Osteoarthritis and the Sleep Connection

Do you ever think of cartilage—the protective and resilient tissue that covers bone ends, making them more resilient, absorbing shocks, and allowing us walk, jump, and jog free of pain and friction? Devoid of blood vessels, cartilage depends on us moving for nourishment and to stay free of metabolic waste. But damaged cartilage can result in tender, swollen, and painful joints.

What is osteoarthritis?

When cartilage breaks down, leaving bones less protected when joints move, it can lead to osteoarthritis, the fastest cause of disability worldwide. Osteoarthritis, the most common type of arthritis, affects 4 million people in Canada. The most affected joints are the knees, followed by big toes, hands, spine, and hip.

What can cause osteoarthritis?

Potential risk factors include genetics (especially for hand osteoarthritis, with a higher incidence in women, and after menopause), aging (though many older adults never develop osteoarthritis), being sedentary, having certain jobs, or practising high-impact sports.

Weight can also be an issue. According to registered physiotherapist Melanie Soer, “Being overweight places higher force load through our weight-bearing joints, which can lead to increased progression of osteoarthritis in those joints.”

How is osteoarthritis diagnosed?

Common symptoms include intermittent joint pain and aching during or after movement, stiffness, swelling, and loss of flexibility. Pain can increase as the disease progresses, with occasional flare-ups related to either movement or lifestyle.

Osteoarthritis is diagnosed using imaging, blood tests, and a detailed physical exam. Though irreversible, osteoarthritis progresses slowly, which makes it possible to mitigate symptoms through a well-designed management plan.

How are osteoarthritis and sleep associated?

Poor sleep makes us feel miserable the next day, but long term, it can increase the risk of chronic conditions such as type 2 diabetes, cardiovascular disease, dementia, and joint disease. It can also exacerbate joint pain.

Pain episodes during sleep are common among people with osteoarthritis. Because sleeping disturbances can increase sensitivity to pain, both daytime and nighttime, this can create a vicious cycle.

“Nighttime pain occurs most often in later stages,” says Soer. Some helpful strategies, according to Soer, include “gentle stretching before going to bed, heat applications, and using multiple pillows for support.”

Prevention works

Maintain a healthy weight by following a diet based on whole foods that provide adequate protein, fibre, complex carbohydrates, and healthy fats. Obesity, type 2 diabetes, and metabolic syndrome can increase the risk of developing osteoarthritis.

“Being active and strengthening muscles, especially the ones that support the joints, is helpful in preventing the risk of injury as we get older,” says Soer. Physical activity also helps deliver adequate nourishment to the joint tissues, which enables proper functioning and repair processes. Ditto for cardiovascular, metabolic, and brain health benefits.

Manage osteoarthritis symptoms and improve sleep 

Diet 

Switching to a Mediterranean-style diet that includes whole foods rich in anti-inflammatory compounds and healthy fats can help reduce inflammation and pain, improve digestion, and achieve a healthy weight, which reduces the stress on joints, slowing progression.

Exercise

Joint pain can result in fear of exercise, including something as simple as walking, which has been shown to be a helpful management tool. “Weight management and specific strengthening and mobility exercises prescribed by a physiotherapist after a thorough assessment can be helpful,” says registered physiotherapist Melanie Soer. “Gentle exercise, including swimming, can help with maintaining range of movement, which can help minimize pain and swelling,” she adds.

Complementary therapies 

Heat and cold therapies can help relieve joint pain, says Soer, adding that “some people respond well to complementary therapies, including acupuncture and intramuscular stimulation.”

Supplements 

·         Some studies suggest chondroitin and glucosamine sulphate may help reduce pain, tenderness, and stiffness, mostly for knee osteoarthritis.

·         Topical anti-inflammatory creams, including some with capsaicin, a compound from chili peppers, may help relieve pain.

·         Vitamin K, important for cartilage metabolism and available as a supplement, may help in relieving joint pain.

·         Omega-3s are also key in osteoarthritis management by preventing cartilage loss.

Osteoarthritis and the melatonin connection

Often used to promote sleep, melatonin is a hormone that helps regulate sleep cycles. When it comes to joints, melatonin can mop up free-radical molecules involved in inflammation caused by aging, injury, and established osteoarthritis. Melatonin has been shown in animal and human studies to promote cartilage regeneration, though more studies are needed to solidify it as a treatment option for osteoarthritis.

Osteoarthritis in numbers

·         20 percent of women and 10 percent of men over the age of 60 suffer from osteoarthritis

·         1 in 7 Canadians live with osteoarthritis; 1/3 are diagnosed before the age of 45

·         1/2 of the working population diagnosed with osteoarthritis experience school or work disruptions due to their disease

·         1/3 of younger adults with osteoarthritis suffer from related anxiety and/or mood disorders, which affects their quality of life