Winning the Nighttime Battle with Axial Spondyloarthritis

Symptoms of Axial Spondyloarthritis (AS) are often worst after dark. 

Sleep disruption and pain can make getting through the night a daunting task. This article explores practical strategies to help you maximise sleep, manage pain, and combat fatigue.

A Vicious Cycle

For most individuals dealing with AS, it’s common for inflammatory pain to intensify during periods of rest. This can turn an average night’s sleep into a battle and contribute to the vicious cycle of daytime fatigue.

I remember a time when I dreaded going to bed. This was when symptoms peaked—agonising lower back pain combined with the fear and exhaustion of chronic sleep deprivation. I navigated my days like a zombie, wondering if I’d ever experience a restful night again.

I’ve since learned to manage my pain better. I also keep a few effective strategies in my arsenal for when pain disrupts my nights. Improving my sleep has significantly impacted my overall physical and mental health, so I’m eager to share these insights with you in the hope they might help you too.

Pain Management is Key

If sleep deprivation is an ongoing issue for you, it’s essential to discuss it with your doctor. 

Persistent sleep disruption may signal that your pain management and overall treatment approach need adjustment. A good doctor understands that pain preventing sleep must be taken seriously.

This also presents an opportunity for you to explore lifestyle changes that can help reduce inflammation. Many individuals find daily stretches, dietary adjustments and stress management techniques can have a measurable impact on pain and nighttime disruptions.

Fighting Fatigue

The systemic inflammation characteristic of AS places strain on the body’s resources, leading to fatigue. When you add sleep deprivation to the equation, it’s easy to see why exhaustion is just as troubling as pain for most people dealing with this condition.

Strategies to navigate your day include setting realistic expectations and being self-compassionate, finding moments to rest, making time for sunshine and exercise, and ensuring you’re well-nourished and hydrated.

I used to resist the idea of napping, but I’ve come to realise it’s a valuable skill. If napping comes naturally to you, find opportunities in your day to give yourself extra rest. It can offset the effects of broken sleep and significantly improve your overall well-being.

Having a Nighttime Plan

Even when your condition is well managed, pain can still occur and have you wandering the house at 3 AM. Knowing how to respond when this happens can make a significant difference. And being familiar with your go-to plan ahead of time can prevent fear from taking hold when you’re dealing with pain in the dark.

With that in mind, here’s a list of strategies to help you create your nighttime pain plan:

• Stretches: There are stretches you can do without leaving your bed, and these often provide enough relief to help you fall back asleep. My favourite is yoga’s Reclined Pigeon Pose. It’s an excellent stretch for tight hamstrings and can address pain stemming from the sacroiliac joint.
• Meditation: If you’ve ever searched for pain relief meditations online, you know there are hundreds of free resources available. Having your phone, earbuds, and a favourite meditation handy can be an effective way to counter pain and relax back to sleep. I was initially skeptical about this, but I’ve found practicing mindfulness around nighttime pain is now one of my preferred strategies.
• Get Up and Move: Set a time limit for how long you’re willing to lie in pain. If you’re not back to sleep within half an hour and still in pain, frustration can take over. Getting up and stretching, walking around the house, or even taking a hot shower can break that pattern and make it easier to return to sleep. Keep an eye on the clock; the average adult sleep cycle is about 1.5 hours, so every 90 minutes presents a brief window when sleep is more likely.
• Top-Up Pain Relief: Talk to your doctor about over-the-counter solutions that can complement your current treatment plan. Options such as analgesics or topical anti-inflammatory creams can provide additional relief and help you return to sleep.
• Heat: Applying a heat pack directly to areas of pain can increase blood flow and ease the discomfort of nighttime inflammation. I also make an effort to stay warm, especially my feet, if I get out of bed, as it’s harder to return to sleep if I’m cold.
• Resist the Fear: Thoughts often become darkest at night, and it’s easy to feel overwhelmed by pain and symptoms when you’re alone during the wee hours. Other problems may appear worse as well, and we tend to envision the worst-case scenarios. Try to view your nighttime thoughts through a self-compassionate lens and maintain perspective. Write down anything that’s weighing heavily on you and plan to revisit it in the morning. Those lists tend to feel more manageable in the light of day.

Living with Axial Spondyloarthritis presents unique nighttime challenges that can disrupt your sleep and create a cycle of fatigue. Talk to your doctor, and start working on lifestyle changes and a plan for nighttimes to give yourself the best chance at coping with disruptions when they occur.

What appeals to you most from this list? Which strategy are you ready to try next time you experience broken sleep with AS?