Arthritis and Rheumatism Associates, P.C.
Sleep Hygiene Strategies

Matthew Reed, PT, MPT, CMTPT

The health benefits of quality sleep, and risks associated with sleep deprivation, are wide-ranging and well-understood, and we cherish that feeling of rejuvenation after a night of productive sleep. Yet, for many, a good night’s sleep is hard to come by, and we often rise in the morning feeling unrested and lethargic. And worse, the hormonal disturbance caused by lack of productive sleep can have compounding effects and further reduce the prospects of achieving productive sleep in the future. This creates a vicious cycle that may have detrimental health consequences over time.

Sleep deprivation has been associated with increased risk for heart disease, stroke, cancer, serotonin deficiency and depression; imbalance of hormones that regulate appetite and difficulty managing weight; and decreased alertness, memory and cognitive function.

Sleep deprivation has been associated with increased risk for heart disease, stroke, cancer, serotonin deficiency and depression; imbalance of hormones that regulate appetite and difficulty managing weight; and decreased alertness, memory and cognitive function. Additionally, of consequence to many of our physical therapy patients, lack of sleep can lead to production of stress hormones that increase inflammation in the body and cause the body’s “engine” to run at high levels. This contributes to even greater difficulty sleeping, fatigue and lack of energy, delayed healing of tissues, and, potentially, development of persistent pain and sensitivity. Conversely, quality sleep can help manage and reduce pain and sensitivities by restoring hormonal balance and repairing tissues that have been damaged or altered by injury, chronic conditions, and even stress.

If you’re concerned about the potential health consequences associated with lack of sleep,or even looking to improve your ability to manage or reduce pain, here’s a checklist of practical tips to consider to improve the quality of your sleep and your ability to rejuvenate and heal overnight.

Your sleep plan:

  1. Aim for 7-9 hours of sleep at night
  2. Set a sleep time BEFORE midnight; you’ll get 2 hours’ credit for every hour slept before midnight
  3. Start “winding down” and quieting the house an hour before bedtime (phones off, lights out, house tidied)
  4. Do stretches, meditation, deep breathing, light reading, other relaxation techniques in the hour before bedtime
  5. Take a warm shower 1-2 hours before bedtime
  6. Keep your bedroom dark and cool for greater melatonin production
  7. No bed buddies (pets or kids)
  8. Stay hydrated during the day, but reduce water intake later in the evening
  9. Limit intake of caffeine and alcohol, especially later in the evening
  10. Limit naps during the day to 20 minutes to prevent sleep disruption at night
  11. Park your thoughts at night (make notes on paper of any thoughts and keep nearby to avoid thinking in bed)
  12. No TV, social media, work emails, or other screens or blue light before bedtime
  13. Maintain a consistent regimen of aerobic exercise
  14. Position pillows for body support and comfort when lying in bed
  15. Ask your doctor about melatonin supplements
  16. Try to sleep naturally (no noise makers)
  17. Your partner/spouse must leave the bedroom if he/she snores or moves around

Now, go to bed!

Grant H. Louie, MD, MHS, FACR

By: Grant H. Louie, MD, MHS, FACR

Cardiovascular disease (CVD) remains the leading cause of death in the UnitedStates. Rheumatoid arthritis (RA) is now fast becoming considered a major CVD risk factor among traditional ones, such as high blood pressure and high cholesterol. RA no longer is thought of as a disease of only joints.

RA is a chronic condition in which the body’s own immune system attacks its own joints by mistake. This results in joint inflammation. Patients experience joint pain and swelling that can make doing normal daily functions more difficult. Dressing, holding a utensil to eat, and getting up and down stairs may be harder to do without help. Untreated disease eventually may lead to permanent joint damage and severe physical disability.

Cardiovascular Disease in Rheumatoid Arthritis

Because RA is a systemic disease, other organs and tissues in addition to joints can be affected. A growing number of medical research studies have reported on the harmful effects of RA on heart health. The arteries that supply oxygen and nutrients to the heart can get blocked in patients with RA even when they do not have major CVD risk factors. This can lead to a heart attack and possibly even death.

Patients with RA have a higher CVD burden compared to the general population. It is estimated that their CVD risk is increased by 1.5 to 2 times. Most doctors believe that having untreated or undertreated RA is what leads to heart disease rather than having RA itself. This belief is similar to cases of patients with high blood pressure. If left untreated, high blood pressure can lead to severe heart disease.

Patients with chronically active RA are more likely to have heart attacks than those with controlled disease. Researchers believe the heart arteries become permanently damaged from inflammation over many years. How this happens exactly is not well understood. But researchers think the lining of the heart arteries gets damaged from direct inflammation. This contributes to hardening and blockage of the passageway for the heart to receive the necessary constant supply of oxygen and nutrition it needs. Harmful forms of cholesterol are often higher in patients with RA. Medicines such as non-steroid anti-inflammatory drugs (NSAIDs) and steroids used to treat RA also have been associated with higher risk of CVD.

“Rheumatologists have learned that the best way to lower the risk of heart disease in patients with RA is to first control joint inflammation.”

Rheumatologists have learned that the best way to lower the risk of heart disease in patients with RA is to first control joint inflammation. They may use traditional medicines that lower the immune system, such as methotrexate. If RA remains active, patients may be placed on a biologic that further dampens the body’s immune response. Research studies have shown that RA patients who have less inflammation in their bodies than those with more inflammation are less likely to have heart disease. Patients with RA should be examined carefully to see if they have traditional CVD risk factors. These should be identified and treated aggressively.

Much more research is needed to develop a CVD risk calculator that takes into consideration the presence of RA. There are a number of such risk predictors already, however, these do not factor in RA. Armed with this knowledge, both patients and their doctors will gain a better appreciation of the effect of RA on heart health. This can lead to a meaningful dialogue on ways to lower CVD risk. Rheumatologists are encouraged to identify RA as early as possible and treat it as aggressively as possible. The ultimate goal is to achieve disease remission. RA patients also should be screened regularly for traditional CVD risk factors and get those under control.

For more information about this topic and other arthritis conditions please visit WashingtonArthritis.com

Adey A. Berhanu, MD, FACR, RHMSUS

CLICK HERE to learn more about our qualified physicians such as Dr. Adey Berhanu who’s NOW accepting patients at our DC office location.

 

Unscramble each of the clue words. Copy the letters in the numbered cells to other cells with the same number.

Have fun while you learn rheumatoid arthritis facts!

BY DANIEL EL-BOGDADI, MD, FACR

Snap, crackle, pop…“Doctor, why do my joints make these noises?!?”

Snap, crackle, pop… “Doctor, why do my joints make these noises?!?”

Crackling, snapping, popping. These are common sounds that a joint may make. There are several reasons for why a joint may make these sounds. It may be due to wearing of the cartilage. It could be caused by ligaments stretching and releasing or by compression of nitrogen bubbles in the spaces of the joints. It may happen if there are a lot of moving structures in a joint. Such is the case with shoulders or knees, which are the “noisiest” joints.

Joint crackling and popping on their own do not require treatment. They are normal (most of the time).

Cracking Bones

Many also worry that popping their knuckles will cause them to have arthritis. Despite this common belief, you will not make your knuckles big or develop arthritis in them by cracking them.

However, if swelling or pain or laxity of the joint accompanies the joint sounds, then it is time to visit your doctor as these symptoms could be pointed to serious joint issues.

Also, if you have a previous injury to the joint and it healed improperly, the joint may pop when you move it.

Is there anything you can do to prevent the noises? Yes, actually, the more you move the more your body lubricates itself. Some gentle stretching that involves the joint and the surrounding muscles may help as well. A good physical therapy program often is helpful in guiding an individual to properly engage in some difficult stretches.

Sometimes, though, no matter what you do, some noises will persist.


View Full Site
Top