Ankylosing spondylitis (AS) is a type of inflammatory arthritis that often affects the spine but can have broad effects on the entire body and overall wellness. The symptoms and comorbidities of ankylosing spondylitis may lead to sleep issues, such as insomnia.

Insomnia is a common sleep disturbance that affects a person’s ability to fall asleep, stay asleep, or get high quality sleep.

There are two types of insomnia: short-term and chronic.

Short-term insomnia lasts for days or weeks and occurs due to temporary factors, such as changes in sleep routine, travel, stress, or other issues. Doctors will describe insomnia as chronic if it occurs three or more times per week for a minimum of 3 months and does not seem to be due to another health condition.

Insomnia can also be either primary or secondary. Primary insomnia occurs for no known reason, whereas secondary insomnia is due to an underlying condition, such as anxiety or depression, or other known factors.

Living with AS can affect a person’s sleep duration and quality. These disturbances can have a negative effect on a person’s overall quality of life.

This article discusses the connection between insomnia and AS and provides some tips on how to manage insomnia.

The body of research looking specifically at AS and insomnia is generally sparse. As a result, studies examining the effects that AS has on sleep are also limited.

The scant data mean that sleep disturbances may affect anywhere from 64.8% to 91.0% of people living with AS. However, most of the available studies focus on other sleep issues not necessarily related to insomnia.

The researchers behind a 2019 study propose that AS increases the risk of new-onset sleep apnea. The study showed that people with a new diagnosis of AS had an increased risk of developing sleep apnea within the first 2 years following diagnosis. The population most at risk were people aged 40–50 years.

This study supports the findings of a 2015 study, which indicated that people with AS have a 30.9% higher risk of developing obstructive sleep apnea than people without AS.

An older study from 2012 reports that the symptoms of AS affect various aspects of sleep, increasing the time it takes to fall asleep and raising the chance of waking during the night. The authors conclude that these sleep disturbances negatively affect a person’s quality of life.

AS can cause a variety of symptoms, including pain and stiffness. Comorbidities, such as anxiety and depression, are also common. These different factors may cause secondary insomnia in people living with AS.

Depression and anxiety

Depression and anxiety can often lead to sleep disturbances, such as insomnia, which can be both a symptom and a comorbidity of these two conditions.

Research has shown that people living with AS have a much higher chance of developing depression than the general population.

As a result, a person with AS who is also living with depression, anxiety, or both may find that they experience insomnia.


The pain that AS can cause may sometimes lead to insomnia. Studies have also shown that pain and insomnia can make each other worse.


Stress can worsen insomnia. If a person experiences insomnia, the stress associated with not getting enough sleep can make it more difficult to fall asleep. In other words, a person enters a cycle of stress and sleeplessness.

People living with AS who experience insomnia may benefit from talking with a doctor about their sleeping issues. The doctor may be able to help identify the root cause of the insomnia, which can then allow them to address it directly.

Treating and keeping AS under control can help improve the symptoms, including insomnia.

A person can adopt good sleep hygiene practices to minimize the likelihood of insomnia. These practices include:

  • avoiding large meals late at night
  • going to bed only when sleepy
  • avoiding caffeine
  • setting a regular sleep schedule
  • avoiding screen time before bed
  • refraining from hitting snooze on the alarm clock
  • setting up a suitable environment in the bedroom by minimizing noise and light and making the room cool
  • leaving the bedroom if unable to fall asleep
  • avoiding napping during the day

AS may cause a person to experience insomnia. In some cases, insomnia may be the result of a direct symptom, such as AS-associated pain. In others, it may occur indirectly because of a comorbidity, such as depression or anxiety.

A person should talk with a doctor if they experience insomnia. The doctor may be able to help them find a solution. A person can also take steps to improve their sleep, such as avoiding caffeine and establishing a fixed bedtime routine.