Sleep is one thing many of us are lacking in. About one in three Americans say they don't get the recommended seven to nine hours of restful sleep each night. Atopic dermatitis (AD) can make a good night's sleep even harder to come by.
Between 33% and 90% of adults with AD have trouble sleeping. The lack of sleep can have big effects on your quality of life. But a few easy hacks can help you rest more soundly.
Why Sleep Is Important With Atopic Dermatitis
Sleep is important in general. When you don't sleep enough, your health and emotional well-being suffer. People who are sleep-deprived miss work and visit the doctor more often than those who sleep soundly.
The lack of sleep can also make it harder for you to concentrate and get out socially. Driving while sleepy increases the risk of car accidents. Excessive tiredness can also make you moodier and more cranky than usual.
If you have AD, a lack of sleep could make your symptoms flare up. And people who have both eczema and sleep problems tend to be less healthy than those who don't have these two conditions.
How Atopic Dermatitis Disrupts Sleep
Both children and adults with AD say they have trouble falling asleep. They also wake up more often during the night and feel sleepy during the day as a result. You're more likely to have trouble sleeping if your AD is severe or you're in the middle of a flare.
The most likely cause of sleep disruptions in AD is itching, which tends to get worse at night. One possible reason for the itch is that the skin barrier doesn't work as well at night, leading to more water loss and drier, itchier skin.
When you're itchy, you scratch. Constant scratching damages your skin. In response, your body launches an allergic response. The chemicals released during that response cause even more middle-of-the-night awakenings and more disrupted sleep. They also damage your skin, making the itch even worse.
A lack of sleep also changes your immune system, boosting levels of inflammatory chemicals like interleukin-6 (IL-6) and IL-12 in your body. It also lowers levels of melatonin, a hormone that promotes sleep. Lower levels of these chemicals might be another reason why you don't sleep well. Also, sleep disorders like obstructive sleep apnea are more common in people with AD, possibly because both conditions feature inflammation.
Eventually, you'll get into a cycle where AD prevents you from sleeping, which will make your itching and other symptoms even worse.
Do You Have a Sleep Problem?
It may be easy to tell when you're not getting enough sleep by how groggy and cranky you feel the next day. Tests like these can confirm whether you have a sleep issue:
Sleep diary. This is the easiest and lowest-tech way to track your sleep. Write down when you went to bed and woke up each day, how long it took you to fall asleep, and the number of times you woke up during the night. You can also note:
- Whether you had caffeine or alcohol close to bedtime
- How much exercise you did, and when you worked out
- Your bedtime routine
- The temperature in your bedroom
- What you wore to bed
- Which treatments you used
Share your diary with your doctor. It will give them information they need to adjust your treatment.
Sleep study. This test is done overnight while you sleep. Electrodes placed on your face, chest, belly, and legs capture information like your brain activity, muscle movements, and eye movements to see how soundly you're sleeping. You can have this test done at a sleep laboratory or do it yourself with a portable monitor at home.
Wearables and sensors. You either wear a device around your wrist or put it underneath you while you sleep. It measures your movements to track when you're asleep and when you're awake.
How to Get More Sleep
Try following these tips to help you sleep better.
Take your medicine
If you can't sleep well, ask your doctor about making changes to your treatment plan to get your AD under better control. Therapies like these reduce itch and inflammation, which could help you sleep better:
- Topical corticosteroids and tacrolimus – apply these at night before you go to bed
- Immunosuppressants such as azathioprine (Azasan, Imuran), cyclosporine (Gengraf, Neoral, Sandimmune), and methotrexate (Jylamvo, Trexall, Xatmep)
- Topical Janus kinase (JAK) inhibitors like ruxolitinib (Opzelura)
- Biologic drugs like dupilumab (Dupixent) and nemolizumab (Nemluvio)
- AhR agonist – tapinarof 1% cream (Vtama)
- Wet wraps — apply moisturizer to your skin and then cover it with a damp cloth or gauze
- Light therapy
Try CBT-I
CBT-I stands for cognitive behavioral therapy for insomnia. It's a type of therapy that aims to help you sleep better. You work with a therapist for six to eight weeks to change the thoughts and behaviors that are preventing you from sleeping. Most people who try CBT-I report less insomnia and improved sleep quality.
Take melatonin
This hormone, which your body naturally makes, helps to regulate your circadian rhythm, or sleep-wake cycle. Taking melatonin before bedtime might help you fall asleep faster and make your AD less severe. Researchers still haven't confirmed what dose of melatonin works best and how long you need to stay on this supplement.
Clean up
Irritants lurk everywhere in your bedroom. Dust mites, pet dander, pollen, and mold spores hide in curtains, bed linens, and carpeting. These allergens make AD symptoms worse. Get rid of them with these methods:
- Vacuum, sweep, and dust often.
- Clean your curtains and blinds.
- Put an anti-allergy cover over your mattress and pillow.
- Wash your sheets, pillowcases, and duvet covers in hot water.
- Vacuum your mattress every time you wash your bedding.
Keep it cool
Heat can worsen AD symptoms. Set your bedroom thermostat between 60 and 64 degrees Fahrenheit. Turn on a fan or the air conditioner to maintain this temperature range. Use a humidifier or dehumidifier to keep the humidity in your room at a constant level.
Don't sleep on a memory foam mattress. Because it conforms to your body, air can't circulate around you, and you'll get hotter.
Use cotton sheets. They feel cool and soft against your skin, plus they absorb moisture when you sweat. Layer a cotton blanket and duvet on top. You can pull them off during the night if you get too warm. Night clothes made from cotton, bamboo, or silk are cool and comfortable. If you often scratch at night, you may want to wear cotton gloves to bed.
Moisturize
Keeping your skin well-moisturized is important at any time of day, but especially at night when itching could wake you up. Apply a thick layer of emollient or moisturizer to your skin within an hour before you go to bed. Cover it with wet wraps or bandages to hold in moisture.
Trim and file your nails
Keep them short and smooth to prevent you from damaging your skin if you scratch during the night. You can also wear gloves to bed.
Try progressive relaxation
Research has shown this technique can help reduce itchiness and improve sleep in people with AD. Starting with your feet, tighten one group of muscles at a time. Hold the contraction for 10 seconds and then relax for 20 seconds. Work your way through each muscle group until you reach your head.
Practice good sleep hygiene habits
Add these to your sleep routine:
- Go to bed and wake up at the same times each day.
- Do something relaxing before bed. Take a warm bath, do gentle stretches, or listen to calming music.
- Turn off your phone, tablet, and TV at least two hours before bedtime. The blue light their screens release suppresses melatonin.
- Keep your bedroom as quiet as possible.
- Avoid caffeine close to bedtime.
Visit a sleep specialist
Get screened for sleep disorders like obstructive sleep apnea and restless legs syndrome. If you have these disorders, they might be keeping you awake.
Take a sleep aid
If other methods don't help, these medicines may help promote sleep. But they do come with some risks.
Antihistamines like diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton) make you sleepy and may reduce AD itchiness. But your body could become tolerant to them after a few days, plus they come with side effects like dry mouth and blurry vision.
Benzodiazepines such as alprazolam (Xanax) and diazepam (Valium) make you sleepy, but they could be addictive, cause memory problems, and increase the risk of falls.
Clonidine (Nexiclon XR, Onyda XR) is a blood pressure drug. Sleepiness is a side effect. You'll need to check your blood pressure while taking clonidine to make sure it doesn't drop too low. Clonidine can also cause side effects like dry mouth, weakness, and headache.
Show Sources
SOURCES:
Cleveland Clinic: "Sleep Disorders."
European Journal of Allergy and Clinical Immunology: "Mind and Skin: Exploring the Links Between Inflammation, Sleep Disturbance, and Neurocognitive Function in Patients with Atopic Dermatitis."
Journal of Allergy and Clinical Immunology: "Sleep Disorders and Atopic Dermatitis: A 2-Way Street?"
Journal of Investigative Dermatology: "Sleep Disturbances in Adults with Eczema Are Associated with Impaired Overall Health: A US Population-Based Study."
MedlinePlus: "Clonidine."
National Eczema Association: "20 Lifestyle and Health Hacks for Controlling Eczema."
National Eczema Society: "Sleep and Eczema."
National Jewish Health: "Eczema: Lifestyle Management."
National Heart, Lung, and Blood Institute: "Sleep Diary," "What Are Sleep Deprivation and Deficiency?"
National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Atopic Dermatitis: Diagnosis, Treatment, and Steps to Take."
Sleep Foundation: "Cognitive Behavioral Therapy for Insomnia (CBT-I): An Overview."
The Journal of Allergy and Clinical Immunology: In Practice: "Sleep Disturbances and Atopic Dermatitis: Relationships, Methods for Assessment, and Therapies."
