SKIN IN SLEEP: UNDERSTANDING THE BIDIRECTIONAL RELATIONSHIP

Medically Reviewed by Dr. Sony Sherpa (MBBS) - March 8, 2024

Sleep serves as a cornerstone of overall health, playing a critical role in physical restoration, cognitive function, and emotional well-being. The intricate relationship between sleep and health becomes particularly evident when examining the challenges faced by people with skin conditions such as eczema, rosacea, hives, and psoriasis.

These conditions are frequently associated with significant sleep disturbances, affecting many.. The prevalence of these disturbances highlights a concerning correlation between dermatological health and sleep quality.

Types of Sleep Disturbances

Individuals with skin issues may experience a range of sleep disturbances, including:

• Insomnia: This is the most prevalent type of sleep disorder, characterized by issues with falling or staying asleep. For those with skin conditions, nighttime itching and discomfort can make insomnia more pronounced.
• Sleep Apnea: Although not directly caused by skin issues, sleep apnea can be exacerbated in people with systemic inflammation related to certain skin conditions.
• Restless Leg Syndrome (RLS): This disorder causes an uncontrollable urge to move the legs, often in response to uncomfortable sensations. RLS can be more prevalent in people with skin conditions due to itchiness and discomfort.

These sleep disorders can significantly impact sleep quality and daytime productivity, leading to fatigue, decreased cognitive performance, and impaired emotional well-being. Furthermore, disrupted sleep may not be only because of skin issues but can also contribute to their exacerbation. Poor sleep quality can worsen skin symptoms, creating a vicious cycle of discomfort and sleeplessness.

How Skin Issues Affect Sleep

Itch & Discomfort

Skin issues often bring about symptoms like itchiness, dryness, and inflammation, all of which can severely disrupt sleep cycles. It can be difficult to get to sleep and stay asleep when itchy skin is involved, especially when it is severe and persistent. Additionally, dryness and inflammation can lead to discomfort, further exacerbating sleep disturbances.

This discomfort can set off a vicious cycle of scratching and sleeplessness. The act of scratching, while providing momentary relief, can actually worsen skin irritation, leading to more itching and perpetuating the cycle. Consequently, people find themselves caught in a loop of scratching and sleeplessness, making it difficult to achieve restorative sleep.

The impact of sleep quality on daytime fatigue is profound. Continuous disruptions to sleep result in fragmented and shallow sleep patterns, leaving people exhausted during the day. Daytime fatigue can significantly impair cognitive function, productivity, and overall quality of life.

Psychological Stress

Skin conditions not only affect the body physically but also take a toll on mental health. Feelings of stress, anxiety, and depression can result from skin conditions such as psoriasis and eczema. The visible nature of these conditions may cause embarrassment or self-consciousness, contributing to psychological distress.

These negative emotions can further exacerbate sleep disturbances. Anxiety and stress make it challenging to relax and fall asleep, while depression can lead to excessive daytime sleepiness. This creates a cyclical relationship between stress and sleep problems, where one exacerbates the other, leading to a continuous loop of poor sleep and heightened stress levels.

Pain & Discomfort

Skin conditions such as psoriasis or open wounds can cause significant pain and discomfort, further complicating sleep. Pain makes it difficult to find a comfortable sleeping position, leading to difficulty falling asleep and staying asleep. Moreover, even when people manage to fall asleep, they may be awakened by pain during the night, disrupting the sleep cycle.

Managing pain is essential for improving sleep quality. Pain management strategies, such as medication, topical treatments, or relaxation techniques, can help alleviate discomfort and promote better sleep.

Medications & Side Effects

Some medications used to treat skin conditions may have sleep-disrupting side effects. For example, certain topical treatments or oral medications may cause drowsiness or insomnia. Additionally, corticosteroids, commonly used to reduce inflammation, can affect sleep patterns.

It is crucial for people to consult with their healthcare provider about alternative medications or strategies to manage side effects. Adjusting medication dosage or timing, exploring non-pharmacological treatments, or incorporating lifestyle modifications may help minimize sleep disruptions while effectively managing skin issues.

The Impact of Sleep on Skin Health

Inflammation & Healing

Sleep plays a crucial role in regulating immune function, including the immune response in the skin. During sleep, the body produces cytokines and other immune molecules that help combat inflammation and promote tissue repair. Without adequate sleep, this immune response is compromised, hindering the skin's ability to heal.

Sleep deprivation can have detrimental effects on skin inflammation and healing processes. When sleep is disrupted or insufficient, the body's inflammatory response can become dysregulated, leading to increased inflammation in the skin. This prolonged inflammation can impair the skin's ability to heal properly.

Numerous studies have demonstrated the connection between sleep and skin healing. For example, research has shown that people with chronic sleep disorders exhibit delayed wound healing compared to those with normal sleep patterns. Additionally, experimental studies in animals have shown that sleep deprivation can impair skin wound healing by disrupting immune function and inflammatory responses.

Stress & Flare-Ups

Prolonged sleep deprivation can raise stress hormone levels, including cortisol. High levels of cortisol in the body can trigger inflammation and immune dysregulation, contributing to the development or worsening of skin issues.

Sleep disturbances can also directly trigger flare-ups of skin conditions like eczema. Lack of sleep disrupts the body's natural circadian rhythms, leading to imbalances in hormone levels and immune function. This disruption can prompt eczema flare-ups or exacerbate existing symptoms.

Stress management is essential to keeping your skin healthy. Deep breathing exercises, mindfulness meditation, and regular physical activity are among the stress-reduction strategies that can help mitigate the negative effects of stress on the skin. Additionally, prioritizing good sleep hygiene and seeking treatment for sleep disorders can help reduce stress levels and improve skin health.

Skin Barrier Function

The skin barrier is in charge of regulating temperature, keeping in moisture, and guarding against pollutants and infections. Sleep deprivation can disrupt the skin's barrier function, leading to dryness, irritation, and increased susceptibility to environmental irritants and allergens

During sleep, the body undergoes processes of skin cell turnover and regeneration. Sleep deprivation disrupts these processes, resulting in impaired skin barrier function and compromised skin integrity. As a result, people may experience increased dryness, redness, and sensitivity in their skin.

Getting enough sleep is crucial to preserving the integrity of the skin barrier. It strengthens the skin barrier, promotes general skin health, and enables the skin to rejuvenate and repair itself. Optimizing skin function can be supported by incorporating appropriate sleep hygiene habits, such as keeping a regular sleep schedule and establishing a calm nighttime routine.

Management Strategies

Sleep Hygiene Practices

• Consistent Sleep Schedule: Maintaining a regular sleep-wake schedule, even on weekends helps regulate the body's internal clock.
• Relaxing Bedtime Routine: Activities such as reading, gentle stretching, or taking a warm bath to unwind before bed signals the body that it is time to sleep.
• Cool Room Temperature: Try to keep the bedroom cool, ideally between 60-67°F (15-20°C), to promote comfortable sleep.

Stress Management and Screen Time

• Managing Stress Before Bed: The mind can be calmed down before bed with the use of stress-reduction methods including progressive muscle relaxation, deep breathing exercises, and meditation.
• Avoiding Screen Time: Because the blue light emitted by screens, such as phones, computers, and TVs can interfere with sleep patterns, experts recommend limiting screen use at least an hour before bedtime.

Skincare Tips for Better Sleep

• Calming Skincare Routines: Using gentle, fragrance-free skincare products before bed soothes irritated skin. Avoid products containing potential irritants or allergens.
• Moisturizers and Emollients: Moisturizers and emollients hydrate the skin and reinforce the skin barrier function. Opt for products with ingredients like ceramides, hyaluronic acid, and shea butter.
• Cooling Products or Sleepwear: Cooling products or breathable sleepwear has potential benefits, especially for people with skin conditions prone to heat-induced flare-ups, such as eczema or psoriasis.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

• Explanation of CBT-I: CBT-I is a structured, evidence-based therapy that targets thoughts and behaviors affecting sleep. It aims to identify and modify negative sleep patterns.
• Benefits of CBT-I: CBT-I can help people with skin issues by addressing insomnia symptoms and improving sleep quality without relying on medication. It teaches techniques to challenge unhelpful thoughts and establish healthy sleep habits.

Addressing Underlying Triggers

• Allergy Management: This entails identifying and avoiding allergens that may exacerbate skin symptoms or interfere with sleep quality.
• Dietary Changes: Maintain a balanced diet and monitor how certain foods may affect the skin or sleep.
• Managing Stress: Stress management techniques, such as exercise, relaxation, or seeking support from a therapist, can help minimize stress-related sleep disturbances and skin flare-ups.

Seeking Professional Help

It is important to consult a healthcare professional if sleep disturbances due to skin diseases significantly impact daily life. Healthcare providers, including dermatologists and sleep specialists, can offer tailored treatment plans to address both the underlying skin conditions and sleep disturbances.

Depending on the precise diagnosis and degree of symptoms, discussing possible treatments for underlying skin disorders may involve a combination of topical medicines, oral drugs, phototherapy, or biologic therapies. Additionally, addressing sleep disorders may require interventions such as cognitive-behavioral therapy for insomnia (CBT-I), medication management, or referral to a sleep specialist for further evaluation and treatment.

Conclusion

In summary, the relationship between sleep and skin issues is bidirectional and complex. Skin conditions can disrupt sleep patterns, leading to sleep disturbances, while poor sleep can exacerbate skin symptoms. It is essential to manage both sleep and skin health for overall well-being.

By implementing effective management strategies such as sleep hygiene practices, skincare routines, stress management techniques, and seeking professional help when needed, people can improve their sleep quality and manage their skin conditions more effectively. Prioritizing both sleep and skin health is vital for enhancing overall quality of life and promoting optimal well-being.

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References:

• Freeman, Daniel, et al. "Sleep disturbance and psychiatric disorders." The Lancet Psychiatry 7.7 (2020): 628-637.
• Spindler, Max, et al. "Sleep disturbance in adult dermatologic patients: A cross-sectional study on prevalence, burden, and associated factors." Journal of the American Academy of Dermatology 85.4 (2021): 910-922.
• Podder, Indrashis, Himel Mondal, and George Kroumpouzos. "Nocturnal pruritus and sleep disturbance associated with dermatologic disorders in adult patients." International Journal of Women's Dermatology 7.4 (2021): 403-410.
• Chamlin, Sarah L., et al. "The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis." Archives of pediatrics & adolescent medicine 159.8 (2005): 745-750.
• Smith, Tracey J., et al. "Impact of sleep restriction on local immune response and skin barrier restoration with and without “multinutrient” nutrition intervention." Journal of Applied Physiology 124.1 (2018): 190-200.
• Kim, Min Ah, et al. "The effects of sleep deprivation on the biophysical properties of facial skin." Journal of Cosmetics, Dermatological Sciences and Applications 7.1 (2017): 34-47.
• https://www.healthline.com/health/atopic-dermatitis/sleeping-severe-eczema#sleeping-tips

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