If you’re one of the 2.7 million Americans living with axial spondyloarthritis (axSpA), you know the autoimmune condition can make falling and staying asleep difficult. “The type of back pain with axSpA is inflammatory back pain. It gets worse with prolonged rest—your back stiffens, which can wake you up,” says Abhijeet Danve, MD, associate professor of medicine at Yale School of Medicine and director of the Yale Spondyloarthritis Program.
This feeling can be so uncomfortable that you have to get up and walk around or stretch in the middle of the night, something that’s not exactly conducive to sleep. And all of that waking up can have a domino effect, with research showing that axSpA’s sleep disturbances are linked to higher levels of stress, pain, and disease activity, as well as a poorer quality of life.
Sound familiar? Well, you don’t have to resign yourself to yet another sleepless night. There are things you can do to help yourself feel better at night, including pre-bed stretches, lifestyle changes, disease-management practices, and tweaks to your sleeping habits.
Bedtime stretches
Before you turn off the lights, take a few minutes to do these six stretches from American Physical Therapy Association spokesperson Robyn Culbertson, PT, DPT. Conveniently, all of them are meant to be done on your bed. You can also give them a try if you wake up in the middle of the night—they can help you get back to sleep more quickly.
- Lie in the center of the bed and place a pillow lengthwise under your head and upper back.
- With your knees bent and your feet flat on the bed, reach your arms out to the sides in a T shape and let them relax down toward the bed. You should feel a stretch across the front of your chest.
- Hold for 30 to 90 seconds.
- Lying in the same T position you were in for the chest stretch, reach one arm across your body and touch your other hand.
- Try to move only from your upper to mid-back and minimize any motion at your waist. Return to a T shape and repeat on the other side.
- Do five to 10 reps per side.
- Remove the pillow and lie flat on your back.
- Keeping one leg straight on the bed, bend the other knee and use your opposite hand to pull it across your body until you feel a stretch in your lower back. Try to keep both shoulders in contact with the bed so that you’re only rotating from your waist.
- Hold for 30 to 90 seconds, then repeat on the other side.
- Lie with your knees bent and feet flat on the bed. Allow your knees to fall to one side, return to the center, and then fall to the other side. Use slow and controlled movements.
- Do five to 10 reps per side.
- Bend one knee, keeping that foot flat on the bed.
- Cross the ankle of the other leg over the bent knee, making a figure four with your legs.
- Use one of your hands to gently apply pressure to the thigh of the top leg until you feel a stretch.
- Hold for 30 to 90 seconds, then repeat on the other side.
- Lying down, scoot over to the edge of the bed. Bend the knee that's farther from the edge, keeping that foot flat on the bed. This will support and protect your lower back. Then allow your outside leg to fall off the side of the bed. You should feel a stretch in the front of your hip.
- Hold for 30 to 90 seconds, then repeat on the other side.
Additional things that may help
On top of doing those stretches, making a few changes to your daily routine and the way you manage your condition can have a big impact on your sleep quality. Here are some other worthwhile steps you can take.
If you’re not already taking medication for your arthritis, that’s a great place to start. “Getting treated for axSpA should help with the nocturnal back pain,” says Dr. Danve. “And the first line of treatment is NSAIDs.” NSAID is short for nonsteroidal anti-inflammatory drug, a category that includes common painkillers like ibuprofen (Advil) and naproxen (Aleve). If NSAIDs aren’t doing the trick, though, other medications, including biologics, may help improve axSpA back pain. Your doctor can tell you which medicine you should take for your symptoms.
Equally as important as medication and stretching before bed is physical therapy. “With other inflammatory conditions, like lupus, we don’t harp much on physical therapy, but with axSpA regular stretching exercises and supervised physical therapy are very important,” says Dr. Danve. “If you’re doing those things, plus stretching right before bed, your nocturnal back pain will get much better.”
You may not feel like being very active when you’re dealing with axSpA-related back pain, but movement can actually help. And don’t be afraid to go hard. One study found that after three months of doing three 60-minute high-intensity workouts a week (40 minutes of cardio plus 20 minutes of strength training), participants with axSpA reported improvements in sleep, fatigue levels, and mood. Study participants did strength moves like squats, deadlifts, rows, and bench press, and got their cardio in by walking, running, and cycling. But any exercises that feel comfortable (and safe) to you are fair game.
That doesn’t mean you should necessarily jump right into a HIIT class, though. “Always start off slow, try a few reps, and see how you feel,” says Culbertson. “If it hurts, stop.” Another good idea before kicking off an exercise routine: For activities that involve spinal twisting and bending, talk with your physical therapist to get tips on proper form.
While it can be hard to change your sleeping position, try lying on your back with your legs straight, placing a thin pillow under your head and another one under your knees. This posture should be the least painful for you. “It promotes optimal spinal alignment,” says Culbertson. Don’t give up if you struggle to switch positions. “When you’re used to sleeping in a certain position, you may return to that position while you sleep without even realizing it,” says Culbertson. “Placing pillows strategically along the sides of your body may keep you from rolling to your side.”
Your bed might also be part of the problem. Firmer mattresses support your spine while you’re asleep, so if you can, swapping out your bed might bring some relief if your mattress is currently on the softer side, research suggests. “A soft mattress may feel good at first, but it offers less support when sleeping on your back,” says Culbertson. “You end up sinking into the mattress.”
If none of these options work, don’t just suffer silently. Talk with your doctor about trying different treatments or exercises until you find what helps your nights—and days—go better.
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