Getting a good night’s sleep is something you can’t take for granted when you have ankylosing spondylitis (AS). Symptoms such as pain, especially in the second half of the night, can result in impaired sleep, affecting as many as 6 in 10 of those with AS, according to research. Then, symptoms like stiffness can make your morning routine harder to manage, says Elyse Rubenstein, MD, a rheumatologist with Providence in Santa Monica, California.
But it’s not just a bad night’s sleep and the related physical challenges: A study from April 2023 found that “sleep problems and depressive symptoms were significantly higher” in people with AS, and that “poor sleep quality, depressive symptoms, and low quality of life were strongly correlated with each other.”
But if you have AS, you don’t have to give up on quality sleep if you put these tips to use.
Call Your Rheumatologist
One study found that sleep disturbances were significantly higher in people with ankylosing spondylitis compared with controls without the condition. If back pain or other symptoms are interfering with your ability to get quality sleep, it’s time to speak to your doctor, says Eric Ruderman, MD, rheumatologist and professor of rheumatology in the department of medicine at the Northwestern University Feinberg School of Medicine in Chicago. If you experience them regularly, it may be a sign to check in with your rheumatologist. “You need to look at sleep problems as a clue that your ankylosing spondylitis isn’t as well-controlled as you’d like it to be,” Dr. Ruderman says.
Shrink the Size of Your Pillows to Control Posture
Dr. Rubenstein says that people with ankylosing spondylitis who sleep on large pillows may awake in the morning to find their head hunched forward when they stand up, similar to the way that the pillow propped up their head while sleeping. For this reason, she recommends using a thin pillow at night. You may even find it more comfortable to use no pillow at all to maintain better control of your posture.
Stop Propping Up Your Legs to Avoid Body Position Changes
After a long day of dealing with ankylosing spondylitis, it may be tempting to place a pillow under your legs to provide some back pain relief and better sleep, but resist the temptation. Rubenstein says that using a pillow to prop up your legs can alter your body position when you wake up, similar to the way that a large pillow behind your head can negatively affect your head and neck position.
Firm Up Your Mattress to Ease Ankylosing Spondylitis Pain
As any mattress commercial on TV can tell you, the quality of your mattress can affect your sleep. A firm mattress is important to support your body’s posture and ease pain; even a mattress overlay on top of your current mattress can help. Just don’t rely on your mattress to correct all your nighttime woes. “All the mattresses in the world won’t solve anything if you have fundamental issues with your back,” Ruderman says. While it’s important to have a good-quality mattress, if your nighttime pain persists, it’s best to check in with your rheumatologist.
Plan for Enough Hours of Sleep to Help Ankylosing Spondylitis
When you have ankylosing spondylitis, getting adequate sleep is even more important than it may be for other people, says Ruderman. “Ankylosing spondylitis is a systemic disease, and, as such, causes significant systemic impact, including fatigue,” he explains. “Getting adequate sleep is a way to mitigate this fatigue.” According to the Centers for Disease Control and Prevention, the standard for adults is between seven and nine hours of sleep every night. Create a better sleep habit by going to bed at the same time every night and waking up at the same time every morning. It also helps to make your bedroom a place of quiet relaxation, and keep out the TV, laptops, tablets, and other electronic gadgets.
Develop a Morning Routine to Ease Stiffness
If you can’t sleep at night, don’t fret — instead, try planning a morning routine to address ankylosing spondylitis symptoms like stiffness, back pain, and inflammation. Starting the day with stretching and movement — as well as using nonsteroidal anti-inflammatory (NSAID) medications — can make your morning more pleasant, Rubenstein says. “Stretching is very important with ankylosing spondylitis, and morning is an ideal time to do it,” Ruderman adds. Additionally, some people may benefit from a hot shower or back exercises to alleviate morning stiffness, he adds.
Additional reporting by Blake Miller
- Karatas G, Bal A, Yuceege M, et al. Evaluation of Sleep Quality in Patients With Ankylosing Spondylitis and Efficacy of Anti-Tnf-a Therapy on Sleep Problems: A Polisomnographic Study. International Journal of Rheumatic Diseases. June 2018.
- Yüce E, Sentürk E, Sagaltici E, et al. Sleep Quality and Depression in Patients With Ankylosing Spondylitis and Their Associations With Clinical Parameters: A Cross-Sectional, Case-Control Study. Agri. January 2023.
- Aydin E, Bayraktar K, Turan Y, et al. Sleep Quality in Patients With Ankylosing Spondylitis. Brazilian Journal of Rheumatology. July–August 2015.
- How Much Sleep Do I Need? Centers for Disease Control and Prevention. September 14, 2022.
Beth Biggee, MD
Medical Reviewer
Beth Biggee, MD, is medical director and an integrative rheumatologist at Rheumission, a virtual integrative rheumatology practice for people residing in California and Pennsylvania. This first-of-its-kind company offers whole person autoimmune care by a team of integrative rheumatologists, lifestyle medicine practitioners, autoimmune dietitians, psychologists, and care coordinators.
Dr. Biggee also works as a healthcare wellness consultant for Synergy Wellness Center in Hudson, Massachusetts. Teamed with Synergy, she provides in-person lifestyle medicine and holistic consults, and contributes to employee workplace wellness programs. She has over 20 years of experience in rheumatology and holds board certifications in rheumatology and integrative and lifestyle medicine. Dr. Biggee brings a human-centered approach to wellness rather than focusing solely on diseases.
Dr. Biggee graduated cum laude with a bachelor's degree from Canisius College, and graduated magna cum laude and as valedictorian from SUNY Health Science Center at Syracuse Medical School. She completed her internship and residency in internal medicine at Yale New Haven Hospital, completed her fellowship in rheumatology at Tufts–New England Medical Center, and completed training in integrative rheumatology at the University of Arizona Andrew Weil Center for Integrative Medicine. Following her training, she attained board certification in rheumatology and internal medicine through the American Board of Internal Medicine, attained board certification in integrative medicine through the American Board of Physician Specialties, and attained accreditation as a certified lifestyle medicine physician through the American College of Lifestyle Medicine. She is certified in Helms auricular acupuncture and is currently completing coursework for the Aloha Ayurveda integrative medicine course for physicians.
In prior roles, Dr. Biggee taught as an assistant clinical professor of medicine at Mary Imogene Bassett Hospital (an affiliate of Columbia University). She was also clinical associate of medicine at Tufts University School of Medicine and instructed "introduction to clinical medicine" for medical students at Tufts. She was preceptor for the Lawrence General Hospital Family Medicine Residency.
Dr. Biggee has published in Annals of Rheumatic Diseases, Arthritis in Rheumatism, Current Opinions in Rheumatology, Journal for Musculoskeletal Medicine, Medicine and Health Rhode Island, and Field Guide to Internal Medicine.
Vanessa Caceres
Author
Vanessa Caceres is a freelance medical writer for Everyday Health, Newsday’s Healthlink, and a variety of physician-geared publications and medical societies. She is based in Southwest Florida.