What to Do When Atopic Dermatitis Starts Disrupting Your Sleep

With its itchiness, soreness, weeping patches and pain, severe eczema can be difficult enough to deal with during daylight hours, let alone the nightmare it can become as soon as your head hits the pillow.

“Itching and sleep go hand in hand, so the more patches you have, the itchier you become and the more sleep you lose,” says Emma Guttman-Yassky, MD, PhD, director of the occupational dermatitis clinic at Mount Sinai in New York City.

So, why is nighttime more fraught for people with severe eczema, also known as atopic dermatitis (AD)? There could be several factors at play that are tempting you to scratch the night away. Luckily, there are also several ways to get the relief you crave and the rest you need.

How Eczema Affects Your Sleep — and Vice Versa

Daytime offers plenty of distractions, from your job to errands to watching that binge-worthy series. Once you shut your eyes at night, those distractions disappear, making it more likely you’ll focus on your itchy skin.

While giving into temptation relieves the itch for an instant, it’s only temporary. What’s more, scratching the skin can unleash a vicious cycle: Your skin gets even more irritated and itchy, which leads to more scratching and less sleep.

All that disrupted sleep may be setting up another vicious cycle. Sleep regulates your immune system, lowering inflammation. It also affects your skin. Too many nights of poor quality sleep can lead to more inflammation and drier skin, which could be making you itch more, according to a study.

Eventually, night after night of poor sleep affects your work, personal relationships, and mood. “If you don’t sleep, you’re likely to be shorter with people, have more accidents, and become less productive, all while the body’s general inflammatory burden increases,” says Dr. Guttman-Yassky.

Medications That Ease Nighttime Eczema Symptoms

There are many topical, oral, and prescription remedies to treat and manage severe eczema and rehydrate your skin. How well they work, though, can vary from person to person. So, when in doubt, check with your doctor to see which solutions might best relieve the itchiness for you.

Topical Moisturizers

The National Eczema Association (NEA) lists 171 products meant to protect and fortify skin without harmful ingredients. From topical steroids to herbal formulas, products that are awarded the NEA Seal of Acceptance are free of formaldehyde, zinc oxide, bacitracin, fragrance, and other irritants. Many of the formulas, normally applied twice a day, are rich in natural emollients.

Over-the-Counter Topical Medications

Sometimes, a regular moisturizer won’t cut it for easing nighttime eczema symptoms. Reaching for over-the-counter (OTC) formulas, including some antihistamines or sleep products, can help calm inflamed skin and promote sleep for some people.

Rx Drugs

“If all these things don’t help, we can ramp things up by trying a new oral or injectable therapy,” says Jonathan Silverberg, MD, PhD, an associate professor of dermatology and the director of clinical research and dermatology at George Washington University School of Medicine & Health Sciences in Washington, DC. Most of the time, doctors start their patients with a topical prescription product, such as a steroid or calcineurin inhibitor. But, in cases of severe eczema, systemic therapies may be needed. Talk to your doctor about which medication would best fit in your treatment plan.

Nondrug Ways to Get More Rest With AD

Topical treatments and OTC meds can provide almost instant relief, but there are a few lifestyle changes, too, that can ease the itch, get you better quality z’s, or both. These include the basic rules of sleep hygiene — the behaviors and environment around how you sleep.

For better shut-eye:

• Put the devices away. Shut off your phone or laptop before you get ready for bed. The light from these devices disrupts the sleep-wake cycle. A good way to do that is to leave them charging in a separate room.
• Darken your room. Consider blackout shades and a sleep mask to eliminate light. You can also use a white-noise machine to help block out sleep-disrupting sounds.
• Skip the late-night snack. Try to avoid heavy foods and alcohol right before bed. Instead, sip on herbal tea to prepare for sleep.
• Work out in the morning. Too much physical activity close to bedtime can disrupt your sleep. If possible, try to squeeze in your workout in the morning or a few hours before you hit the hay.
• Say no to afternoon coffee. It can be hard to resist, but that 3 p.m. cup of java can severely affect the sleep you get that night.
• Unwind and relax. Try adding yoga, meditation, or another calming practice to your nighttime routine. It helps lower your stress levels, too, which can also help your atopic dermatitis.

There are also a few things to keep in mind that are specific to atopic dermatitis itch:

• Avoid drastic temperature changes. People with eczema have a hard time regulating body temperature, so it’s better to keep the room temperature stable. That may mean keeping your bedroom cooler than the rest of your home, running fans, or investing in heavier bedding.
• Skip the scalding shower. Amping up the heat in your shower is going to strip your skin of much needed moisture, so it’s best to keep your water warm, rather than hot.
• Go for products that aren’t scented. Scented moisturizers and other skin products contain irritants that can make you itchier.
• Opt for washable linens. Rugs, drapes, and bedspread fabrics that can’t be tossed in the washer easily can start collecting dust and allergens. Mite-proof materials, when washed frequently in hot water with hypoallergenic detergent, are better for people with severe eczema.
• Wear gloves to sleep. Putting gloves on your hands when you go to sleep can help reduce damage if you scratch during the night.
• Wear breathable fabrics. Stick to soft cotton and loose clothing when climbing into bed, as tight and stiff pajamas can only make the itching worse.

Because each case is unique, Guttman-Yassky carefully tailors her protocols to an individual’s needs — even taking into account their race or ethnicity.

“People of African descent and Asians tend to develop more eczema with more severe and resistant lesions, so we adjust to ensure all patients achieve relief,” she says.

Finally, many dermatologists encourage people with chronic AD to fully understand their triggers and treatments, share any updates, and learn to powerfully advocate for themselves.

“We now have so many effective options that patients shouldn’t settle for a treatment or a doctor who can’t provide relief,” says Guttman-Yassky. “We aim for 100 percent symptom clearance.”