Unlocking the healing power of sleep for better rest

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1. Why Sleep Matters More for Autoimmune Health

Sleep is essential for everyone, but for individuals living with autoimmune and rheumatologic conditions, restorative sleep can be the difference between flare-ups and stability. The body uses sleep to repair cellular damage, regulate hormones, and rebalance the immune system. When sleep is compromised, inflammation rises—a dangerous cycle for patients with conditions like lupus, rheumatoid arthritis, and fibromyalgia.

A growing body of research shows that poor sleep may worsen disease activity and even contribute to the onset of autoimmune conditions. A 2021 study published in Frontiers in Immunology found that sleep deprivation disrupts circadian rhythms and skews cytokine production, leading to increased systemic inflammation and autoimmune reactivity¹.

2. How Autoimmune Disorders Disrupt Sleep

Autoimmune diseases often interfere with sleep quality in both direct and indirect ways. Joint pain, muscle stiffness, and systemic inflammation can cause discomfort that interrupts sleep cycles. Additionally, many autoimmune conditions involve dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated nighttime cortisol levels that delay sleep onset or cause nighttime awakenings.

Common sleep-disruptive features in autoimmune patients include:

• Fibromyalgia: Non-restorative sleep and alpha-delta sleep anomalies²
• Lupus: Increased prevalence of insomnia, restless leg syndrome, and sleep apnea³
• Rheumatoid Arthritis: Morning stiffness and nighttime pain causing frequent awakenings
• Sjogren’s Syndrome: Dry mouth and dry eyes disrupting comfort and continuity of sleep
• Hashimoto’s Thyroiditis / Hypothyroidism: Fatigue paradoxically coexisting with poor sleep quality

3. The Inflammation-Sleep Feedback Loop

Inflammatory markers such as IL-6, TNF-alpha, and C-reactive protein (CRP) tend to increase in individuals who are sleep-deprived. In autoimmune patients, these markers are already elevated and can rise further with poor sleep, worsening fatigue and triggering flare-ups. Conversely, restorative sleep has been shown to lower systemic inflammation, improve pain thresholds, and support immune tolerance.

“Sleep is not just rest. It’s immunological housekeeping,” says Dr. Michael Irwin, a neuroimmunologist at UCLA. His studies found that even mild sleep loss significantly upregulated proinflammatory gene expression⁴.

4. What Patients Can Do: A Personalized Sleep Checklist

For patients managing autoimmune disease, sleep hygiene needs to be a core part of their treatment plan. Here are proactive steps that can help:

Daily To-Do List for Better Autoimmune Sleep:

• 🛏 Consistent Sleep-Wake Schedule – Aim for 7–9 hours of sleep per night, including weekends
• 🌞 Morning Sunlight Exposure – Helps reset your circadian clock and balance melatonin
• 🧘 Evening Wind-Down Routine – Gentle stretching, meditation, or a warm bath to reduce cortisol
• 📵 Device Curfew – Avoid blue light 1–2 hours before bed
• 🧂 Limit Nighttime Inflammation Triggers – Reduce refined sugars, alcohol, and sodium-rich foods
• 💊 Check Medication Timing – Some steroids and thyroid meds can disrupt sleep if taken too late

5. Treatment Considerations from a Rheumatologist’s Perspective

Dr. Susan Baker emphasizes a holistic approach to sleep disruption that includes addressing the root cause of inflammation. In some cases, sleep difficulties may be a sign that autoimmune disease activity is not well-controlled. Adjusting medications, such as shifting corticosteroid timing or evaluating biologics, may improve both pain and sleep.

Additionally, referrals for sleep studies may be appropriate when there is suspicion of obstructive sleep apnea or periodic limb movement disorder, both of which are more common in autoimmune populations⁵.

6. Beyond Sleep Aids: What Doesn’t Work (and What Might)

Many patients reach for over-the-counter sleep aids, but antihistamines and melatonin supplements often provide inconsistent results, especially for chronic autoimmune-related sleep disruption. Long-term use of these agents can lead to tolerance or mask underlying issues.

What may help instead:

• Cognitive Behavioral Therapy for Insomnia (CBT-I)
• Low-dose naltrexone (LDN) — shown to improve fibromyalgia symptoms and sleep quality⁶
• Magnesium glycinate or threonate supplements
• Anti-inflammatory diets (Mediterranean-style)

Final Thoughts

Sleep is not a luxury for those living with autoimmune disease—it's a powerful tool for healing and resilience. At her Beverly Hills practice, Dr. Susan Baker integrates sleep assessments into her rheumatologic care to ensure patients receive the deep rest their bodies need to repair and thrive. By addressing inflammation, pain, and behavioral triggers, patients can reclaim better nights and brighter days.

Footnotes

1. Irwin, M. R., & Opp, M. R. (2017). Sleep Health and Inflammation: A Multi-Organ Perspective. Frontiers in Immunology. https://doi.org/10.3389/fimmu.2017.00751 ↩
2. Moldofsky, H., & Scarisbrick, P. (1976). Disturbed sleep in fibromyalgia. Journal of Rheumatology. ↩
3. Palagini, L., et al. (2016). Sleep disorders and systemic lupus erythematosus: a review. Lupus. ↩
4. Irwin, M. R. (2015). Why sleep is important for health: a psychoneuroimmunology perspective. Annual Review of Psychology. ↩
5. Kaneita, Y., et al. (2010). Association between autoimmune disorders and sleep problems. Sleep and Biological Rhythms. ↩
6. Younger, J., & Mackey, S. (2009). Fibromyalgia symptoms are reduced by low-dose naltrexone. Pain Medicine. ↩

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By Dr. Susan Baker | Rheumatologist in Beverly Hills