“If your pain is keeping you awake today, you’re at risk of
functional decline in the future,” said lead author Patricia A.
Parmelee of the Center for Mental Health and Aging at The University
of Alabama in Tuscaloosa.
But these are very preliminary results, she added, noting that her
team is among the first to examine how pain, sleep and mental health
symptoms interact over time.
Almost 15 percent of U.S. adults over age 35 have some form of
osteoarthritis, joint pain due to wear and tear on cartilage,
according to the Centers for Disease Control and Prevention.
Previous studies have found that having arthritis increases the
likelihood of sleep problems as well.
But it’s been unclear which comes first and what role mood plays in
both pain and sleep problems.
For the new study, the researchers mailed questionnaires on sleep
disturbances, pain, functional limitations and depression symptoms
to 367 adults with diagnosed knee arthritis.
During follow-up diagnostic interviews, participants discussed
trouble falling asleep, waking frequently in the night or waking too
early in the morning. About 70 percent of people in the study
reported some form of sleep disturbance.
For physical function, participants rated their mobility, ability to
walk and bend, hand and finger function, arm function, self-care and
ability to do household tasks.
Those with sleep problems were more likely to have symptoms of
depression and tended to have worse pain compared to people without
sleep problems, but sleep was not linked to functional disability.
Especially for those with more severe knee pain, sleep problems were
linked to worse depression symptoms, according to the results in
Arthritis Care and Research.
When 288 participants answered the same questions a year later,
those who had previously reported sleep disturbance were more likely
to report an increase in depression and functional disability.
At any given moment, the results showed that “the combination of
sleep and pain puts depression through the roof,” Parmelee told
Reuters Health. Over time, “sleep disturbance predicts increased
depression and increased disability.”
“A lot of people would expect that the sleep problems would result
in more pain,” which didn’t seem to happen in this study, said Kelli
Allen, associate director at the Center for Health Services Research
in Primary Care at the Durham VA Medical Center in North Carolina.
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“But there’s some relationship directly between pain and downstream
disability,” she told Reuters Health.
The measure of sleep conditions was very broad, Parmelee said, which
might explain why sleep disturbance wasn’t linked to an increase in
pain. Self-reported sleep problems and objectively measured sleep
problems don’t always line up, she said.
In any case, there should be more emphasis on the importance of
screening for sleep problems, particularly for people with
arthritis, said Allen, who was not part of the new study.
Some medications treat both sleep and depression, while some help
with pain and depression, but medications are not the only options,
Physical activity is known to improve pain levels and sleep quality
and to reduce depression risk, Allen said. Cognitive behavioral
therapy may also address multiple dimensions of osteoarthritis
“We do need to intervene as much as possible because sleep problems
put people at risk of depression and disability,” Parmelee said.
Two decades ago when she started studying osteoarthritis, people
thought disturbed sleep was just something patients had to learn to
live with, but that attitude has changed recently, Parmelee said.
“Very often in talking with people about this, some folks don’t put
that much emphasis on the importance of sleep and don’t understand
that in the long range it can be important,” Parmelee said. “If
you’re having sleep problems you need to get help for that.”
SOURCE: http://bit.ly/1yR6pkW Arthritis Care and Research, online
October 6, 2014.
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