Age: 38 Condition: Rheumatoid arthritis How long she’s been living with RA: 18 years I’ve always loved to sleep, but ever since my diagnosis of rheumatoid arthritis (RA) at the age of 20, I’ve really come to appreciate how important a good night’s sleep is for my overall health and well-being. Rheumatoid arthritis is a chronic autoimmune disease which causes a variety of body-wide symptoms, including joint pain and fatigue, both of which can interfere with sleep. People with RA are also at a higher risk for developing depression and anxiety, which can also make it harder to fall or stay asleep. In the last 18 years, I’ve experienced rheumatoid arthritis during many different stages of life. For example, I’ve spent nights sleeping in college dorm rooms while exhausted after a soccer game, resting in hospital beds, crashing on friends couches in city apartments after long nights of swing dancing, sleeping in basic bunk beds in volunteer housing in rural Central America, and crashing on the floor next to my newborn’s crib. As my disease activity has gone up and down and I’ve experienced major life changes, such as becoming a mom, I’ve faced many barriers to achieving a good night’s sleep. For example, disease symptoms such as pain have made it hard for me to fall or stay asleep, a phenomenon some call “painsomnia.” I’ve also had difficulty sustaining a good night’s rest due to interruptions from my child or spouse, which are followed by good old-fashioned insomnia. For example, if my child cries and wakes me at 2 a.m., it can take me up to two hours to fall back to sleep. Sometimes I’ve experienced a vicious cycle where I’m so tired I have to take a nap midday, but then due to my nap I have a hard time falling asleep at night. When an Everyday Health editor gave me the chance to try and review the Oura Ring, a wearable smart ring that tracks sleep and activity levels, it felt like perfect timing. I have so many questions about how sleep affects my RA and overall health: When I’m tired, is it from RA disease activity or from lack of sleep? What’s the difference between fatigue tiredness and sleepy tiredness? Can obtaining data from a device such as Oura help me tease apart these variables? Are naps interfering with my nighttime sleep quality? Could more daytime exercise help me sleep more deeply, which is something I’ve heard about but never experienced myself? In the last year, I had used an app that synced up with my Apple Watch in order to report my daily sleep levels, but I was curious what Oura had to offer that was different.

What Is Oura?

Oura is, to put it most simply, a smart ring. On the surface it looks like a simple piece of jewelry, but it actually has sensors inside it that communicate to an app on your phone. The app gives you basic data about your sleep and activity levels by detecting your heart rate, body temperature, and movement. It then aggregates some of the data into a daily “readiness score.”

3 Things I Liked About Oura

I tried Oura for three weeks, and here’s what I liked the most about it:

  1. The ring is lightweight. This is a huge deal for someone with hand pain! The ring is much lighter weight than the average smart watch, which means it didn’t put much extra strain on my hand or wrist joints.
  2. The app is visually appealing and intuitive. The Oura app presents my sleep and activity information in a simple yet informative manner. The app includes different kinds of graphs, charts, and written data and also provides color coding to help important things stand out. For example, sometimes my REM sleep or deep sleep numbers are much lower than usual, so the app displays these in red (rather than the default colors of white and turquoise) in order to help me pay attention to them. Also, the sleep stages graph makes it very easy to see at a glance where and when I was getting deep versus light sleep.
  3. It produces meaningful data. The app not only displays details about my sleep and activity levels, it also helps me make sense of what this data actually means for my everyday life! Three things I find particularly helpful are:

A daily Readiness Score is displayed each morning. The company defines readiness as “your ability to perform at your best both mentally and physically.” I found this super helpful because basically it means the app calculated what all the different numbers actually meant for how I might feel and function on a given day. The readiness score helps you determine whether you are in a good place to challenge yourself physically, or whether it might be best to take a rest day. This seems most helpful for people who are using the product for fitness and activity purposes.An ideal bedtime is suggested. Each day it suggested when would be best for me to get ready for bed, given my previous data. It also gave me notifications to remind me to get ready for bed.Weekly reports are displayed. Again, Oura makes meaning out of my data by presenting me with very simple, intuitive graphs about my weekly trends. These graphs cover everything from wake-up times to heart rate.

3 Things I Disliked About Oura

  1. The app doesn’t always collect accurate data on interrupted sleep, or nighttime insomnia, and there is no override feature. This is the biggest disappointment for me, because one of my main priorities is determining how sleep interruptions affect my overall health and “readiness” for daytime activities. For example, if I went to sleep at 9 p.m. and was woken up at 2 a.m. by my son, and then fell back to sleep from 4 a.m. until 6 a.m., the app would sometimes display that I had been asleep from 9 p.m. until 6 a.m. and create data based on nine full hours of sleep, rather than the seven hours of sleep I actually got. I believe this is because when I am awake in the middle of the night I sometimes continue to lay down and read on my Kindle, and my various physiological markers make it appear that I’m asleep. I contacted the developers and they confirmed that there is currently no way to “monitor polyphasic sleep” but they hope to develop it in the future. In contrast, the other app that I own that syncs sleep data from my Apple Watch tracks nighttime waking more accurately, and it also allows me to manually adjust numbers within the app if they are inaccurate. In Oura, you can manually adjust your bedtime or wakeup time but you cannot edit the data in the middle of those two points.
  2. Daily sleep graphs don’t clearly display daytime naps. Like many people living with a chronic illness, I take naps at least two times a week, and I was hoping to be able to correlate how daytime napping affected my nighttime cycles. At first it appeared that the app wasn’t tracking daytime naps because they didn’t appear in the beautifully designed graphs I mentioned earlier! However, I did more research and found that naps are included in the data but not shown in your daily sleep graphs. The daily graphs just show your nighttime sleep. This was a little disappointing because I wanted to be able to see at a quick glance how naps were affecting my other elements of sleep (such as deep versus light sleep).
  3. There are a lack of options for ring colors and styles. The ring styles currently available are pretty masculine looking, which isn’t my preferred aesthetic for jewelry. The color choices are silver, black, and dark gray. I would love to see a blush pink or a more colorful choice!

The Bottom Line

I’m a giant nerd and I love having a lot of data at my fingertips. This is especially true for health-related data. I also sometimes get overwhelmed with too much data, or when I lack understanding of what my health data actually means. I really enjoyed using the Oura Ring because it helped me not only learn my daily sleep and activity trends but also make sense of how that data affected my daily life. That being said, I do have a concern about this kind of tracking. Sometimes my readiness scale did not match my perception of how alert or healthy I felt on a given day. For example, on a few days when I woke up feeling very tired, the app rated me as feeling “rested,” whereas on other days, it rated me as not rested when I actually felt pretty good. I started becoming concerned that the readiness scale could potentially negatively alter my expectations about how a day could go; would it make me feel more tired than I actually would otherwise have felt? In other words: Knowledge is power, but too much knowledge can be dangerous depending on how the knowledge affects our expectations. This is not as much a specific criticism of Oura as it is an important point about tracking health-related data for people with chronic illnesses — it’s important for me to be careful about not letting the data from the device overrule my inner sense of my bodily state. Long story short: It’s possible to feel great and ready to face the day even when the app says my readiness scores are low, or vice versa. I am concerned that the suggestion that someone is not ready to face the day might psychologically make them feel less well than they otherwise would. For people with arthritis specifically, I would also caution you to consider that this ring might not be a good option if you have arthritis in the “proximal interphalangeal” or PIP joint, which is the one in between your knuckle and the furthest away one. This is because the Oura Ring needs to sit tightly on the skin in order to accurately gather data. Since you have to be able to get it to sit tightly in the space above your knuckle, some people with deformities or hypertrophy (increased muscle volume) of the distal finger joints won’t be able to get it on their fingers as the product is currently designed.

Other Ways I Manage Sleep With Rheumatoid Arthritis

Over the last 18 years of living with RA, I’ve tried lots of different things to help me sleep better and combat the daily fatigue that can come with this illness. When I was first diagnosed in 2003, smartphones didn’t even exist yet, much less “smart wearables” such as the Oura Ring. It’s really exciting to delve into how modern technologies can help those of us living with chronic illnesses. At the same time, I continue to benefit from some really simple, low tech strategies for maximizing my sleep. These include:

Making Sure My Environment Is Conducive to Sleep I try to keep the bed strictly for sleeping or restful activities, and make sure my mattresses and pillows are optimal for my comfort.Presleep Routines This is hard for me as I’m sometimes tempted to look at my phone right before bed, but I really try to avoid LED lighting before bed. I have a Kindle Paperwhite, which doesn’t have LED lighting. I also have started listening to daily mindfulness exercises prior to bedtime, which can help me wind down.Managing Anxiety Through working with my therapist on anxiety, I discovered that sometimes my nighttime insomnia was related to worries about the future. Since I live with a lifelong illness with no cure, it’s understandable that I would worry about that at times, but therapy has helped me cope with those worries and not allow them to spiral such that they interfere with sleep.

I’d love to hear from others about how they manage their sleep with chronic illnesses. You can follow me on Instagram @Arthritis Life, or on Twitter, Facebook, my website, or my blog. Medically Reviewed by Alexa Meara, MD.