Exploring the Intricate Link Between Lupus and Sleep

May 23, 2025 | Blog, Health, Insomnia, Sleep Apnea, Sleep Disorders, Sleep Tips

Imagine turning out the light exhausted, only to wake up feeling just as tired, achy and foggy headed. For roughly half to three quarters of people living with systemic lupus erythematosus (SLE), that is not an occasional rough night, it is the norm (Palagini et al., 2014). Below we take a look at why lupus so often hijacks good sleep, why that matters, and what you can do about it.

The Loop Between Lupus and Sleeplessness

Lupus sparks chronic inflammation and pain, and poor sleep magnifies both problems. Researchers have shown that getting fewer than seven hours a night can even raise the odds of developing lupus in at‑risk relatives (Young et al., 2018). Once the disease is established, broken sleep feeds more fatigue, pain, and the “lupus fog” many patients describe (Harrison, n.d.). Inflammation disrupts sleep, and lost sleep drives more inflammation (Haspel et al., 2020).

Common Sleep Disrupters

  • Pain and joint swelling. Achy joints make it harder to fall or stay asleep (Gudbjörnsson & Hetta, 2001).
  • Medications. Hydroxychloroquine can occasionally trigger restless agitation. Biologics such as belimumab have been linked to early‑treatment insomnia, though problems often fade with time (Manzo et al., 2017; Strand et al., 2019).
  • Hormones and the body clock. Flares can disturb the circadian rhythm that tells us when to feel sleepy.
  • Sleep apnea. People with lupus are more likely to have obstructive sleep apnea (OSA), repeated breathing pauses that jolt the body awake night after night (Meidan et al., 2023). Untreated OSA not only ruins sleep but also raises heart and stroke risk, already a concern in SLE.

Why Pushing Through Is Risky

Chronic sleep loss can blunt vaccine responses, weaken infection‑fighting cells, and fuel depression (Haspel et al., 2020). Among women followed for decades, routinely sleeping five hours or less almost doubled later lupus risk (Choi et al.,2022). In people who already have SLE, poor sleep tracks with higher disease‑activity scores and more frequent flares (Palagini et al., 2014).

Steps Toward Better Nights

  1. Create a sleep‑friendly space. Keep the bedroom dark, cool, quiet, and free of pets that steal your pillow.
  2. Power down early. Screens pump out blue light that tells the brain it is daytime. Switch them off at least half an hour before bed.
  3. Rethink evening habits. Large meals, caffeine, and alcohol can fragment sleep. Finish dinner two hours before lights‑out and swap the nightcap for herbal tea.
  4. Stay active at the right time. Regular daytime movement eases pain and promotes deeper sleep. Vigorous workouts right before bed can have the opposite effect.
  5. Ask about screening for sleep apnea. Loud snoring, morning headaches, or waking up gasping are red flags. Home monitors can spot OSA, and modern treatments often bring dramatic relief (Meidan et al., 2023).
  6. Review medications. If insomnia starts after a new prescription, timing or dosage adjustments may help (Manzo et al., 2017).

When to Call Your Doctor

If you spend seven to nine hours in bed yet still feel wiped out, or if mood changes, brain fog, or pain are ramping up, bring it up at your next visit. Together you can decide whether to order a sleep study, tweak medications, or add pain‑management or counseling support. Lupus may complicate sleep, but persistent exhaustion is not something you have to accept.

Learn More

At Somnology, we understand the complex role sleep plays in overall wellbeing. Our platform enables ongoing sleep monitoring, helps detect sleep disruptions early, and connects individuals with sleep specialists to create tailored care plans that support long-term health and wellbeing. Visit our website to learn more.

Sources:

  1. Centers for Disease Control and Prevention. (2024, May 15). Lupus Basics. https://www.cdc.gov/lupus/about/index.html
  2. Choi, M. Y., Malspeis, S., Sparks, J. A., Cui, J., Yoshida, K., & Costenbader, K. H. (2022). Association of sleep deprivation and the risk of developing systemic lupus erythematosus among women. Arthritis Care & Research, 75(6), 1206–1212. https://doi.org/10.1002/acr.25017
  3. Gudbjörnsson, B., & Hetta, J. (2001). Sleep disturbances in patients with systemic lupus erythematosus: a questionnaire-based study. Clinical and experimental rheumatology, 19(5), 509–514.
  4. Haspel, J. A., Anafi, R., Brown, M. K., Cermakian, N., Depner, C., Desplats, P., Gelman, A. E., Haack, M., Jelic, S., Kim, B. S., Laposky, A. D., Lee, Y. C., Mongodin, E., Prather, A. A., Prendergast, B. J., Reardon, C., Shaw, A. C., Sengupta, S., Szentirmai, É., Thakkar, M., … Solt, L. A. (2020). Perfect timing: circadian rhythms, sleep, and immunity – an NIH workshop summary. JCI insight, 5(1), e131487. https://doi.org/10.1172/jci.insight.131487
  5. Harrison, M. (2022). The Lupus-related Fatigue and Cognitive Dysfunction: The Chicken and the Egg. Hospital for Special Surgery. https://www.hss.edu/conditions_lupus-fatigue-cognitive-dysfunction.asp
  6. Lamore, R., 3rd, Parmar, S., Patel, K., & Hilas, O. (2012). Belimumab (benlysta): a breakthrough therapy for systemic lupus erythematosus. P & T : a peer-reviewed journal for formulary management, 37(4), 212–226.
  7. Lupus Foundation of America. (2021). Sleep better when you have lupus. Retrieved August 22, 2022, from https://www.lupus.org/resources/ways-to-get-better-sleep-when-you-have-lupus
  8. Manzo, C., Gareri, P. & Castagna, A. Psychomotor Agitation Following Treatment with Hydroxychloroquine. Drug Saf – Case Rep 4, 6 (2017). https://doi.org/10.1007/s40800-017-0048-x
  9. Meidan, R., Elalouf, O., Tauman, R., Furer, V., Polachek, A., Wollman, J., Eviatar, T., Zisapel, M., Levartovsky, D., Seyman, E., Elkayam, O., & Paran, D. (2023). Systemic Lupus Erythematous and Obstructive Sleep Apnea: A Possible Association. Life, 13(3), 697. https://doi.org/10.3390/life13030697
  10. Palagini, L., Tani, C., Mauri, M., Carli, L., Vagnani, S., Bombardieri, S., Gemignani, A., & Mosca, M. (2014). Sleep disorders and systemic lupus erythematosus. Lupus, 23(2), 115–123. https://doi.org/10.1177/0961203313518623
  11. Strand, V., Berry, P., Lin, X., Asukai, Y., Punwaney, R., & Ramachandran, S. (2019). Long-Term Impact of Belimumab on Health-Related Quality of Life and Fatigue in Patients With Systemic Lupus Erythematosus: Six Years of Treatment. Arthritis care & research, 71(6), 829–838. https://doi.org/10.1002/acr.23788
  12. Young KA, Munroe ME, Harley JB, et al. Less than 7 hours of sleep per night is associated with transitioning to systemic lupus erythematosus. Lupus. 2018;27(9):1524-1531. doi:10.1177/0961203318778368