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Despite this, it is only subjective sleep which has been commonly measured in epidemiological studies because, historically, it has been difficult to objectively measure sleep outside artificial laboratory settings.

Thus, a comprehensive assessment of sleep health requires measurement of objective and self-reported sleep domains, including appraisals of sleep quality and quantitative estimates of sleep continuity and duration.

First, sleep is a multifaceted behavior comprising both objective and subjective components. However, few studies have determined the relationship between sleep variables and HRQoL and understanding whether these sleep disturbances reduce HRQoL remains a challenge. During a disease flare, people with RA experience more fragmented sleep, shorter total sleep time, and lower sleep efficiency. Studies of sleep in RA have reported less total sleep time, more waking periods after sleep onset, higher levels of nonrestorative sleep, and increased periods of mini arousal. Sleep disturbances are common in RA and have been identified by patients as a possible driver of low HRQoL. RA disease activity is a major contributor to lower HRQoL, although HRQoL remains significantly lower than that of the general population, even in those with well-controlled disease. There are likely numerous causes for poor HRQoL. People with RA have poorer HRQoL compared with patients with other rheumatic diseases and the general population. People living with rheumatoid arthritis (RA), a long-term progressive autoimmune disease, experience a significantly reduced health-related quality of life (HRQoL), which can be characterized as the impact a condition has on physical, emotional, and social well-being.

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