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Podcast, Provider Interviews, Rheumer Has It

Rheumer Has it: Tips for Sleep, with Dr. Deb Da Costa 

3 months ago
19 min read
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Summary:

Sleep is a vital yet often overlooked aspect of arthritis care, despite its significant impact on symptoms such as pain, fatigue, depression, anxiety, and cognitive function.On this episode, Cheryl & Eileen talk with sleep expert and researcher D. Deborah Da Costa about evidence based interventions to improve sleep in people with rheumatic conditions.

Dr. Da Costa explores how sleep challenges are deeply entangled with social and emotional wellbeing as well as pain, fatigue and cognition for those living with rheumatoid arthritis and related conditions.

She also overviews Cognitive Behavioral Therapy for Insomnia (CBTI), which is the the gold standard for treating sleep disturbances. Whether it’s resisting social pressure to stay up late or coping with fatigue while caregiving, this episode explores sleep-related struggles and provides specific tips for improving sleep.

Episode at a glance:

  • Sleep Is a Critical Yet Underrecognized Component of Arthritis Care: Despite its profound impact, sleep is often neglected in both patient and provider conversations. Poor sleep can worsen arthritis symptoms such as pain, fatigue, depression, anxiety, and cognitive dysfunction—even when the disease is otherwise well-managed.
  • Cognitive Behavioral Therapy for Insomnia (CBTI) Is a Promising Non-Pharmacological Treatment: CBTI is considered the gold standard for treating insomnia without medication. It helps patients reframe negative beliefs about sleep and adopt healthier sleep behaviors, such as limiting screen time in bed and creating a relaxing pre-sleep routine. Internet-based CBTI programs tailored for arthritis patients are currently being piloted.
  • Sleep Challenges Are Deeply Intertwined with Social and Emotional Wellbeing: The podcast highlights how sleep difficulties affect social life, relationships, and self-advocacy. From navigating social pressure to stay up late to managing fatigue while caregiving, the conversation emphasizes the need for greater awareness and support around sleep in the context of chronic illness.

Medical disclaimer: 

All content found on Arthritis Life public channels (including Rheumer Has It) was created for generalized informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Episode Sponsors

Rheum to THRIVE, an online course and support program Cheryl created to help people with rheumatic disease go from overwhelmed, confused and alone to confident, supported and connected. See all the details and join the program or waitlist now! 

Speaker Bios:

Deborah Da Costa

Deborah Da Costa, PhD, is a health psychologist and Associate Professor of Medicine at McGill University.  My research focuses on the interplay between modifiable psychosocial and behavioural (e.g. exercise, sleep) factors and health status in various chronic illnesses and in relation to mental health in populations at risk, guided by a biopsychosocial framework. This has laid the foundation for the knowledge-transfer phase of my program which focuses  on tailoring and evaluating evidence-based digital behavioural interventions through an equity, diversity and inclusivity lens to empower individuals with the skills needed to optimize their health and wellness across the lifespan at teachable moments.

Eileen Davidson Bio

Eileen Davidson, also known as Chronic Eileen, is a disability and chronic illness advocate from Vancouver BC Canada. Living with a diagnosis of rheumatoid arthritis, she spends a large focus on volunteering and creating awareness around arthritis. With The International Foundation for Autoimmune and Autoinflammatory Arthritis (AiArthritis) Eileen is the Educational Media Assistant. Along with AiArthritis, Eileen is a member of the Arthritis Research Canada patient advisory board, and author with over 100 published articles.

Cheryl Crow

Cheryl is an occupational therapist who has lived with rheumatoid arthritis for over twenty years. Her life passion is helping others with rheumatoid arthritis figure out how to live a full life despite arthritis, by developing tools to navigate physical, emotional and social challenges. She formed the educational company Arthritis Life in 2019 after seeing a huge need for more engaging, accessible, and (dare I say) FUN patient education and self-management resources.

Episode links:

Full Episode Transcript:

[00:00:05] Eileen Davidson: Welcome to Rheumer Has It the podcast at bust myths, highlights evidence and inspires hope for living better with rheumatic disease 

[00:00:19] Cheryl Crow: Through plain language, interviews with experts, we offer actual knowledge so you can thrive today.

[00:00:25] Eileen Davidson: My name is Eileen

[00:00:26] Cheryl Crow: and my name is Cheryl.

[00:00:28] Eileen Davidson: Join us as we bust myths and spotlight evidence.

[00:00:33] And today we have a very special guest from Canada, actually one of the researchers with Arthritis Research Canada that I’ve had the pleasure of collaborating with and also hearing speak before we have Deborah Da Costa here and she lives in Montreal. I’m gonna let describe the work she does and her background, but today we’re talking about a very appropriate topic because I didn’t get very much of it last night.

[00:00:59] We’re [00:01:00] talking about sleep. So Deborah, can you let us know a little bit about your background and how you came to specialize in sleep? 

[00:01:08] Dr Deborah Da Costa: Sure. So I’m a health psychologist and I’ve received training in administering behavioral approaches to treat insomnia. And early on in my career, I conducted a couple of studies looking at fatigue in people living with arthritis.

[00:01:25] And one of the things that kept reemerging as an important factor associated to fatigue was poor sleep. And that really sparked my interest in trying to better understand what some of the causes are of poor sleep in people living with arthritis so that we can better manage it.

[00:01:44] Eileen Davidson: Yes, I would agree. I think sleep is a very under-discussed topic, especially in the rheumatologist office and has such an impact on us. I’m gonna hand it over to Cheryl now to ask the first question. 

[00:01:58] Cheryl Crow: Yeah. Similar [00:02:00] to what Eileen said when it comes to lifestyle habits that might improve quality of life, I notice a lot of patients, including myself initially, tend to focus on like nutrition and exercise and maybe neglect sleep.

[00:02:12] It’s almost like a blind spot we have. So can you explain to the listeners a little bit why sleep is so CR critical for our health and how it can impact inflammatory arthritis symptoms? 

[00:02:24] Dr Deborah Da Costa: Absolutely. So it’s interesting you say that a lot of patients tend to focus more on nutrition and exercise, but healthcare providers as well.

[00:02:32] And those are really important things to, to look at and to address. But sleep is. Oftentimes very much so neglected, and it’s surprising given that up to 70% of patients who have arthritis experience, sleep difficulties. And just for the audience, when we’re talking about sleep difficulties, I’m talking about difficulty falling asleep, difficulty stay, staying asleep, early morning awakenings, and just feeling un refreshed in the [00:03:00] morning.

[00:03:00] Sleep difficulties tend to be under recognized undertreated and or treated only with medication, which really doesn’t address the underlying issues. But sleep is essential. It’s essential to sustain our wellbeing, our mental wellbeing, our physical wellbeing. I mean, it’s a biological process.

[00:03:19] It helps to maintain metabolic balance. It helps with tissue repair and our overall sense of, wellbeing. The thing about sleep in the context of arthritis is that we tend to underestimate just how important it is. A poor night’s sleep doesn’t only affect our ability to concentrate. Of course it makes us more irritable as well, but when we, in the context of living with arthritis, it could also worsen certain symptoms.

[00:03:46] Even when the condition is well managed and there’s a good body of evidence showing that, prolonged poor sleep can have a negative impact in terms of pain, in terms of depression and anxiety, as well [00:04:00] as worsening fatigue. So all these reasons highlight the importance of better addressing sleep in the context of arthritis.

[00:04:09] Cheryl Crow: That’s so helpful. Thank you. And I’ve definitely noticed that in my own life it can be a bit of like a vicious cycle. ’cause then I don’t sleep well enough, maybe I have a little bit more pain and then I’m stressed and then that stress and anxiety feeds, so yeah, the vicious, 

[00:04:25] Dr Deborah Da Costa: absolutely. 

[00:04:26] Cheryl Crow: So yeah, I’ll hand it over to Eileen for the next question that addresses that.

[00:04:30] Eileen Davidson: Yeah, and I would love to just mention because it’s not just joint pain. I love saying that it was our little a CR presentation that panel discussion that Cheryl and I did. But there’s also other factors that when you get a poor sleep with a rheumatic disease, I find you. The brain fog is so difficult to navigate and how it also increases malaise.

[00:04:54] Living with rheumatoid arthritis, I always feel like I have the flu and when I don’t get a good night’s sleep that. [00:05:00] Symptom is so heightened. Yeah. And then of course with the GI issues that come with it can really interrupt her sleep. So yeah, there it, it is that vicious cycle that if we don’t get good sleep, we’re gonna feel worse.

[00:05:11] And then if we get a heightened symptoms that don’t let us sleep. We’re gonna feel even worse the next day. So it’s, it is a definitely a vicious cycle. So I know in my own personal experiences trying to navigate fragmented sleep and the disruptions in my sleep and how it impacts the end of the day, I think one of the most important questions that we can ask you today is what are some of the, your best non-pharmacological treatments to manage sleep when you have arthritis, particularly with insomnia or insomnia and like pain, insomnia.

[00:05:45] Speaker 3: We don’t have a lot of published research on non-pharmacological treatments for sleep. It’s specifically conducted with patients with arthritis, but sleep experts definitely consider cognitive behavioral therapy for [00:06:00] insomnia. Also called CBTI as being the first line, non-medical or non-pharmacological.

[00:06:06] Treatment for insomnia. So, CBTI is a multi-component type of intervention that really focuses on identifying and changing negative thoughts and behaviors that interfere with sleep. So, for instance we conducted a study with over 200 arthritis patients to do a sleep needs assessment and.

[00:06:29] Many of them who were experiencing sleep difficulties had this belief that sleep is, sleep difficulties is just part of living with arthritis. I have to accept it. There’s really not much I can do about it. That, of course, is going to perpetuate sleep difficulties. So CBTI focuses on identifying and modifying these types of thoughts as well as, implementing some behavioral techniques that can assist with promoting sleep. So for instance, identifying [00:07:00] making a stro a stronger connection between the bed and sleep, and how do we do that while we restrict time in bed? That’s related to nons sleep activities. So you shouldn’t be. For instance, lying in your bed and on your iPad or on your computer, that’s not going to make that association between sleep and the bed strong.

[00:07:18] If you’re gonna do those activities, try to do it in another place that’s equally as comfortable, but just not your bedroom. That’s one example. Other things is promoting a relaxing bedtime routine. Maybe 20, 30 minutes before going to bed. So this isn’t the time that you’re going to get into a heated conversation with your partner.

[00:07:37] For instance, it’s a time where, you know, you should adopt some activities like a warm bath reading some something that you enjoy, listening to some soft music. Just something to kind of promote it’s time to shut the brain off and just, you know, relax a little bit. These are, are the types of things that cognitive behavioral therapy for insomnia focuses on.[00:08:00] 

[00:08:00] And really in the general population with insomnia and in certain chronic conditions where it has been evaluated more, we see that it not only improves sleep, but it improves other symptoms such as pain sh such as depression, such as fatigue. That is really of, in that caught my interest because I know that these are symptoms that, patients who are living with arthritis struggle with. So if we can address sleep and address these other symptoms as well, that would be a win-win situation. The thing is, CBTI is not easily accessible because there aren’t a lot of providers out there who have been trained. So there’s a long waiting list as well as it can be costly if one goes privately.

[00:08:43] But there have been internet delivered CBTI programs that have been shown to be just as effective. They’ve been evaluated in, in people suffering from insomnia as well as those in specific chronic conditions such as cancer. I. So, [00:09:00] what we’ve done is we’ve kind of, tailored one of the CBTI interventions that were, was evaluated in cancer with Dr.

[00:09:08] Jose Ard from University of Laval. And we’ve adapted it and we’re just completing a pilot study with arthritis patients to see whether or not it’s effective and to see, you know, whether it’s something that is acceptable. To patients living with arthritis as a in terms of how it’s delivered through the internet.

[00:09:27] And we’re excited to see how that turns out. 

[00:09:32] Speaker 2: That’s, that’s so exciting. And, you know, I think when it comes to sleep hygiene, just to add my, my personal story, I being diagnosed in my early twenties, I found that one of the most difficult things was actually the social pressure to stay up late. And I ended up adopting a persona that I started calling a sleep diva.

[00:09:55] And like I, and it was kind of, I, I’m, I’m a unique individual, so I don’t, I [00:10:00] don’t know how this would work for everyone else. But I ended up like my, or my, my friends on the soccer team would call me like mom as a nickname because I was like, guys, we have to get our sleep before the big game. And, but really learning like to, I think for a lot of younger people, especially learning to advocate for yourself and say, so your friends, you wouldn’t tell me to just push through not eating all day.

[00:10:21] Why should I push through not sleeping enough? Is that something you’ve found in some of the patients you’ve kind of studied is that it’s, it’s hard to advocate for your need to sleep socially. 

[00:10:30] Speaker 3: Absolutely. It, it’s very hard because of this, there is this social pressure that, you know, we don’t need much sleep.

[00:10:37] People kind of brag about it sometimes, where it’s like, you know, sleep is essential. It really is. I, and I’m, I’m a sleep diva too, so I get it. 

[00:10:47] Speaker 2: Yeah. I actually looked into, I made a t-shirt and then I need to, so maybe by the time this is published, I, I can link, I made an Etsy store, but then I never finished.

[00:10:56] I was nervous about publishing it anyway, anxiety. I had a little [00:11:00] anxiety ’cause I was like, oh, what if I do it wrong and like, don’t report the taxes right. Or something. But hopefully this will, this will gimme a deadline to get the sleep diva shirts. ’cause I do think that having others around you who support you, you know, in my case.

[00:11:11] My husband. He, I, I, we joke, but especially when my son was little, that like giving me sleep was like a love language. Absolutely. You know, he would take my, my son for a while so that I could get uninterrupted sleep and he just knows he, he, he’s an engineer and that kind of helps because, and there’s times I, we sleep in separate bedrooms sometimes when I really need to get a good sleep.

[00:11:34] And we don’t see that in the context of our relationship as threatening. Are in relationship because again, I think it helps, he’s an engineer, so we’re both like, kind of like, you know, this is a body function that I need to maximize, and he knows Cheryl’s gonna be feeling better. That means I’m gonna be feeling better if her mood’s better and her everything’s, you know, so I, I, I am very lucky, I’m going to say.

[00:11:56] Yeah. Eileen, I think you had some perspectives on, on that as [00:12:00] well. 

[00:12:00] Eileen Davidson: Yeah. I just have to add in a little perspective as a single woman who finds that to be a very particular troubling situation when you have chronic fatigue and like to go to bed at like 8, 8 30 o’clock at night and you can try and date, it’s.

[00:12:19] Probably not considered very sexy. I like to say I’m a grandma and I need to go to bed at, you know, after my 5:00 PM dinner kind of thing. But yeah, it, it is touching on the social aspect of it. The need for sleep and the need for rest can have such a impact on so many aspects of a social life. I’m actually a caregiver to my dad going through cancer right now, and I’m finding I actually have worse fatigue than him.

[00:12:48] It’s giving you a whole new perspective of how bad fatigue is when you live with a rheumatic disease. And back onto Cheryl. 

[00:12:57] Speaker 2: Yeah, absolutely. Sorry, and I’m gonna [00:13:00] throw it back to Deborah Da Costa because we wanna utilize your, your expertise as well. You, you did, you alluded to some research that you’re about to publish, it sounds like on CBTI four, which is again, cognitive behavior therapy for insomnia for people with arthritis.

[00:13:15] Is there any other, exciting or groundbreaking research projects that you wanna kind of highlight that are underway for you? 

[00:13:22] Speaker 3: Oh, absolutely. So another area of research for the last couple of decades is mental health during the transition to parenthood. So for both moms and birthing persons as well as dads and non birthing co-parents.

[00:13:37] So I’ve done a lot of work to, try to understand the transition to parenthood and really to promote mental health during this life stage, which can be very challenging. And although living with a chronic condition is a risk factor for depression during the perinatal period. There really is very few studies that have looked at the transition to parenthood in [00:14:00] people living with arthritis and what it’s like to be new parents and what some of the challenges are.

[00:14:04] So that’s one of the studies that we’ve recently launched for patients with autoimmune arthritis to, with young children to really identify what their mental health needs are so that we can develop better supports and resources to, that are tailored for young parents living with arthritis.

[00:14:24] Eileen Davidson: I wanna say that’s really incredible because one thing I’ve noticed as being a parent myself and living with rheumatic disease, my son is 12 now. So I think some of the unique challenges of having a, a young child is passed. But I also found in research there was so much about, I. Can we have a baby? Is it okay to take our medications?

[00:14:44] But little of what about when the child is here, because that’s gonna last a lot longer than the pregnancy. And so I really thank you for taking on that role of touching base on that research topic because it’s one that I haven’t [00:15:00] really seen around now. Have provided us with some valuable information and some insights into current research that’s going on with you.

[00:15:11] And we are at the end of our terribly short conversations here. There’s so much that we could talk on, but I’m wondering what is the most important takeaway you’d like for someone to gain from this episode? 

[00:15:24] Speaker 3: Sleep matters. Absolutely. If you’re experiencing sleep difficulties, talk to your healthcare provider.

[00:15:30] There are non-medical approaches to help improve your sleep. Absolutely that’s 

[00:15:38] Speaker 2: in incredible, and I’m just gonna throw in one more fact, I hope this is okay to say, but something that blew my mind was that people with rheumatoid arthritis specifically are at a hugely greater risk of all sleep disorders than even if they have no other risk factors.

[00:15:53] So, so like for me, I thought, well, there’s no way I could ever have sleep apnea because I don’t snore and I [00:16:00] don’t have any of the other kind of risk factors associated. With sleep apnea, but it turns out you can still have sleep apnea and if you don’t do those things, so, so, I’ll put a citation link to that, but I always encourage people when I do my support groups to to if, like you said, get help from your providers if you’re having difficulty with sleep.

[00:16:20] So thank you so much again, Dr. Acosta. It’s been amazing talking to you. If people wanna connect with you further or learn more, where do you recommend that they go? 

[00:16:30] Speaker 3: They can email me. Oh, great. Absolutely. So it’s Debra dacosta@mcgill.ca. 

[00:16:38] Speaker 2: Great. And we are also gonna put links to your profiles at arthritis Research Canada and at your university as well, so people can Perfect.

[00:16:47] Dig into your research if they wanna learn more. Great. Thank you. 

[00:16:51] Eileen Davidson: Incredible. Thank you so much for joining us today. It’s been an absolute pleasure and I know our paths will cross again soon. 

[00:16:59] Speaker 2: Yay. [00:17:00] Thank you all. Thank you. And everyone reminder to go to the show notes to see all the links to things that Dr.

[00:17:05] DaCosta and Eileen and I discussed today. Thanks so much. Bye-bye for now.[00:17:11]

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