TNF and insomnia: According to the authors, this suggests a feedback loop between sleep maintenance, slow-wave sleep, and cellular inflammation.44 Treatment of RA patients with anti TNF- alpha therapy has been shown to improve sleep quality.35Another study reported improvement in insomnia scores in RA patients treated with Upadacitinib.45 Similar improvements in sleep quality after treatment with anti-TNF agents have been seen in patients with inflammatory bowel diseases and ankylosing spondylitis.37,46 This suggests the role of inflammatory cytokines and disease activity on sleep quality.