Home' Trinidad and Tobago Guardian : October 13th 2014 Contents A28
body & soul
Guardian www.guardian.co.tt Monday, October 13, 2014
Having sleep problems in addition to osteoarthri-
tis may lead to greater disability over time, according
to a new study.
"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
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
Almost 15 per cent of US 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 ques-
tionnaires 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 per cent 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
Those with sleep problems were more likely to
have symptoms of depression and tended to have
worse pain compared to people without sleep prob-
lems, but sleep was not linked to functional disability.
Especially for those with more severe knee pain,
sleep problems were linked to worse depression symp-
toms, according to the results in Arthritis Care and
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 prob-
lems 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.
"But there s some relationship directly between
pain and downstream disability," she told Reuters
The measure of sleep conditions was very broad,
Parmelee said, which might explain why sleep dis-
turbance 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, par-
ticularly 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 med-
ications are not the only options, she said.
Physical activity is known to improve pain levels
and sleep quality and to reduce depression risk, Allen
said. Cognitive behavioral therapy may also address
Arthritis pain, lost sleep
may lead to disability
YOUR DAILY HEALTH
News and Advice
multiple dimensions of osteoarthritis symptoms.
"We do need to intervene as much as possible
because sleep problems put people at risk of depres-
sion 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.
Persons with sleep problems were more likely to have symptoms of depression
and tended to have worse pain compared to people without sleep problems.
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