Mental Health Spotlight: Eczema and Sleep

Sleep problems are common in people with eczema. Some studies estimate that up to 80% of children and 90% of adults with eczema have some kind of sleep issues, especially during flares.

According to 2017 research, people with eczema are nearly three times as likely as people without eczema to feel like they don’t get enough sleep each night. They are also more likely to

• have trouble falling asleep
• wake up during the night
• wake up early
• feel unrested after sleep

Sleep problems were the third most bothersome symptom of eczema collectively reported by people living with the condition in a web-based survey hosted by the More Than Skin Deep initiative. This symptom came behind only itch and skin appearance.

Symptoms of eczema like itchiness and inflammation tend to get worse at night, which can lead to sleep trouble. This is partly because the body naturally releases heat during the hours leading up to sleep time, which can irritate the skin and trigger eczema symptoms right before going to bed.

As a result, kids with eczema tend to sleep most soundly once they’ve reached their coolest body temperature during the night, between 2 to 4 a.m.

People with eczema may also have difficulty sleeping because symptoms like skin pain and itch can wake them up in between sleep cycles. Sleep cycles in children are shorter than in adults, which may be why it seems kids with eczema are awake and itching so frequently during the night.

Sleep is an important part of both physical and mental health. The American Academy of Sleep Medicine suggests that all adults should get at least 7 hours of sleep or more each night. Sleep needs are higher in children: Teens should get between 8 and 10 hours of sleep each night, with sleep needs increasing even more for younger age groups.

Too little sleep or poor-quality sleep can negatively affect your mental health. According to research from the Centers for Disease Control and Prevention (CDC), people who don’t get enough sleep (less than 6 hours per day) are 2.5 times more likely to experience frequent mental distress compared with people who get more than 6 hours of sleep each night.

Sleep issues have been linked to a number of different mental health conditions, including:

• depression
• anxiety disorders, such as panic disorders or obsessive-compulsive disorder (OCD)
• post-traumatic stress disorder
• eating disorders
• psychiatric disorders, such as borderline personality disorder and schizophrenia

It’s possible that people with mental health conditions may be more likely to have trouble with sleep, which would explain why these disorders are so common among people with sleep concerns.

However, results from more than 65 studies demonstrate that improving sleep quality improves many aspects of mental health, including depression, anxiety, and stress. These results indicate a causal relationship between sleep and mental health concerns. This suggests that sleep issues can directly affect the mental health of people with eczema.

The relationship between stress and sleep concerns is bidirectional — sleep problems can cause stress, and stress can cause sleep problems.

Sleep plays an important role in your brain’s ability to process emotions. During sleep, especially rapid eye movement (REM) sleep, the brain reflects on all of the things you did during the day and processes the negative (and positive) emotions attached to these experiences. This may explain why some people have very vivid or emotional dreams during periods of stress.

Emotional processing during sleep is necessary for regulating day-to-day stress levels. Without enough quality REM sleep, people may wake up in the morning in a bad mood, still burdened by the stress their brain didn’t get the chance to process the night before.

People who have high levels of daily stress are especially prone to feeling these effects. According to a study from the American Psychological Association, 45% of people with self-reported high stress levels say that they feel even more stress if they don’t get enough sleep.

This can be problematic for people with eczema, since stress is a common trigger for eczema symptoms. Levels of cortisol — the stress hormone — increase during times of stress, which can affect the immune system and lead to inflammation.

In this way, people with eczema are susceptible to a cycle of sleep problems, stress, inflammation, and itchiness that it can feel difficult to break free from.

It may seem difficult at times, but quality sleep with eczema is possible. The National Eczema Association and the American Academy of Dermatology share several tips for getting a good night’s sleep while living with a skin condition like eczema:

• Establish a bedtime routine. Go to bed and wake up at the same time every day, even on weekends. Minimize exposure to bright lights and electronic devices at least 2 hours before bedtime. Keep the bedroom cool, dark, and quiet.
• Take a warm bath before bed. A warm bath before bed can help with your body’s natural process of temperature regulation before sleep. It can also help relieve dryness and itchiness from eczema — just be sure to moisturize after.
• Limit or avoid naps. Napping during the day can make it harder to fall asleep at night.
• Pay attention to eczema triggers. Excessive heat, certain types of fabrics, and skin care products with fragrances can trigger eczema symptoms. Make sure none of these possible triggers are part of your nighttime routine, otherwise they may be causing itchiness or irritation overnight.
• Be mindful of caffeine. Skip caffeine consumption after lunch to ensure it’s not interfering with your ability to fall asleep at night.
• Practice stress-relieving techniques. Laughter before bedtime can help the body produce more melatonin — the sleep hormone — and may help with sleep. Mindfulness exercises, such as progressive muscle relaxation, can help improve sleep quality, too.
• Follow your eczema treatment plan. Keeping your eczema symptoms under control can help prevent flares that can lead to sleep loss. If your current treatment plan isn’t managing your symptoms well, your dermatologist can help reassess whether a different approach may be needed.
• Leverage your medications. If your treatment plan includes an antihistamine, consider taking it at night to help promote sleepiness.

Sleep issues are common in people with eczema, which can contribute to stress and mental health concerns. Stress is a common trigger for eczema symptoms, which can lead to a frustrating cycle that can negatively affect your mental and emotional health.

Managing your eczema and practicing good sleep habits can help avoid or minimize sleep problems. If your eczema symptoms are making it hard to get a good night’s sleep, a dermatologist can help you identify solutions to provide nighttime relief.