by Stefanie Remson
Medically Reviewed by:
Nancy Carteron, M.D., FACR
by Stefanie Remson
Medically Reviewed by:
Nancy Carteron, M.D., FACR
Changes in daylight hours can affect your circadian rhythm and the severity of your rheumatoid arthritis symptoms. Here are six tips to help.
Chronic pain occurs all year round. But the winter months can be especially difficult for many people living with rheumatoid arthritis (RA). Colder temperatures can make joints feel stiff and cause symptoms to flare.
While temperature plays a key role, the shorter days and longer nights during the winter months might also contribute to how your symptoms change.
It’s hard to say definitely whether RA symptoms get worse after dark because there isn’t a lot of available research. But some reports suggest that symptoms can worsen at night.
For example, a 2020 study found that visits to “pain management” pages peaked during 11 p.m.–4 a.m. on the National Health Service website, a major source of online health information in the United Kingdom.
In addition, a 1998 study explored how pain differed between night and day in people living with RA. The study found that people with active disease and greater inflammation were more likely to experience worse pain at night. People with joint damage were more likely to experience worse pain during the day.
Research from 2011 suggests that symptoms are worse in the morning for people with RA or other inflammatory conditions, with many using the term “gelling phenomenon” to describe their morning stiffness.
There could be several reasons why your RA symptoms may change at night.
When you are resting or trying to sleep, fluid can accumulate in your joints, which can cause swelling and inflammation and result in pain. Lying in a particular position might also put pressure on some joints and aggravate pain.
But it could also be due to the sun setting and the response of your circadian rhythm.
The circadian rhythm is the 24-hour cycle that includes physical, mental, and behavioral changes, such as sleeping. Essentially, it’s your body’s internal clock, and it responds primarily to cycles of light and dark.
An example of the circadian rhythm is feeling sleepy when it’s dark and waking when the sun rises, regardless of what the clock says.
RA may have a circadian rhythm component, meaning that symptoms and disease markers might vary between day and night.
One task the circadian rhythm helps regulate is your immune system, with certain bodily processes activated at different times depending on daylight hours.
For example, cortisol is one hormone with a circadian component. Cortisol typically rises at night and acts as a powerful anti-inflammatory agent.
People living with RA don’t produce enough cortisol to suppress nighttime inflammation, often leading to morning pain and stiffness.
The circadian rhythm can be disrupted by travel, work, or seasonal changes in daylight hours. This can affect how your immune system and pain response work.
A 2020 study conducted in Sweden and the United States considered the effects of daylight savings time. It found that people with chronic and stress-related immune conditions were more negatively affected by the time shift than those without these conditions.
So, there might be a link between an altered circadian rhythm with increased symptom severity in people with RA and those living with chronic conditions.
Longer nights during the winter could be one cause of this.
I personally experience more pain and inflammation during the longer, winter nights.
Every year, the symptoms seem to hit me like a ton of bricks on the Monday following daylight savings weekend. The dreaded reminders to “fall back” actually bring on slight panic in the weeks prior, too.
It has taken me a decade to find ways to manage this pain.
Here are my personal tips for managing worsened RA pain during longer, winter nights.
Some of them are types of chronotherapy.
Chronotherapy refers to optimizing a medical treatment or any intervention by taking into account the body’s circadian rhythms. For example, this can include taking medications at certain times of the day or practicing good sleep hygiene habits to encourage sleep during nighttime hours.
Any chance I can stand in the sun and reset my circadian rhythm is helpful.
Sunlight can help you reach your recommended amount of vitamin D, and this 2016 study showed that vitamin D supplementation led to lower reported pain levels.
When I move more, I have less pain and swelling, and my joints have more range of motion. I prefer exercising in the morning sunlight whenever possible during the winter, as this seems to help reset my circadian rhythm.
Research from 2017 suggests that taking methotrexate at bedtime helped people manage their RA symptoms more effectively. Several nonsteroidal anti-inflammatory drugs (NSAIDs) have also been modified to provide more focused action at night.
I got so fed up with my morning symptoms that I started setting an alarm 1–2 hours before I had to wake up to take my medications. I would go back to sleep and give them time to kick in. This worked for me, but it’s important to discuss when you’re taking your medications with your rheumatologist.
Some medications might not be suitable to take at night, and interrupting sleep could have other negative consequences. Talk with your doctor about whether timing your medications could help reduce morning symptoms.
Sleep when it’s dark outside and wake when the sun comes up. Although this can mean going to bed at 8 p.m. and waking at 5 a.m., I find this is very helpful for managing my pain, especially after daylight savings when the darkness comes much earlier.
Be consistent with your meditation and mindfulness practices. I find it beneficial to practice these both after the sun sets when it’s dark outside to help my body associate this signal with rest and eventually sleep.
Your mental health plays a big role in the management of RA pain, and it can change with the seasons. For example, seasonal affective disorder symptoms usually begin in the fall or winter.
If you begin experiencing symptoms of depression, be sure to talk with your healthcare team right away. They may recommend medications you can take for a few months during the longer, darker winter months. You can also seek counseling, therapy, or coaching for extra support.
If you have more RA symptoms at night and during the winter, you are not alone.
There are several reasons why your RA symptoms may worsen during these times. It might be due to a drop in temperature, which can affect your joints, but it might also be related to shifts in your circadian rhythm caused by changing daylight hours.
Your circadian rhythm plays a role in your immune system, and seasonal disruptions can affect your symptoms.
You might try different types of chronotherapy, such as taking medications at certain times of the day, to help relieve these changes.
Medically reviewed on January 24, 2024
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About the author
Ms. Stefanie Remson MSN, APRN, FNP-BC is the CEO and founder of RheumatoidArthritisCoach.com. She is a family nurse practitioner and is a rheumatoid arthritis (RA) patient herself. She has spent her entire life serving the community as a healthcare professional and has refused to let RA slow her down. She has worked with The Arthritis Foundation, The Lupus Foundation of America, Healthline, Grace and Able, Arthritis Life, Musculo, Aila, and HopeX. You can learn more at her website and on Instagram, Facebook, and Pinterest.