If your physical activity and sleep improve, that often leads to improved spirits and less pain. On the other side, if you have more pain, you may move less, sleep poorly, and feel down. “The people with KOA who do best stay active and involved in their family, community, and work,” says Abigail Gilbert, MD, an assistant professor of medicine at the University of North Carolina Thurston Arthritis Research Center in Chapel Hill. “They try to get out of the house every day and do something.” Osteoarthritis (OA) is the most common chronic condition of the joints, according to the Arthritis Foundation. Half of all adults will develop symptoms of knee osteoarthritis in their lifetime. Primary OA is caused by normal aging and gradual wear and tear on your joints, whereas secondary OA is preceded by another health condition or injury, such as obesity, gout, or rheumatoid arthritis.
What Is Preventing You From Sleeping Well and Exercising Regularly?
If your health goals for managing KOA have gotten off track, you may be unsure of where to focus your energy. Did your restless sleep lead to depression, which then kept you from exercising? Or did your knee pain keep you from being active, which led to weight gain and feeling down?
Reality Check: Key Questions to Ask Yourself About KOA
If you don’t feel rested when you wake up in the morning, it could be a good time to check in with yourself, your partner, and your doctor to explore ways you can improve your sleep and start feeling better. Here are four questions and topics to consider if you have knee osteoarthritis.
1. Are you getting restful sleep most of the time?
For most people with KOA, nights of uninterrupted, refreshing sleep can be few and far between. Research published in the Journal of the American Geriatrics Society examining the sleep patterns of people with knee OA found that nearly one-third of people with the condition struggle with falling asleep and over 80 percent have a hard time staying asleep. It’s especially important to practice good sleep hygiene when you have a condition like knee osteoarthritis, says Dr. Gilbert. She suggests a few best practices to keep in mind, which include the following:
Keep a consistent sleep schedule where you go to bed and get up at about the same time.Set the room at a cool and comfortable temperature.Don’t use electronics in bed.Don’t spend a lot of time watching television or reading in bed but instead use it only for sleeping or intimacy.
If you sleep with a partner, ask them what it’s like for them to sleep next to you. “Your partner can tell you what they observe about your behaviors at night: snoring, restless legs, or tossing and turning,” says Gilbert, although she emphasizes that only you know the pain you are experiencing. “Everyone experiences pain differently, and you are the best judge of your pain level.”
2. How much physical activity are you getting? Does it help your pain or restless sleep?
It may seem counterintuitive to move more when you have arthritis, but it’s one of the best things you can do to feel better. “Keeping your muscles and bones strong is important for healthy joints. Exercise increases blood flow, improves range of motion, and prevents stiffness,” says Gilbert. “Exercise also increases pain endorphins — pain-fighting chemicals that help you feel less pain and improve your pain threshold,” she says. “There are so many benefits to regular exercise,” says Gilbert, adding that you should check in with your doctor before beginning an exercise plan.
Short Exercise Stints Help Reduce Osteoarthritis Knee Pain
In a study published in December 2018 in Osteoarthritis and Cartilage, a research team that included Gilbert found that replacing just 10 minutes of sleep or sedentary behavior with moderate physical activity was actually shown to reduce knee pain by 17 to 20 percent. The benefits were greatest in people without restless sleep. Even though it can be harder to be active when you’ve had a bad night of sleep, that shouldn’t keep you from moving. “I recommend pushing through with some light exercise such as going for a walk or gentle yoga and stretching,” says Gilbert. “Physical activity is a low-cost way to help you feel better without the side effects of medication,” she says. “There’s significant evidence that exercise helps people with KOA sleep better at night.” There are many different kinds of activities that are safe and beneficial, but the best type of exercise is the one you enjoy doing and that you will do, says Gilbert. If you choose an activity that you loathe, chances are slim that you’ll stick with it. “A few examples of good low-impact activities would be water aerobics, swimming, or water walking; water can be gentle on the joints. Stationary bikes or elliptical machines are also low impact,” says Gilbert. “Walking is another great activity that doesn’t require access to a pool or special equipment. Start slowly and try to walk 10 minutes three to five times a week and then build gradually from there,” adds Gilbert. If you prefer a group setting and find that more motivating, there are many great exercise classes designed for people with arthritis, says Gilbert. “If you visit the resources page on Arthritis.org and type in your ZIP code, you can find fitness classes in your area.”
Listen to Your Whole Body (Not Just Your Knees)
Even after your doctor clears you for exercise, pay attention to how your body responds. “If your heart keeps beating fast 15 to 20 minutes after you’ve stopped exercising, you should talk to your doctor before exercising again. If you’re having significant or sharp pain or soreness after your activity, you may have worked too hard. You may want to scale back on your next workout,” says Gilbert.
3. How is your mood? Could exercise, meditation, or relaxation exercises improve it? Would sleeping better make a difference?
“People with KOA are susceptible to depression and mood disorders, and this is true for anyone with chronic pain issues,” notes Gilbert. The lack of sleep that accompanies knee osteoarthritis adds to the risk for depression. Research published in Arthritis Care and Research found that for people with KOA sleep troubles there was an increased likelihood of depression a year later. If you begin to feel down or suspect you might be depressed, it’s important to talk with your doctor.
Knee Pain Influences Sleep Quality and Vice Versa
Lack of sleep and the experience of pain have what’s called a bidirectional relationship. Research suggests that people who have a poor night’s sleep feel more pain the next day, and people in pain sleep more poorly. Research even suggests that certain pain centers in the brain are actually more active when people are deprived of sleep. People with KOA can also experience what’s referred to as catastrophizing, Gilbert explains. Catastrophizing is a thought pattern that causes a person to have an exaggerated perception of negative or anticipated pain.
What Is Pain Catastrophizing? And What Can You Do About It?
“Pain catastrophizing is when pain becomes such a huge focus that the person becomes helpless and feels like pain has taken over their life. It leads to a heightened emotional response to pain and increased pain perception,” says Gilbert. A person who is in this state of mind may feel like the pain will never end, like they can’t deal with the pain, and they can’t do anything else because of the pain. Focusing your efforts on sleeping better can help your mood and reduce pain catastrophizing, according to research published in the journal Pain. People with KOA and insomnia received either sessions of cognitive behavioral therapy focusing on helping them sleep better or a placebo, which was behavior desensitization. Not only did cognitive therapy help the insomnia group sleep better, it also significantly decreased their pain catastrophizing. There may be cognitive or mindfulness courses in your area, or there are some internet-based classes that you can take. Books on mindfulness can be found in your local library as well, says Gilbert.
4. Does your doctor support your efforts to sleep well?
Make sure you talk with your doctor about all aspects of your knee osteoarthritis. Primary care physicians can be a great source for referrals and resources, says Gilbert. Whether you’re looking for a mindfulness class or an exercise group, your doctor may be able to point you in the right direction. “I encourage my patients to do as much as they can and not feel limited by their arthritis,” says Gilbert. If your doctor isn’t asking you about your sleep, it may be up to you to begin the conversation. Ask about assessment tools such as the Sleep Health Index, which can help determine if you have restless sleep and how it may be impacting your life.
