CHAPEL HILL -- Perhaps surprisingly, not being able to sleep appears to be the chief reason that older people with arthritis turn to traditional medical care, as well as non-traditional or alternative care, for relief of their illness. Sleep disruption even outweighs other arthritis concerns such as reduced mobility, not being able to visit family and friends as often and missing work or favorite recreational activities.
That's the conclusion of a new study by University of North Carolina at Chapel Hill researchers.
"We believe this unexpected finding is important because it's not well recognized by either patients or physicians," said Dr. Joanne Jordan, research associate professor of medicine at UNC-CH's School of Medicine. "As a rheumatologist, I know that you can give patients all the anti-inflammatory drugs in the world to try to control their arthritis, but if you don't take care of their sleep disruption, they may not get any better. Oftentimes, patients don't tell doctors about it because they think nothing can be done to treat problems with sleeping."
A report on the findings will be published in the February issue of the Archives of Family Medicine, which appears Thursday (Feb. 17). Besides Jordan, authors are Drs. Shulamit L. Bernard, Leigh F. Callahan, Jean E. Kincade, Thomas R. Konrad and Gordon H. DeFriese, all of UNC-CH.
The study, which involved both the university's Thurston Arthritis Research Center and Cecil G. Sheps Center for Health Services Research Center, was part of the 1993-94 follow-up to the Sheps Center's 1989 National Survey of Self-Care and Aging.
Participants were a random subsample of 937 non-institutionalized Medicare beneficiaries aged 65 and older who answered questions about strategies they used for dealing with arthritis and how the illness affected them. Such strategies ranged from traditional doctor visits and trips to chiropractors to applying heat or over-the-counter medications.
"Another reason this finding about sleep is important is that patients also may not connect their arthritis with sleep disruption, which can make their pain worse," Jordan said. "Arthritis is the most common cause of disability in people 65 and older, and it is responsible, along with other musculoskeletal disorders, for $149 billion in direct and indirect U.S. medical costs each year."
Other findings were that 66 percent of patients used over-the-counter medications, 63 percent visited physicians, 48 percent took prescription medications, almost 45 percent applied ointments or rubs and 10 percent sought out chiropractors, she said. More than 67 percent relied on rest, almost 52 percent offered prayers, about 50 percent swam or exercised in other ways, 44 percent relied on heat, cold or massage, more than 16 percent tried biofeedback, meditation or counseling and 7.3 percent wore jewelry or ate special foods.
About a third of patients asked said arthritis kept them from sleeping, Jordan said.
Wilma Howard, a 92-year-old participant in the survey and a full-time worker in the Johnston-County Osteoarthritis Project Jordan directs, wrote of her distant childhood and recent experiences with arthritis in a commentary accompanying the research paper.
"I was one of the thousands of children who lived on a farm in the early half of this century. Farm work was hard and used every muscle in our bodies," she wrote. "... My back hurts today when I think of 'pegging' tobacco. ... I carried a five-gallon bucket of fertilizer up and down the rows of cotton, corn and tobacco to drop by the side of the plants to fertilize them. ...
"Fodder pulling began in the hottest days of August. ... This was the hardest, hottest work I ever did, and I often prayed that I would not ever have to pull fodder again. After a day of strenuous work I looked forward to sleep, that period of complete relaxation and rest from pain, worry and activity. Many mornings I would tell my 'empty bed' that I would be back when my days' work was finished."
When Howard reached age 80, "my old body seemed to fall apart," she wrote. She began to ache in her back, legs, knees and hips.
"I used anything that I heard would relieve pain such as: WD 40, nine white raisins per day that had been soaked in gin, ice packs, heat, snake oil, linseed oil, acetaminophen p.m., 'Bone-eez' and, of course, prayer," she said. "I finally went to my doctor for a pain medication and something to help me sleep.
"I believe that if the arthritis pain could be relieved that my sleep and 'old self' would be back to normal or near normal again. My hope is that this young generation that has been spared the hard, strenuous work while they were young will be stronger, wiser, happier and more productive. But let me say I have had fun and enjoyed every day that I have lived even if the days were hard and bumpy."
Note: Jordan can be reached at (919) 966-0559.
Contact: David Williamson, 962-8596.
Journal
Archives of Family Medicine