Do you have trouble sleeping through the night? If you’re living with rheumatoid arthritis (RA) and you take a disease-modifying antirheumatic drug like methotrexate, you may be wondering whether the medication could be linked to your sleep problems. As one myRAteam member recently asked, “Does anyone experience insomnia on the night of taking methotrexate orally?”

If you’re having sleep issues, methotrexate may or may not be related. But learning about the factors that contribute to poor sleep will help you begin to gain control over your sleep cycle.

What Is Insomnia?

Insomnia is a sleep disorder characterized by having difficulty falling asleep or staying asleep through the morning. The lack of sleep resulting from insomnia can lead to health issues, including fatigue, forgetfulness, and irritability during waking hours. Insomnia can be a frustrating, anxiety-provoking, and challenging condition to manage, especially if it lasts for weeks, months, or years.

Long-term insomnia can be diagnosed through a sleep study, physical exam, and/or a sleep-habits questionnaire administered by your doctor.

Causes of Insomnia

Common causes of insomnia include:

• Being stressed
• Using a screen or eating too close to bedtime
• Maintaining an irregular sleep schedule
• Traveling between time zones
• Consuming caffeine, nicotine, and/or alcohol

Outside of these everyday causes, many chronic (long-term) conditions and medications may disrupt your sleep.

These may include:

• Sleep disorders such as sleep apnea (trouble breathing while asleep) and restless leg syndrome
• Chronic conditions like asthma, cancer, chronic pain, diabetes, heart disease, Parkinson’s disease, and overactive thyroid disease
• Mental health conditions like anxiety and PTSD (short for post-traumatic stress disorder)
• Prescription drugs such as antidepressants and blood pressure medications
• Over-the-counter medications that contain caffeine, including some pain medications
• Aging, which is associated with increased chronic conditions and medication usage

Risk factors for insomnia are greatest in those who:

• Are female
• Are over 60 years old
• Have chronic mental or physical health problems
• Experience chronic stress
• Are dependent on caffeine or alcohol
• Have irregular work schedules

Rheumatoid Arthritis and Insomnia

RA is an inflammatory disease that causes your immune system to attack its own cells. Although RA has not been shown to directly cause insomnia, common symptoms of the condition include daytime sleepiness and joint pain. Chronic joint pain can lead to trouble sleeping.

In many people with RA, the worst arthritis pain and stiffness occur in the early morning hours, so you may find yourself waking up before dawn, unable to go back to sleep. One myRAteam member who experiences insomnia said, “No matter what meds I am on, I haven’t had a good night’s sleep for years, as the pain wakes me up.”

To manage this and other symptoms, speak to your doctor about what combination of RA treatments can best keep your disease activity under control.

Certain medications, including some prescribed by your rheumatologist to treat arthritis symptoms, may affect your sleep. One member attributed their insomnia to another common RA drug, noting, “I had that feeling with prednisone.”

Corticosteroids have been shown to interfere with sleep, so make sure to take them early in the morning.

Even common nonsteroidal anti-inflammatory drugs like ibuprofen and aspirin have been found to potentially interfere with sleep patterns. On the other hand, biologics to treat rheumatic disorders have actually been found to decrease symptoms of insomnia and depression.

Methotrexate and Insomnia

If you’re taking methotrexate to treat RA, you may have experienced a few of its side effects. Although insomnia is not a direct effect of methotrexate, common adverse events include fatigue, pain, nausea, and diarrhea, all of which may disrupt your sleep.

Fortunately, many of these side effects will likely get better as your body gets used to this treatment. Your doctor may recommend that you take folic acid and a B vitamin to make this treatment more bearable. They may even prescribe antinausea drugs to manage gastrointestinal symptoms.

If side effects are significantly reducing your quality of life, seek medical advice about altering your dosage or switching to another treatment.

Ways To Get Better Sleep

Sleep experts suggest many strategies that can help you reduce sleep disturbances, some of which may work to help you sleep better.

Certain lifestyle changes can improve your sleep hygiene, making it easier for you to stay or fall asleep. Among them:

• Stick to a consistent sleep schedule.
• Remain active throughout the day (but not before bedtime) and avoid taking naps.
• Avoid eating or drinking before you sleep.

Make sure to check the side effects of your current medications to ensure that insomnia is not a side effect.

If you face chronic insomnia, your doctor may recommend cognitive behavioral therapy (CBT). One type of CBT that can help with insomnia is called stimulus-control therapy. Here, a therapist guides you in eliminating habits that may contribute to your insomnia. Another type of CBT is sleep restriction, which entails spending less time in bed until your sleep improves. These strategies can help you take control of your sleep patterns with evidence-based psychological tools.

According to Sleep Foundation, light therapy may also be effective in helping relieve insomnia. The therapy involves being exposed to bright light similar to natural sunlight. Sessions may last 20 minutes to as long as two hours, depending on the light-emitting device being used.

People struggling with insomnia sometimes use over-the-counter drugs and supplements. Melatonin, a supplement created using a naturally produced hormone, can help you feel drowsy and fall asleep more easily. However, its long-term safety is unknown. Valerian is another supplement that causes drowsiness and is sometimes used as a sleep aid. Check with your health care provider before trying it to see if it’s safe for you.

Your doctor may also prescribe sleeping pills for the short or long term. Sleep medicine comes with risks and should be taken exactly as prescribed.

If you experience sleeplessness, it may be due to many health factors, including your RA treatment. Seeking support from a rheumatology provider can help you improve your sleep quality and overall well-being.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 192,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA. Here, finding ways to manage and time rheumatoid arthritis treatment while improving quality of life is a commonly discussed topic.

Have you experienced insomnia while on methotrexate? Share your experience and advice in the comments below, or start a conversation by posting on your Activities page.