Claire Park, a pediatric nurse and mom to a 2-year-old in Atlanta, has been battling atopic dermatitis (AD) on her hands for years. But in the last 5, it’s gotten so bad that nighttime itching keeps her awake.
During the day, Park can keep her mind off the itch. But when she’s falling asleep it’s harder and she notices it more. “I keep thinking about it, and it keeps me awake,” she says.
She has plenty of company. Research has found that as many as 80% of children with atopic dermatitis have trouble sleeping because of it, and between one-third and 87% of adults do.
“People who have atopic dermatitis are often itchier at night, which disrupts their sleep,” says Melissa Piliang, MD, a dermatologist at Ohio’s Cleveland Clinic.
The itch alone can wake you up. Or you may scratch yourself while still asleep, and that wakes you up. In extreme cases, Piliang says, you could wake up covered in blood from all the scratching.
Why Sleep Matters When You Have AD
Sleep is a main component of a healthy life. It’s incredibly important for your mental function and emotional well-being. If you aren’t sleeping well, you won’t do well at work or school. And being chronically fatigued makes you feel terrible. Plus, a lack of sleep can change how you interact with others. All that can boost your stress level, which, in turn, “has a negative impact on your eczema and your skin,” Piliang says.
Experts aren’t exactly sure why stress makes AD worse, but it may have to do with a link between the stress hormone cortisol and inflammation levels in your body. At the same time, stress makes your immune system less able to do its job. Plus, when you’re stressed, you may not eat well or exercise often.
It becomes a vicious feedback loop, because the stress makes your eczema worse, Piliang says. And that makes it hard to sleep, which increases your stress. Studies show that people who have atopic dermatitis that disrupts their sleep say they have a lower quality of life as a result.
It can also impact you if you have a bed partner or child that often wakes up in pain or itching terribly. Studies show parents of children with atopic dermatitis have worse sleep, too.
How to Get Better Sleep
Use a humidifier
Dry skin makes atopic dermatitis worse, so running a humidifier, which provides a cool or warm mist, will help keep your skin from drying out. If you don’t have a humidifier, Piliang suggests placing a bowl of water in front of an air vent.
Stay cool and comfortable
Sweating will make your itching worse. A lower body temperature helps keep skin inflammation in check. So turn your thermostat down at night to keep you cooler.
If allergens in your environment are an eczema trigger, use dust mite covers on your mattresses and pillows. Pick linens that are easy to wash and feel soft and cooling, like linen, cotton, or bamboo. The same goes for your PJs. “Find something that is soft, comfortable, and loose-fitting,” Piliang says.
Ease the itch
Use a good moisturizer or medicated ointment at night. Ask your dermatologist for ideas. Then put your pajamas on right away to help it soak in.
Icepacks can also help relieve intense itching, because the sensations of cold and itch are on the same nerve fibers, Piliang says. Your body can’t experience both of them at the same time, so it will focus on the cold. Piliang suggests using small frozen ice packs for kids or bags of frozen peas.
One of the things that works best for Park is plunging her hands into icy cold water before bed, which seems to “reset” her itchy skin. She then covers her hands in thick moisturizing cream and sleeps with cotton gloves when her AD is really acting up.
Scratching makes your body release the chemical histamine, which makes you itchier. Over time, scratching also thickens your skin, making it more likely that you’ll have atopic dermatitis. Scratching can damage your skin, putting you at risk for infections. To control it:
- Wear cotton gloves or socks on your hands at night to remind you not to scratch and to put a barrier between your skin and your hands.
- Trim your nails so they’re less likely to cause histamine release or break your skin if you do end up scratching.
Practice good sleep hygiene
Follow these routines to give you the best shot at restful sleep:
- Stay off screens an hour before bed
- Limit your caffeine intake to the morning.
- Find a deep breathing exercise that helps you relax before bed; 4-7-8 breathing is a good one to try.
- Try guided meditations that help you relax.
- Keep a regular wakeup time and bedtime to help your body know when it is time to sleep.
See a Dermatologist if You Still Can’t Sleep Well
Your doctor could prescribe a medication for sleep or medications to treat your atopic dermatitis or lessen itching, including:
- Antihistamines you take at night. They ease the itch and help you sleep through it.
- Oral steroids, which can calm inflammation
- Other non-steroid medications that help with skin inflammation that results from AD
- Light therapy
- Medications or supplements for sleep like melatonin. Atlanta mom Roxanne Buckman uses it when she’s having a lot of stress.
Your doctor might try a new type of lab-made medication that affect eczema’s causes at the cellular level. The first to market was dupilumab (Dupixent), says Michelle Pelle, MD, medical director of MedDerm Associates in San Diego, CA. It quiets Interleukin 4, one of the main cytokines (proteins that help your cells talk to each other) responsible for the itch of eczema. “In one dose, a lot of people shut off their eczema reactions,” she says.
The medication is so good at “eliminating the itch/scratch sleep cycle, it has changed people’s lives completely.”
Side effects are low, Pelle says. The medication doesn’t suppress your immune system and is approved for children as young as 6. “Dupixent is the superhero right now of eczema and prevention of sleep disturbance,” she says.
“It's important to recognize that itch is miserable,” Piliang says. “It’s almost worse than pain for some people, and it’s important to do everything you can to relieve it and get good sleep.”
Claire Park, patient, Atlanta.
The Journal of Allergy and Clinical Immunology: “Sleep disorders and atopic dermatitis: a 2-way street?”
Melissa Piliang, MD, dermatologist, Cleveland Clinic, Cleveland, OH; spokesperson, American Academy of Dermatology.
Dermatology Times: “Pearls for improving sleep in atopic dermatitis patients.”
Roxanne Buckman, patient, Atlanta.
Michelle Pelle, MD, medical director, MedDerm Associates, San Diego, CA.