Waking during the night because of pain, and stiffness on rising, are among the symptoms the NHS lists for ankylosing spondylitis. That is one of the reasons sleep deserves its own line in an AS record rather than being an afterthought.
How common poor sleep is in axSpA
Very. A systematic review of studies in ankylosing spondylitis and non-radiographic axial spondyloarthritis found poor sleep reported in between 35% and 90% of participants depending on the study and the measure, and more often than in healthy comparison groups. Across those studies, poorer sleep tended to go together with higher disease activity, more pain and lower function (Leverment et al., 2017).
The NHS lists waking regularly during the night because of pain among the symptoms of AS, alongside pain and stiffness that are worse in the morning and at night (NHS).
Which direction does it run?
Both, probably, and untangling them is hard. Pain disturbs sleep; disturbed sleep is in turn associated with more pain the following day. In the broader pain literature, sleep problems have been found to predict later pain more reliably than pain predicts later sleep problems (Finan et al., 2013), though that is a population-level finding and not a statement about any one person.
For your own record the honest position is: sleep and symptoms are related in AS, the relationship is likely to run in both directions, and what you can observe is how they move together in your own history.
What to track
| Signal | How | Why it helps |
|---|---|---|
| Hours asleep | Estimate, or from a wearable via Apple Health | The baseline everything else is compared against |
| Night waking | Times woken, and whether pain or stiffness was the reason | Distinguishes AS-related disturbance from other causes |
| Sleep quality | 0–10 on waking | Captures what hours cannot: a long, poor night |
| Morning stiffness | Duration and severity | The symptom most directly paired with the night before |
| Evening activity | Training, screen time, late meal — one line | Context for the night that followed |
You do not need a wearable. If you have one that writes to Apple Health, HAVYT can read sleep analysis, resting heart rate and heart rate variability and show them next to your check-in (Apple Health in HAVYT); if you do not, hours and a quality score entered by hand are enough.
Reading the record
After several weeks, look at the mornings with the longest stiffness and at the nights before them. Look also at the reverse: the nights with the most waking and the days before those. You are looking for whether the two tend to move together in your record — not for a cause. If they do, that is worth telling your rheumatology team, who may consider it alongside everything else they know. HAVYT surfaces this kind of association as a possible pattern to look at, and labels weak ones as weak.
What this guide does not do
It does not offer treatment for sleep problems. Persistent poor sleep — with or without AS — is something to raise with a clinician, who can consider night-time pain, the timing of medication, sleep disorders and other causes. Nothing here should change how you take any medication.