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Joints can swell when we are sleeping – Ogden Clinic provided source, Standard-Examiner 2/10/2015

OGDEN – If your first steps out of bed in the morning are the most difficult, you’re not alone.

When you stop moving, such as when you are sleeping, your joints can swell. This can lead to stiffness and pain and if that’s the case, chances are you’re not getting a restful night’s sleep.

Between 50 and 90 percent of people with chronic joint pain aren’t getting adequate sleep, and that sleep loss can lead to other health problems, including mood disorders, eating problems and low energy.

Dr. Brent Baranko, an orthopedic surgeon at Ogden Clinic, said the importance of obtaining an adequate night’s rest is widely known. Restful sleep allows us to face the challenges of the next day. Inadequate pain relief from ailing joints may interfere with an adequate night’s sleep.

“The National Sleep Foundation reports about 15 percent of the adult population experiences chronic pain and about two-thirds of those say they experience disrupted or unrefreshing sleep,” Baranko said.

In addition, the U.S. Centers for Disease Control and Prevention reports more than 52 million people in the country have one form of arthritis and a chief complaint of arthritis is early-morning stiffness and pain.

“The first steps out of bed in the morning may be the most difficult,” Baranko said. “However, once up and moving, the pain and stiffness often subside. Generally, most patients with arthritis are more comfortable at rest.”

Baranko said pain at night when changing positions is common with arthritis. However, he said, pain shouldn’t cause you to wake up and stay away. If this is the case, it may be a symptom of something more severe.

Dr. Gregory T. Austad, a rheumatologist at Tanner Clinic, said osteoarthritis, or wear and tear age-related arthritis, is what commonly causes night time joint pain.

Normally, a layer of articular cartilage is found where two or more bones have to interact with one another, Austad said. The articular cartilage enables the bones to interact within the joints with very little friction or trauma.As we age, the articular cartilage wears out. This is not a body system that does not heal itself well and wears out over time. This is a part of the normal aging process.

“Among older adults, osteoarthritis is one of the most common comorbidities associated with poor sleep, affecting 50 percent of persons age 65 or older,” Austad said. “In the United States, 60 percent of arthritis sufferers report pain during the night, and pain secondary to arthritis is one of the most common factors predicting sleep disturbance in the population at large.”

Austad said it is well established that pain interferes with sleep and, in turn, that disturbed sleep reduces pain thresholds, or the ability to tolerate painful stimuli. Whether sleep disturbance precedes or follows pain onset is unclear, but reciprocal effects are likely.

“The combined health care costs of pain and insomnia place a substantial economic burden on patients and society,” he said.

Both physicians strongly recommend people with chronic pain see their physician who can help them design a pain-relief plan. In addition, prescription sleep medication should not be used to provide pain relief for ailing joints.

Baranko said acetaminophen and nonsteroidal anti-inflammatories are commonly recommended because they may also reduce warmth and swelling associated with painful joints. Anti-inflammatories should never be taken on an empty stomach nor immediately before bedtime as they can irritate the lining of the stomach.

Baranko also said other treatments may include a change in activities, weight loss, surgery and exercise. Weight loss can greatly reduce pain associated with hip and knee arthritis and is the only intervention proven to slow the progression of knee arthritis.

Austad said regular exercise, although it may be uncomfortable in the beginning, will strengthen the large muscles around the joints and provide additional stability, which can further reduce pain. Physical therapy exercises for the legs, abdomen and lower back can decrease knee and lower back pain related to osteoarthritis in the knees and back.

A warm bath or shower, warming blankets and hot pads can also help, as can a warm paraffin wax bath for the hands, Austad said. Walking, biking or swimming can also help with pain.

Finding the right position to sleep in is also crucial. According to the Cleveland Clinic, starting out on your side with a pillow between your legs may provide some relief, unless you have shoulder pain. Finding a good mattress may also help. A firm mattress with an added foam pad on top can help distribute your weight and keep your joints in alignment.