Arthritic pain can be all-consuming, making a 24-hour daily struggle. It knows no boundaries and the length of pain duration is not necessarily proportional to the amount of joint damage. A severe pain state can be present with minimal joint damage. Chronic pain ranks as one of the most prevalent health issues in the U.S. with osteoarthritis being a primary cause. In the year 2000, it was estimated that 15 million adults suffered from osteoarthritis and this number is expected to be on the rise, projecting 41 million affected by 2030. The knee joint is the most commonly affected area and this is a great concern because most people with symptomatic knee osteoarthritis report a previous knee injury. On top of all of this, sleep and pain make a vicious cycle. The presence of pain can make it difficult to sleep and the lack of sleep can make the pain feel more intense.
When you live in chronic pain, you will do almost anything to get a good night’s rest. For the millions who suffer from deep, aching pain in their bones and joints, arthritis is the brutal culprit robbing them of a restful night. The Center for Disease Control and Prevention has identified sleep disturbance as a public health epidemic with an estimated 50-70 million US adults having chronic sleep or wakefulness disorders. The price tag for a good night’s sleep may be costlier than you think. A national survey found that adults who were experiencing a daytime activity limitation due to chronic joint symptoms had an average of 1.3 days more from lost time from work and an average of 10 days with activity limitations. This time cost was reflected in a loss of over $10,000 annually.
Understanding Knee Pain and Its Impact on Sleep
Pain is the most common complaint among those suffering from knee problems. Knee pain is a common problem with many causes, ranging from acute injuries to complications from medical conditions. For many with chronic knee pain, it is the sleeping rather than the pain that is the issue. It is difficult to get to sleep in the first place, because unless the person is very tired sleep onset is often delayed by the discomfort. If the pain wakes the person up in the middle of the night, it is a bigger issue. Difficulty in returning to sleep is a very common problem, but it is a particular issue for those with chronic pain that wakes them from their slumber. Sleep is such an important part of our overall health, and disruption caused by a painful knee can have a big impact on quality of life. The stiffness and decreased mobility that many with knee pain experience can make the situation worse, as these symptoms are also correlated with poor sleep. Chronic pain results in less total time sleeping, poorer quality sleep and an increased need for sleep during the day. The impact on quality of life and daily function is huge. Because of sleep deprivation, pain sufferers may find it harder to deal with the physical and psychological impacts of their condition, as the restorative function of sleep is compromised. Rat a night pain that wakes the person up has been shown to be the most powerful predictor of subsequent disability, so it is something that needs to be taken seriously. The association between knee pain and sleep disturbance is a bidirectional one, meaning that the pain can cause poor sleep, and poor sleep can make the pain feel worse. This is actually a good thing in some ways, as treating the sleep disturbance may be an effective way of treating the pain. The following is a discussion of sleep and the treatment of sleep disturbance in those with knee osteoarthritis, based on recent research in the matter.
Managing Knee Pain for Better Sleep
Seeking professional help from a knee pain specialist Pain from an injury or medical condition can affect more than just the immediate area where it hurts. It causes fatigue, irritability, and depression. When knee pain is severe or chronic, seeing a knee pain specialist may be in order. They can help diagnose the problem and formulate a treatment plan that will work best for you. The first thing a knee pain specialist will do is take a detailed history of what the problem is, when it started, what makes it better or worse, and what has been tried in the past. This will be followed by a physical examination of the knee to focus on any structural abnormalities such as swelling, deformity, tenderness, or instability. Sometimes the problem may be somewhere else, as knee pain is frequently referred from the hip or lower back. In this case, a more thorough examination of these areas may be necessary. If the history and physical examination do not point to a clear diagnosis, the knee pain specialist will then order further testing in the form of x-rays, MRI, or blood tests. With a diagnosis in hand, the knee pain specialist will then discuss different treatment options with you. This can range from lifestyle modifications, to physical therapy, to various medications, and in severe cases, surgery. Treatment plans are always targeted to best improve your quality of life while minimizing risk and discomfort. With a competent knee pain specialist guiding you through this process, there is a good chance that you can regain control and minimize the effect that knee pain has on your life and sleep.
Seeking Professional Help from a Knee Pain Specialist
When a person has knee pain that is complex or difficult to diagnose, the correct diagnosis and effective treatment often require a team approach involving a variety of knee pain specialists. An accurate diagnosis is required to select the most effective treatments to alleviate the knee pain. For people with osteoarthritis, a common chronic problem is chronic knee pain that is intermittent or constant, which can be difficult to treat with traditional over-the-counter medications or joint supplements. In these cases, the knee pain specialist will often be a rheumatologist. People with osteoarthritis that significantly limits their function and/or leads to severe pain may require assessment for joint replacement. If only the knees are involved, and other methods have not been effective, it may require consultation with an orthopedic surgeon. If knee pain is due to a more systemic inflammatory type arthritis such as rheumatoid arthritis or ankylosing spondylitis, effective treatment of the systemic arthritis often greatly improves knee pain. In this situation, it would be best to see a rheumatologist, as improving the knee pain may require better control of the systemic disease with medications which may affect the knee pain very differently compared to nonsteroidal anti-inflammatory medications. Usually, initial treatment of most types of knee pain will be by a primary care physician who will be the one to determine whether more specific evaluation or treatment is required by a knee pain specialist.
There are many different types of knee pain Singapore specialists that can help people with knee pain. Rheumatologists are internists who are experts in diagnosing and treating arthritis and other diseases of the joints, muscles, and bones. Orthopedic surgeons specialize in surgical treatments for joint problems related to arthritis, traumatic injury, and other degenerative diseases. Physiatrists are knee pain specialist who specialize in physical medicine and rehabilitation. Although there are some primary care physicians and general practitioners who have a special interest in knee problems and may be helpful in evaluating and treating knee pain, the main primary care for chronic knee pain usually involves consulting one of the above specialists. The type of knee pain doctor that a patient goes to will depend on whether an accurate diagnosis and appropriate treatment for the underlying cause of the knee pain is needed, or simply symptomatic relief of knee pain.
Lifestyle Changes to Alleviate Knee Pain
Weight loss can result in significant reduction of pain in the knees. Weight loss relieves stress and pressure on the knee, thereby reducing pain. In fact, losing as little as 5 percent of body weight can decrease pain. Furthermore, maintaining an appropriate weight can prevent the occurrence of knee pain. How does weight loss or maintenance accomplish this? The force on the knee is three to four times body weight when walking. A flight of stairs or walking up an incline increases force to four to six times the body weight. With simple math we see that every 10 pounds of extra weight adds 30-60 pounds of force on the knee. Imagine the exponential effect of additional weight. High force leads to breakdown of cartilage and that of course leads to pain. Weight control is the best weapon in preventing knee pain.
One surefire way to alleviate or prevent knee pain is to make lifestyle changes. Simple changes can lead to pain reduction and prevention. For example, protecting your knees and thereby preventing pain may be as easy as engaging in a knee exercise program. Or it could be as complicated as losing weight to relieve stress on weight-bearing joints. Some changes bolster all-around health, which has added benefit for the knees.
Using Pain Medications and Treatments
The second type of pain is chronic pain. This is an aching pain that can occur during and after physical activity. This pain will progress if the activity causing it is not ceased and may also occur at rest during the evening or when getting up in the morning. This chronic pain is a common feature of degenerative knee conditions.
The types of pain: There are two main types of knee pain. The first one is acute pain, which is a sharp pain that may begin suddenly after an activity and may accompany inflammation. This accumulation of inflammation may cause the knee to feel warm to the touch. This pain may be relieved with rest and the application of ice.
Knee pain management is often done by using specific medications to relieve pain. This can be a very important thing to do, particularly for those who have chronic knee pain.
Creating a Sleep-Friendly Environment for Knee Pain Relief
Pillows are also of the utmost importance in promoting a good night’s sleep for those suffering from knee pain. The choice of pillow can affect the amount of support a person receives and thus the effectiveness of pain control. For example, pillows placed between the legs act to align the knees and can significantly reduce pain during the night and the following day. However, special pillows are available in several designs and it may be required that the patient experiment to see what works best.
There are several ways to create a sleep-friendly environment when dealing with knee pain. The first consideration must be the mattress. A mattress that is too firm or too bouncy may cause discomfort and aggravate the tissue; conversely, a mattress that is too soft may not support movement or maintain the spine in a comfortable position. A good mattress should support the spine and decrease the amount of turning and tossing during the night. If hardness is an issue, a 1 to 2-inch piece of plywood can be placed under the mattress to add support. Mattresses made of memory foam or latex foam have been thought to be good for controlling pain, and certain companies actually produce mattresses that allow differing firmness on each side.
Choosing the Right Mattress and Pillow
When looking for the best mattress for knee pain, the general consensus is that a mattress of medium-firmness is the best choice. As the rate of knee pain increases with age, a mattress with medium-firm support is recommended for all age groups. A recent study has shown that patients with low back pain reported improved pain levels after sleeping on a medium-firm mattress. Though the mattress type is a subjective choice, for those with knee pain, the consensus is that the mattress should be firm enough to provide support for the spine and torso, but soft enough to act as a shock absorber for the hips and knees. This places the majority of individuals on a memory foam mattress or a spring mattress with a memory foam topper. It is recommended to choose a mattress with the least compression to alleviate sagging. This causes indentations in a mattress, and too much compression results in the body being supported unequally and can be a source of pain. A high-quality mattress can last you 8-10 years. Consider the change in your knee pain discomfort during this time and make the best choice that suits your needs.
For those with knee pain issues, the process of falling asleep – and staying asleep – can be riddled with discomfort. Those with knee pain frequently have trouble finding a position that alleviates pressure on the knees, resulting in a night of tossing and turning and constant awakening. Poor quality sleep will increase pain sensitivity, and thus begins a vicious cycle of pain leading to sleep deprivation, leading to increased pain. One of the best ways to break this cycle is to improve one’s sleep environment, namely choosing the right mattress and pillow. This may take a bit of extra time and money, but the relief of waking up feeling refreshed and pain-free makes it more than worth it.
Incorporating Relaxation Techniques into Bedtime Routine
Relaxation techniques and preparation for bedtime are an often overlooked, but crucial, component of a good night’s sleep. There are a variety of small, effective changes that can be made to the bedtime routine that can greatly improve the quality of sleep. One technique to prepare for sleep is to clear one’s mind of worries or anxieties. One simple way to do this is to make a list of things that are causing anxiety and set it aside to be dealt with the following day. Some people use prayer or meditation to clear the mind. These techniques can be coupled with imagery, in which a peaceful, relaxing place is imagined in the mind, serving to remove the sleeper from the stress and worries of the present. Reading is also a good way to relax before bed, but it is important to avoid reading anything too stimulating, and it’s best to avoid reading in bed as it can cause one to associate the bed with activities other than sleep and sex. After getting into bed, progressive relaxation of the body’s muscles can prepare one for deeper sleep. Beginning with the toes and moving up to the forehead, slowly tensing and then relaxing each muscle group in the body can ease physical tension. The last step before sleep is to be mindful and try not to let the mind wander or get up if it does. All of these techniques can serve to ease the transition into sleep and increase the likelihood of an undisturbed night.
Adjusting Sleep Positions for Optimal Comfort
Sleep positions can make a substantial difference with knee pain. While it can be challenging to achieve a comfortable sleep position, it is certainly possible using additional pillows for support. Always try to be conscious of the position of your knees and ensure they are as aligned as possible with the remainder of your body. The worst possible sleeping position with knee pain is undoubtedly on your stomach. This occurs because it is necessary to twist one knee inwards to meet the bed and usually leave the other one hanging off. Side-sleeping is considered the best position for those with knee pain. This can be made more comfortable by placing a pillow between the knees in order to ensure excellent alignment. Using a small pillow to support the knees while lying on your back can also be an effective support. Regardless of whether knee pain is a result of a long-term condition or a recent onset of discomfort, it is important to understand how sleep can affect pain and possibly make it worse. Making alterations to sleeping environments and positions can result in a more pain-free, restful sleep. This can help to create a more positive mental attitude to managing knee pain and enhance overall quality of life.
If we consider that knee pain is a largely treatable condition and it can be one without chronic effects, this augurs well for the population who at some stage in life may have to deal with it. It has been shown that knee pain in older adults is strongly associated with disability and decreasing levels of activity. It is the author’s hope that by understanding the interaction with sleep, people can prevent the pain from becoming this disabling. For those who already have chronic knee pain, improving ways of managing the pain is key to improving sleep and thus quality of life. Measures to improve sleep noted from the anecdotal reports mentioned earlier included finding new sleeping positions and methods of extra padding for the knees. Given that an individual’s quality of life is a very personal thing, anyone with knee pain and sleep difficulties should consider what they can do to improve their own situation.
The implications of problems with knee pain and sleep are a lot more important than some may realize. There is the complaint of tiredness from poor sleep and its association with low mood. Some people with knee pain are actually diagnosed with a movement-restricting disease (e.g. arthritis), and their sleep may be particularly precious to them as the time when they are free from the discomfort of their condition. As mentioned earlier, a bad night’s sleep can impair functioning abilities the next day. A balanced mood, ability to function, and good sleep are things that most people would say they want from life. If knee pain is something preventing these things, it is something that should not be ignored.
It must be said that not much academic literature focuses exclusively on knee pain and sleep. This means finding exact causes and effects is rather difficult. However, there seems to be a common sense idea that when you have pain in something you are trying to rest on, it won’t be a great rest. In order to consider the complex ways of interaction between knee pain and sleep, a more thorough experimental effort would have to be made. An example would be to take two large groups of people with knee pain and have half of them receive treatment. This group could then be compared with the untreated group to see if knee pain is actually a reversible cause of sleeping difficulties.
While not fully disabling, knee pain can be an annoying thing to have to cope with, day and night. Since sleep is the last thing you do in a typical day, what kind of impact does knee pain have on sleep, and if it is negative, what can be done to improve the situation? This essay has taken a look at these questions.