It’s a bit of an understatement to say that falling (and staying) asleep is a challenge when you have psoriatic arthritis (PsA). Not only can PsA symptoms—like achy joints, a stiff back, or swollen fingers and toes—keep you up, but itchy rashes can do the same, since up to 90% of people with PsA also have the skin condition psoriasis.1
There’s a psychological component here too. Your pain flares up. You feel stressed, so your body releases cortisol, a hormone that keeps you alert and awake.2 The next day you’re exhausted and sleep-deprived, which can worsen your pain.3 “When this cycle is going, you have increased fatigue and more stress during the day, which can worsen pain perception—both during the day and at night—making it harder to cope with the condition,” Annie Miller, LCSW-C, a licensed therapist specializing in sleep and chronic pain at DC Metro Therapy, tells SELF.
The good news—yes there is good news—according to Miller and the other experts SELF interviewed: You can break the cycle. Here’s how to get a better night’s rest if you have PsA.
1. Don’t just continue to toss and turn.
If you’re tucked under the covers and can’t take your mind off your stiff neck, aching hip, or itchy skin, try to avoid laying there for an hour in the hope you will eventually doze off—this can cause your brain to associate your bed with pain and sleeplessness (rather than sweet dreams), says Miller.4
Instead, get out of bed after 15 to 30 minutes, Miller recommends. Move to another room (or a chair in your bedroom, if you have one) and do a quiet activity—read a book, listen to calming music or a relaxing podcast, or watch a chill TV show.
Resist the urge to crawl back under the sheets until you’re really sleepy—i.e., your eyelids are heavy and you feel yourself nodding off.
2. Treat any skin symptoms before you get into bed.
As noted above, many people with PsA also have psoriasis, which can result in swollen, inflamed patches of skin that can wreak havoc on your rest, Jison Hong, MD, a clinical assistant professor of immunology & rheumatology at Stanford Medicine, tells SELF.
Dr. Hong recommends keeping your skin super moisturized—especially during cold, dry winter months. Use a humidifier in your bedroom and apply a thick, creamy product—say, Vaseline—after showering, Dr. Hong says. Dry skin can make your symptoms worse.5
Last, keep your showers to five minutes or less and use warm water (not hot!), per the American Academy of Dermatology (AAD). Dr. Hong says this will reduce the odds of your skin drying out and getting itchy overnight.
3. Get checked for sleep disorders.
If you consistently feel like you’re not well-rested, also see your primary care physician, rheumatologist, or sleep specialist (if you have one). Certain sleep disorders tend to be more common among folks with PsA compared with those without this type of arthritis.6