Sleep and lupus: why sleep can be difficult and what may help

Sleep problems can make living with lupus even more difficult.

Pain may make it hard to get comfortable. Worries about your health can keep your mind active at night. Some medicines can affect sleep, and another sleep condition may sometimes be involved.

Poor sleep can also make pain, concentration, mood and everyday coping feel harder the following day.

But it is important to distinguish poor sleep from lupus fatigue. Someone can sleep for many hours and still experience significant lupus-related fatigue.

If sleep has become a problem, understanding what is disturbing it is often more useful than simply trying to spend longer in bed.

On this page

• Sleep problems and lupus
• Fatigue is not the same as sleepiness
• Pain and sleep
• Medicines that may affect sleep
• Mental wellbeing and sleep
• Building a healthier sleep routine
• What to do when you cannot sleep
• Sleep apnoea
• Restless legs syndrome
• Napping and pacing
• When to speak to your GP or healthcare team
• Questions to ask about sleep

Sleep problems and lupus

There is no single sleep problem that affects everyone with lupus.

Different things may interfere with sleep, including:

• pain or discomfort
• difficulty finding a comfortable position
• anxiety, low mood or worry
• medicines
• needing the toilet during the night
• symptoms from another health condition
• an irregular sleep routine
• insomnia
• restless legs syndrome
• sleep apnoea

Sometimes several factors occur together.

For example, pain may wake you during the night, leaving you more tired the following day. You may then rest or sleep during the daytime, which can make it harder to sleep the following night.

The first step is therefore not necessarily to find a way to “sleep more”, but to consider why your sleep is being disturbed.

Fatigue is not the same as sleepiness

This distinction is particularly important in lupus.

Fatigue can feel like an overwhelming lack of physical or mental energy.

The NHS describes extreme tiredness that does not go away no matter how much you rest as one of the main symptoms of lupus.

Sleepiness, on the other hand, usually means feeling as though you could actually fall asleep or struggling to stay awake.

It is possible to:

• sleep poorly and feel tired
• sleep for long periods and still have lupus fatigue
• experience both fatigue and sleepiness
• have fatigue even when your sleep appears reasonably good

Better sleep is important for general health and may make everyday coping easier, but improving sleep will not necessarily make lupus fatigue disappear.

If fatigue is a major problem for you, our Lupus fatigue guide looks at this in more detail.

Pain and sleep

Pain can make it difficult to:

• fall asleep
• find a comfortable position
• remain asleep
• return to sleep after waking

Repeatedly waking because of pain can leave you feeling unrefreshed in the morning.

Poor sleep can then make pain feel more difficult to cope with the following day.

If pain is regularly interfering with your sleep, tell your healthcare team.

Rather than simply trying to tolerate it at night, it may be useful to review:

• what could be causing the pain
• whether your existing pain-management plan is working
• whether your lupus appears to be active
• sleeping position
• pillows or other physical support
• whether physiotherapy or another intervention might help

Do not increase painkillers or change prescribed medicines simply to help you sleep without discussing this with an appropriate healthcare professional.

Our Managing pain with lupus guide explains pain in more detail.

Medicines can sometimes affect sleep

Some medicines can contribute to sleep problems.

One relevant example for people with lupus is prednisolone.

Difficulty sleeping and feeling restless are recognised side effects of prednisolone.

When prednisolone is prescribed as one dose each day, NHS advice commonly recommends taking it in the morning with breakfast because this makes it less likely to interfere with sleep.

However, your treatment may have been prescribed differently for a reason.

Do not change:

• the dose
• how often you take it
• when you take it
• or stop it

without following the instructions you have been given or discussing it with your doctor or pharmacist.

Other medicines can also affect sleep.

If a sleep problem started after a new medicine was introduced or a dose changed, mention this to your GP, rheumatology team or pharmacist.

A medicine review may sometimes identify something worth considering, but changes should be made safely rather than experimenting with medicines yourself.

Mental wellbeing and sleep

Living with an unpredictable long-term condition can give you plenty to think about at night.

You may find yourself worrying about:

• symptoms
• appointments or test results
• work
• family responsibilities
• whether lupus is becoming more active
• how you will manage the following day

Anxiety, stress and low mood are also recognised causes of sleep problems.

This does not mean poor sleep is simply psychological.

Sleep can be affected by physical symptoms, emotional wellbeing, medicines, habits and the environment around you — often at the same time.

If worries repeatedly keep you awake, it may help to give yourself some time earlier in the evening to write down what is on your mind or what you need to deal with the following day.

If lupus is affecting how you are feeling more generally, our Mental wellbeing with lupus guide explains where you can find further support.

Building a healthier sleep routine

Sleep habits are sometimes referred to as sleep hygiene.

There is no perfect routine that guarantees good sleep, but making your sleep pattern more consistent can help.

Keep broadly regular times

Try to get up at around the same time each morning, including after a poor night’s sleep where possible.

A regular waking time can help your body maintain a more consistent sleep pattern.

Go to bed when you feel sleepy rather than simply because the clock says it is bedtime.

Give yourself time to wind down

Try to make the period before bed quieter and less stimulating.

You could:

• read
• listen to music or something calming
• have a warm bath
• dim bright lighting
• do something relaxing that you enjoy

There is no requirement to meditate or follow a particular relaxation technique.

Find something that works for you.

Make your bedroom comfortable

A bedroom that is:

• dark
• reasonably quiet
• comfortable
• not excessively warm

may make sleep easier.

If lupus pain affects your comfort, experiment with pillows and positioning to find what supports you best.

Think about caffeine

Caffeine can remain stimulating for several hours.

Coffee, tea, cola, energy drinks and some other drinks or foods contain caffeine.

If you have difficulty sleeping, consider whether reducing caffeine later in the day makes a difference.

Alcohol is not a sleep treatment

Alcohol can make some people feel sleepy initially, but it can disturb the quality of sleep later in the night.

It should not be used as a way to manage insomnia.

Keep active where appropriate

Regular daytime physical activity can support general health and sleep.

What is appropriate will depend on your lupus, current symptoms and other health conditions.

Some people find vigorous activity close to bedtime makes it more difficult to settle, while others are unaffected.

Find a pattern that works for you rather than forcing yourself to follow a rigid rule.

What if I cannot sleep?

Trying harder to sleep often makes sleep feel even more difficult.

If you are lying awake for a prolonged period and becoming frustrated, it can sometimes help to get out of bed and do something quiet and relaxing elsewhere.

Return to bed when you feel sleepy again.

Try to avoid repeatedly checking the time.

After a poor night, it can be tempting to spend much longer in bed the next morning. Doing this regularly can make it harder to maintain a consistent sleep pattern.

One bad night does not mean the next night will necessarily be the same.

What is insomnia?

Insomnia means regularly having difficulty sleeping.

You might:

• find it hard to fall asleep
• wake repeatedly during the night
• wake very early and be unable to return to sleep
• wake feeling unrefreshed
• have difficulty concentrating because you are tired

The NHS describes insomnia lasting less than three months as short-term insomnia and insomnia lasting three months or longer as long-term insomnia.

If changing your sleep habits has not helped, you have been struggling for months, or sleep problems are making everyday life difficult to cope with, speak to your GP.

The aim is to identify what may be causing the problem rather than simply prescribing sleeping tablets.

A GP may sometimes recommend cognitive behavioural therapy (CBT) for insomnia or refer you for further assessment.

Sleeping tablets are generally only used for limited periods in particular circumstances because they can have side effects and some can lead to dependence.

Could it be sleep apnoea?

Not every sleep problem is insomnia.

Sleep apnoea causes breathing to repeatedly stop and start during sleep.

Signs can include:

• loud snoring
• breathing stopping and starting during sleep
• gasping, choking or snorting noises
• waking frequently
• feeling extremely sleepy or tired during the day
• morning headaches
• difficulty concentrating

People are often unaware that their breathing is stopping. A partner or family member may notice it first.

Speak to your GP if you have symptoms that could suggest sleep apnoea.

If necessary, you may be referred for overnight testing, which can often be performed at home.

Sleep apnoea is treatable and should not simply be accepted as another consequence of having lupus.

Restless legs syndrome

Another condition that can interfere with sleep is restless legs syndrome.

It causes a strong urge to move your legs, usually when resting in the evening or at night.

You may also experience:

• tingling
• throbbing
• itching
• uncomfortable sensations
• pain

Moving or stretching the legs may temporarily relieve the feeling.

Restless legs syndrome can sometimes be associated with conditions such as iron deficiency or kidney disease, and some medicines can make it worse.

Speak to your GP if symptoms are repeatedly preventing you from sleeping or affecting your daily life.

Do not start iron supplements unless you have been advised that you need them.

Napping and pacing

This can be difficult when you live with lupus fatigue.

If you are exhausted during the day, being told simply “don’t nap” may not always feel realistic.

However, long or late daytime naps can sometimes make it harder to sleep at night.

If you need daytime rest, you may find it useful to distinguish between:

resting — reducing activity without necessarily sleeping

and

napping — actually going to sleep.

Pacing may allow you to build periods of rest into the day without automatically sleeping for long periods.

If you do nap and nighttime sleep is becoming difficult, consider whether the timing or length of your naps could be contributing.

Our Lupus fatigue guide includes more information about pacing and managing limited energy.

What about sleep trackers and smartwatches?

Wearable devices can provide interesting information about sleep patterns, but they do not diagnose sleep disorders.

Try not to become overly focused on achieving a particular sleep score.

How you feel and function during the day is often more useful than whether an app says you achieved the “right” percentage of deep sleep.

If you are concerned about your sleep, discuss the symptoms with a healthcare professional rather than relying on a wearable to determine whether something is wrong.

When should I speak to my GP or healthcare team?

Ask for advice if:

• sleep problems have continued for several weeks or months
• poor sleep is affecting your ability to cope during the day
• pain repeatedly wakes you
• a medicine appears to be affecting your sleep
• anxiety or low mood regularly keeps you awake
• you are extremely sleepy during the day
• you regularly fall asleep unintentionally
• someone notices that your breathing stops while you sleep
• you snore loudly and wake gasping or choking
• uncomfortable leg sensations repeatedly disturb your sleep
• your sleep has changed significantly alongside other lupus symptoms

If several lupus symptoms have changed at the same time, tell your rheumatology team rather than assuming that poor sleep is the only cause.

Driving and excessive sleepiness

Do not drive if you feel too sleepy to do so safely.

Excessive daytime sleepiness can affect concentration and reaction times.

Certain diagnosed sleep conditions, including some cases of sleep apnoea, may also have DVLA requirements.

If you are experiencing significant daytime sleepiness, speak to your GP and check current GOV.UK driving guidance where relevant.

Questions to ask at your appointment

If poor sleep has become a persistent problem, you might ask:

• Could pain or another symptom be disturbing my sleep?
• Could one of my medicines be contributing?
• Could my fatigue be related to poor sleep, lupus itself, or both?
• Do my symptoms suggest insomnia?
• Could I have sleep apnoea or restless legs syndrome?
• Do I need blood tests or another assessment?
• Would a medication review be helpful?
• Would CBT for insomnia be appropriate?
• Should I be referred to a sleep service?
• Is there anything about my lupus treatment that needs reviewing?

It can help to make a brief note of your sleeping pattern before an appointment, particularly if you regularly wake during the night or experience significant daytime sleepiness.

Sleep is only one part of lupus fatigue

Good sleep matters.

It supports physical health, mood, concentration and the ability to manage everyday life.

But someone with lupus can follow good sleep habits, sleep for an apparently adequate length of time and still experience severe fatigue.

Do not blame yourself if improving your sleep does not completely resolve how exhausted you feel.

Persistent fatigue deserves to be taken seriously and considered alongside lupus activity, pain, medicines, emotional wellbeing, sleep and other possible contributing factors.

If fatigue remains a major problem, talk to your healthcare team and read our Lupus fatigue guide for more information.

About this information

This information is for general guidance and does not replace advice from your GP, rheumatology team, pharmacist or another healthcare professional.

Sleep problems can have many different causes. Do not change the dose or timing of prescribed medicines without following the instructions you have been given or discussing changes with an appropriate healthcare professional.

Information updated: September 2026

Sources used for this page

NHS — Lupus
General NHS information about lupus, including fatigue, pain and other common symptoms.

NHS — Insomnia
Information about insomnia, common causes, sleep habits, when to see a GP and treatments including cognitive behavioural therapy.

NHS Every Mind Matters — Sleep problems and improving sleep
Practical NHS guidance about sleep routines, the sleep environment and habits that may support better sleep.

NHS — Sleep apnoea
Information about symptoms including snoring, interrupted breathing, daytime tiredness and assessment through specialist sleep services.

NHS — Restless legs syndrome
Information about symptoms, possible underlying causes and when to seek medical advice.

NHS — Prednisolone
Information about sleep disturbance as a recognised side effect of prednisolone and guidance about taking once-daily prednisolone in the morning where prescribed that way.

British Society for Rheumatology — 2026 guideline for the management of children, young people and adults with systemic lupus erythematosus
Current UK specialist guidance emphasising assessment of fatigue alongside lupus disease activity and access to psychological support where needed.