suppress the symptoms, and the symptom of night pain is one that should be listened to. The body has mechanisms for adjusting to long-term pain, and many doctors feel that pain medications actually interfere with normal adaptation to pain.

The sleeping partner is important. A restless partner may make twin beds advisable. On the other hand, sexual relations at bedtime encourage good relaxation and healthy sleep.

A glass of warm non-fat milk at bedtime helps many people. Generally, it is good not to have eaten for two or more hours before retiring. Red wine or whiskey in the late evening are particular enemies of sleep. The ingredients in many common cold remedies can make it difficult for some people to sleep. And be careful, of course, to avoid caffeinated beverages. Be sure to take any anti-inflammatory drugs as prescribed. If your doctor has encouraged you to adjust your own doses, try to increase the number of times each day that you take the medication, and be sure that you have a dose at bedtime. Setting the alarm so you can take another dose in the middle of the night may be worthwhile.

Leg cramps are another common problem. Be sure that you are taking your calcium supplements. Try a warm bath before bedtime. Walk and exercise moderately during the day and do stretching exercises to stretch out the muscles before going to bed. Avoid active exercises within two hours of bedtime.