Geoff Lindsay

How should you sleep with Ankylosing Spondylitis?

In this blog I discuss the issues and some solutions for disturbed sleep with Ankylosing Spondylitis (AS). This also applies to Axial Spondyloarthritis (axSpA), Spondylitis, and any other form of Spondyloarthritis.

Contents:

  1. My experience of living with AS for 50 years and lessons about sleep
  2. What are the issues with sleep and AS?
  3. 10 tips from Yoga for AS for sleep.

My experience

I've lived with AS for nearly 50 years, first symptoms in November 1973. From about the mid 1990s, I used to fall asleep during the day and also wake up in the middle of the night. My circadian rhythm, daily cycle, was all over the place.

My pressure to sleep was intense, at the wrong times. 

It’s only been in recent years that I’ve found how yoga can help with sleep problems. Breaking out of the downward cycle of pain, sleep loss, fatigue is a huge issue for me.

What helps?

  • Regular safe practice of yoga modified for your individual AS.
  • Breath work.
  • Deep relaxation.

What the issues with sleep and AS?

1. Pain from lying on areas of the body affected by inflammation. That is what is waking us up at night. 


I didn't know that it was the pain that was waking me up at night, and for many years I didn't even know I had AS. 

According to the NICE Guidelines: “Waking during the second half of the night because of symptoms”, is common in AS. Nighttime waking is one of the NICE Guidance criteria for referral to a UK Rheumatologist. 

Learn more here


At night we are lying on areas of inflammation anywhere in the body, especially the sacroiliac joints and the neck. This pressure hurts! That pain can be relieved by spreading the load.

For example, the science of memory foam is that it spreads the load, which is why many of us have memory foam mattress toppers.

The NICE Guidance says another reason for seeing a Rheumatologist is there is: “Improvement with movement”.

There is also plenty of science behind some of the yoga practices that can help you with your sleep.

2. Getting back to sleep


My wife says there were many years when she would wake up and I was not in bed. I had woken up, given up and gone to sleep on the settee, eventually. But there are solutions that work in Yoga for AS. 


3. Pain and fatigue led me to daytime sleeps at the wrong times

This in turn affected my getting to sleep at night. This downward cycle is typical of a lot of long term health conditions like AS. 

It may be that sleep disturbance and disturbance of circadian rhythm are contributors to AS fatigue.

10 tips from Yoga for AS for sleep

1. Regular safe practice of Yoga for AS tailored to your individual AS. 

The NICE Guidance section (1.4), “Non-pharmacological management of spondyloarthritis” says people with AS should start 
“an individualised, structured exercise programme, which should include: 
stretching, 
strengthening and postural exercises, 
deep breathing, 
spinal extension, 
range of motion exercises for the lumbar, thoracic and cervical sections of the spine, aerobic exercise.” 
The full Guideline can be found here:
This is one of the main reasons we started Yoga for AS. It meets all these recommendations. It’s driven by us knowing that our pain is relieved by stretching, proper breathing and relaxing. The research evidence isn't there yet to prove that these reduce inflammation but when all the professionals are saying as much, then that is the right direction. 
You do need to work on your whole body.

This free 20 minutes yoga class is simple, easy and can help to reduce your pain and stiffness. Go to our Free Resources Page and check out:
Beginners 20 minute Yoga for AS with Geoff

2. Wind down before bed with some yoga breathing
And also when you can’t get back to sleep. Learn more about the
Yoga for AS Course on breath-work.

3. Try a yoga nidra for getting back to sleep
When you wake up, if you cannot get back to sleep within 15 minutes, try listening to a relaxing Yoga Nidra recording and then you’ll get off to sleep. Yoga Nidra is a form of Non-Sleep Deep Rest (NSDR). 

4. Get morning sunlight before 10.00AM
So in the morning try to get sunlight especially before 10 AM, even if it’s overcast, just getting outside that can help to set our circadian rhythm (the body's inner sleep clock). This is a point from Jamie. In a future blog post, Jamie will discuss what we can do throughout the day to improve sleep quality. Stay tuned!

5. Daytime naps can help, if between 1pm and 3pm 
Recognise that we all have a daily rhythm called the circadian rhythm. This rhythm can be very fixed or very flexible and everything in between. 
Some of us are owls, active at the end of the day; some of us are larks, active in the early morning. 
In your daily rhythm, there is a “post lunch dip”. I find that a catch up power nap between 1 and 3 pm, linked to some breath work or a yoga nidra or a short series of poses with a long savasana/relaxation followed by a short sleep, restores me. It's the best time for a second sleep. I feel much better afterwards. I find this really helps to reduce my pain and improves me all round.
Try not to nap outside of 1-3pm.

Napping in these times is much less likely to disturb your night time sleep. 
I find I have to be quite assertive about napping. Learning that daytime naps really help is one thing; the support of family and friends is crucial.
We are our own best yoga teachers. If a daytime nap with some yoga help from relaxation between 1 and 3 pm restores you, then get into that habit.

Lastly try to keep these naps to under 90 minutes.

6. Improving your posture can help you get comfortable in sleep
Go to our Free Resources Page and check out:
"Quick tips to improve your posture with Ankylosing Spondylitis"

7. Educate yourself about sleep and AS

Watch this free, 23 minutes NASS sleep tips video, with AStretch 

In summary, Emily Clarke, formerly AS Specialist Physiotherapist at the Royal National Hospital for Rheumatic Diseases in Bath, England, reports evidence about sleep and AS:

- Poor sleep is mainly caused by total back pain.
- Up to 90% of us get poor sleep.  
- Poor sleep, less sleep, frequent wakening in the early hours and increased movement at night.
- This can worsen with age; we all need 7-8 hours of good sleep regardless of age. 
- More women with AS report poor sleep.
- Poor sleep may also be because of obstructive sleep apnoea, restless legs syndrome or cramps.  

8. Use a Yoga Nidra recording to make up for lost sleep at night

Learn more about Yoga Nidra here.

9. Yoga can be effective in relieving the fatigue from broken sleep 
Try out this session Jamie did with NASS:
A yoga practice to ease axial spondyloarthritis fatigue

10. Watch this free Yoga for AS video on solutions for AS sleep problems

If you would like to practice Yoga for AS, you can explore a Live Online Class or the Virtual Library.


Both of which you can try for free below.

References:
Toolkit for Sleep https://hubermanlab.com/toolkit-for-sleep/ September 19, 2021

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