Pain at night due to axial SpA can affect how easily you fall asleep, stay asleep and the quality of rest you experience. This can lead to fatigue and pain during the day and can have a huge effect on your life. Osteopath Zoë Clark shares her top tips on helping to reduce night pain and improve your sleep.
Firstly, it’s really important to note that sometimes night pain can be caused by other things and it’s important to speak to your doctor if you’re experiencing new or severe night pain to make sure the cause is identified. If it is caused by axial SpA, then hopefully my advice below will help.
So, what causes night pain in axial SpA?
Back pain at night is a big indicator to healthcare professionals that someone may be experiencing the inflammatory back pain that occurs with axial SpA. This is because when you’re not moving as much during the night, the inflammation can cause stiffness and pain in the area.
It’s important to ensure that your axial SpA is under control. Sometimes tracking your symptoms using an app (such as AS Symptom Tracker and MySpA: Look in Google Play and Apple Store for both) can be helpful to monitor how you feel over long periods. This gives your rheumatologist a great overview of what’s happened between appointments and also serves as a memory jog for you when you have a long gap between checkups.
What can you do to reduce the likelihood of experiencing night pain?
Keeping your axial SpA well managed can be the best remedy for night pain. Ensure you’re doing lots of exercises to help the range of movement in your spine and hips. Walking or swimming can be excellent for loosening joints, strengthening your muscles and improving your heart health as well. We also have lots of exercises available on our YouTube channel. If you experience fatigue, doing small amounts of exercise throughout the day can be more beneficial, rather than doing lots all in one go.
What’s the best mattress and pillow to use?
It’s difficult advising a particular mattress type, because there are lots of options and everyone prefers a different type. Unfortunately a new mattress isn’t guaranteed to help with back pain due to axial SpA. I would say the most recommended mattress is a medium to firm mattress, with a small memory foam topper. This gives your back the underlying support, but provides cushioning for your shoulders and hips when lying on your side. However, everyone is different, so stick with what works for you.
Experiment with different types and heights of pillows to find what works best for you. The most common ideal position is to have your neck and head ‘neutral’, so when you’re lying on your back or side, your neck is in the same alignment as when you’re standing. Whole body pillows can provide good support for your neck and act as a cushion between your knees to help the position of your low back.
To give added support to your neck, you can use a rolled up hand towel inside the pillowcase along the long edge of the pillow. When you’re lying on your back or side, the towel will give added support to your neck and then allow your head to only lie on the pillow. Again, it’s worth experimenting and seeing what works for you.
What can you do to manage the pain?
Heat locally before sleep can be helpful at soothing the area where you normally experience pain. You can use a hot water bottle or microwavable wheat bag (wrapped in a towel) or an electric blanket. To avoid burns, make sure you don’t fall asleep with the heat applied. During our Facebook Live, Rebecca had a great suggestion of placing your pillow under the duvet when you first switch your electric blanket on; when you get into bed, your pillow is pre-warmed to help with neck discomfort.
Changing the timing of your painkillers and anti-inflammatories can make them more effective for night pain and morning stiffness. Speak to your doctor to see if it’s suitable for you to take medication about 30-minutes before bed to ease night symptoms. There are also lots of different types of medications, including long acting anti-inflammatories, so it’s worth speaking to your doctor or pharmacist to explore options.
Some people report using sleeping medication or herbal remedies. Speak to your doctor before taking these, particularly if you have other conditions or you’re taking medication for any reason. Sleeping tablets can sometimes lead to drowsiness in the morning, can lose effectiveness over time and can become addictive. It’s highly recommended to use other tools to control your axial SpA and improve your sleep, rather than medication, but if you’re considering this then speak to your doctor.
Another cause of poor sleep?
Stress can reduce the quality of your sleep and make it difficult to fall asleep. Helping to reduce your stress will have a positive effect, so try to speak to someone about how you’re feeling. Breathing exercises can be a really positive way to promote relaxation before falling asleep. Why not try some of the breathing exercises I’ve shared before?
What is good sleep hygiene and how can I practice it?
Good sleep hygiene involves different techniques to promote good sleep. It’s not specific to axial SpA, but the tips can be really beneficial. The most important technique is to ensure you keep the same sleep/wake cycle by getting up at the same time each day and going to bed at the same time. During the day, try to get out in the daylight to help your body with the hormones it produces during the day part of the sleep/wake cycle.
To help your body switch into the sleep stage of the cycle, try dimming the lights in the evening and avoiding screens (TVs, phones, games) for at least an hour before you plan to go to bed. Keep your room dark and cool, with few or no distractions.
Avoid caffeine or exercise just before bed. Sometimes gentle stretches or yoga nidra can help you relax just before sleep, but avoid anything that gets your heart rate up (save that for the daytime). A hot bath/shower, warm drink and some relaxing music can also help you switch off before bed.
If you have any tips that have helped you with night pain, please share them in the comments to help others.
Zoë Clark is an osteopath living with axial SpA herself and has joined the NASS Helpline team to help with the unprecedented demand over COVID-19. You may have seen her blog posts previously written for NASS and she spoke at the latest parliamentary meeting in January and appeared on Channel 5 News. She’s joining the NASS team to help you keep active and feeling well during this difficult time of isolation. The full video of her Facebook Live session on night pain is available here.
Zoë is available on the Helpline each day, so if you’d like to have a chat then please get in touch and we can arrange a call. She’ll also be sharing some of her top tips and answering any common questions, so please let us know in the comments if there’s any particular advice you’d like.
The Helpline is open 1000-1600 Monday to Friday on 020 8741 1515 or you can email zoe@nass.co.uk
){kind=logo}
)
)
)