LUPUS AND SLEEP

(Or Lack Thereof)

Introduction:

Sleep: we all need it.  Without it, we die…or at very least turn into non-functioning zombie/vampire people.  Sadly, the snowball effect that chronic sleep disruptions have can negatively impact one’s health and life expectancy.   It has been determined that sleep disturbances and/or poor sleep quality is associated with around 60% of lupus patients.  We know that lack of sleep does not cause lupus; however, people with SLE have been associated with having worse sleep patterns than those without.

Why Can’t You Sleep?

Cant sleep.There are various reasons why people with SLE have a more difficult time with falling asleep, staying asleep and achieving a well rested sleep pattern. Below are the most common reasons for sleep disruptions:

  • Breathing Issues: Sleep apnea is a common cause of sleep disturbance in those with SLE.  This is caused by a narrowing of the soft tissues of the neck that constrict the breathing passage.  Pleurisy, COPD, lung disease and pneumonia may all affect sleep quality as well.
  • Sjogren’s Syndrome:  People who suffer from severe dry mouth often wake up in the middle of the night from it. This condition is considered a lupus overlap disease because half of those affected will develop lupus or another condition like rheumatoid arthritis.  
  • Fibromyalgia: Difficulty sleeping is one of the major symptoms of this condition. People often suffer from non-restorative sleep or waking up several times a night. People often feel as if they can never “get enough sleep” and wake up feeling like they have been “hit by a truck.”
  • Movement Disorders: Periodic limb movement disorder (repetitive cramping or jerking of the legs while sleeping) and Restless legs syndrome (strange sensation in the legs that cause the urge to move) are two movement disorders that can affect sleep.
  • Pain: This one is pretty self-explanatory.  If you are in severe pain, getting comfortable enough to fall asleep (and stay asleep) can be nearly impossible.
  • Neurological Diseases: If you have suffered a stroke due to lupus, had seizures, suffered brain trauma or have an over-lap neuromuscular disease, you may experience severe sleep disturbances.  
  • Psychiatric Disorders: Charlotte Bronte once said, “A ruffled mind makes a restless pillow.”  This is true about anxiety and depression disorders and sleep disturbances.  These disorders are believed to be caused by a chemical imbalance in the brain.  Anxiety and stress can deeply affect one’s sleep. Many lupus individuals suffer from anxiety, on some level, throughout the duration of their illness.
  • Medications:  Some medications can cause sleep interference.  These include: antidepressants, corticosteroids,  antihistamines, beta-blockers, pain medications (like tramadol), stimulants (like adderall and ritalin) weight-loss medications and diet pills. If you, like many people who have SLE, are being prescribed a steroid like prednisone, it is important to take it exactly as prescribed and to not take it too late in the day.  Never increase a dose or decrease a dose without speaking to your healthcare professional.  It can greatly affect your sleep and state of mind.    

What Can Lack of Sleep Cause?

People who don’t receive the appropriate amount of sleep (the CDC currently recommends 9-10 hours for teenages and 7-8 hours a day for adults) may experience increased amounts of depression and anxiety, memory problems, severe fatigue (duh) and may even develop the lupus overlap disease fibromyalgia.  Sleep problems have also been associated with obesity.   

 

Age

Recommended Amount of Sleep

Newborns

16–18 hours a day

Preschool-aged children

11–12 hours a day

School-aged children

At least 10 hours a day

Teens

9–10 hours a day

Adults (including the elderly)

7–8 hours a day


What Can You Do About It?

Alternative Therapies

  • Exercise regularly.
  • Avoid caffeinated beverages (6 hours before bed), large meals, alcohol and cigarettes before bedtime.
  • Go to bed at the same time every night and wake up at the same time everyday.  
  • Make sure your bedroom is a quiet, dark and cool (not too cold or not too hot) environment.
  • Keep a sleep journal, which includes how long you slept, if you woke up, what troubled you during your sleep (thoughts/feelings, pain, temperature).Healthy young woman doing abs crunches
  • Make your bed a place that is ONLY for sleeping.  Don’t use your bed as an office, entertainment center or library.  This is a HARD one.  Try to break the cycle of being on your phone before bed and watching too much TV or loud music.  
  • Sleep on a comfortable mattress and pillow.  (You should replace a mattress every 10 years).
  • If you need to decompress before bed, take a bath or go into another room to read to do something relaxing until you feel tired.  
  • Avoid taking late naps in the afternoon or evening.

Modern Medicine

Sometimes, when the issue affects one’s quality of life, doctors may prescribe medications to help treat the insomnia.   

Common Prescription Medications

  • Zolpidem (Ambien): This medication works well to get one to fall asleep, but people have been known to wake up in the middle of the night (hello Ambien eating and online shopping)!!!  If you are thinking about taking this drug, you may want to ask your doctor to prescribe Ambien CR (extended release) which may help you stay asleep longer.  
  • Eszopiclone (Lunesta): This medication works well to get one to fall asleep fast, but he/she better be prepared to sleep for at least 7-8 hours or experience drowsy city.  And don’t expect to be operating any heavy machinery at first, most doctors start out with a low dose of 1 mg until a patient knows how it will make them feel.
  • Zaleplon (Sonata): This medication is on the newer side, and stays active in the body for the shortest amount of time.  So one could take it on the later side and not feel like the “Walking Dead” in the morning.  Word of warning: if you tend to wake up in the middle of the night, this may not be the drug for you.  
  • Ramelteon (Rozerem): This medication works by targeting the sleep cycle directly, not by depressing the central nervous system.
  • Doxepin (Silenor): This is a histamine blocker.  It is important to make sure if you take this, you are prepared to get at least 7-8 hours of sleep.
  • Benzodiazepines: The “classics” (Xanax, Restoril, Halcion) have been used for sleep disorders like night terrors and sleepwalking.  The downside with these is they can cause you to feel very drowsy and may cause dependency.  
  • Antidepressants (Trazodone, Mirtazapine): These are used to effectively treat insomnia and anxiety.
  • Over-the-counter Sleep Aids: These are usually antihistamines. They can work well and you do not need a prescription to buy them.  But always beware of any other cold or flu medications you are taking along with them.  You do not want to take too much of the same thing.

Common Vitamins and Supplements

  • Melatonin: This is something that the body’s pineal gland naturally releases.  Taking melatonin supplements have been found helpful in inducing and maintaining sleep in both children and adults. However, it should not be taken by those with kidney disease or women who are breastfeeding or pregnant.
  • Calcium: This is a natural relaxant that may aid in sleep.
  • Magnesium: Having a magnesium deficiency can cause feelings of nervousness which can hinder sleep.
  • The B Vitamins: B6 and B12 have been found to be helpful in improving insomnia.
  • Valerian Root: This plant may reduce the amount of time it takes to fall asleep and help you sleep better and longer.  
  • Tryptophan: This naturally occurring amino acid slows down nervous activity and can induce sleepiness.

 

In conclusion, the sweet mystery of a good night’s sleep is still just that – a mystery.  Miguel de Cervantes put it best when he penned this in Don Quixote:

 

“Now, blessings light on him that first invented sleep! It covers a man all over, thoughts and all, like a cloak; it is meat for the hungry, drink for the thirsty, heat for the cold, andcold for the hot. It is the current coin that purchases all the pleasures of the world cheap, and the balance that sets the king and the shepherd, the fool and the wise man, even.”

A young woman putting her alarm clock off in the morning
Sources:
The Lupus Encyclopedia, by Donald E. Thomas, Jr.  2014 Johns Hopkins University Press.

*All images unless otherwise noted are property of and were created by Molly’s Fund Fighting Lupus. To use one of these images, please contact us at [email protected] for written permission; image credit and link-back must be given to Molly’s Fund Fighting Lupus. **All resources provided by Molly’s Fund are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your medical provider with any specific questions or concerns.    

Article by : Kelli Roseta

Kelli Roseta is the Client Services Coordinator for Molly’s Fund Fighting Lupus and facilitates the patient and caregiver support groups. She is also a 26-year lupus survivor. Connect with Kelli at [email protected].