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The Complex Relationship Between Psoriasis and Sleep

By Claire Gillespie
Reviewed by Allison Truong, M.D.
March 17, 2022

Sleep is a crucial component of optimal health. It’s the time when the body regenerates tissue, renews hormones, and creates long-term memories. According to the National Sleep Foundation, adequate sleep for most adults is between seven and nine hours a night. If you don’t get enough shut-eye, you’re likely to experience a significant dip in mental function and mood the following day.

While it’s common to focus on whether we’re getting the requisite hours of sleep every night, sleep continuity (i.e., uninterrupted sleep) is also important. Research has shown an association between sleep continuity and sleep quality, suggesting that interrupted or fragmented sleep can lead to insomnia and daytime sleepiness, plus all the other consequences of insufficient sleep.

When Psoriasis Keeps You Up at Night

Insufficient sleep is where psoriasis—and the itching, burning, and skin discomfort that often go along with it—can be an issue. “Patients and their spouses will often report interference with sleep, waking up scratching, or waking up with blood on their sheets from scratching,” says Tanya Nino, M.D., a board-certified dermatologist with St. Joseph Hospital in Orange County, California.

A case-controlled study, published in the British Journal of Dermatology, found that 25 percent of people with psoriasis reported clinical insomnia (compared to 10.5 percent in the control group). Insomnia, by definition, according to the American Academy of Sleep Medicine, is persistent difficulty with sleep initiation, duration, consolidation, or quality; simply put, it’s difficulty with falling asleep, staying asleep, and sleep quality. Overall, 53.6 percent of people with psoriasis were poor sleepers compared to 21.9 percent in the control group. And itch was a significant factor in the people with poor sleep.

Psoriasis can impact sleep through the associated symptoms or complications of the condition, says Alia Ahmed, M.R.C.P., a psycho-dermatologist practicing in the U.K.

“In addition to physical symptoms, the psychological impact of psoriasis can affect a person’s mood to further disrupt sleep,” Ahmed says. “People with psoriasis are also at risk of sleep disorders such as insomnia, obstructive sleep apnea, and restless legs syndrome.”

Does Lack of Sleep Make Psoriasis Worse?

It’s still not clear whether poor sleep can contribute to a worsening of psoriasis symptoms. “Research has shown a relationship between psoriasis severity and sleep quality, however other factors, such as quality of life, have also been implicated,” Ahmed says.

Many studies have found an association between lack of sleep and higher stress levels, and that stress can drive skin conditions such as psoriasis. Stress may prevent the skin barrier from functioning properly, causing dry skin, allowing skin to become more easily injured, and interfering with its ability to heal, Ahmed explains.

Nino says her patients often report that their psoriasis worsens with stress. “It all goes hand in hand,” she explains. “Poor sleep can worsen stress, which patients have reported can cause their psoriasis to flare up.”

There’s also a suggestion that sleep deprivation disrupts the normal body clock and affects blood flow to and from the skin, which in turn, may reduce the effectiveness of treatments applied at night, says Ahmed.

When Sleep Problems Get Serious

For some people with psoriasis, sleep issues go further than waking up through the night to scratch the itch. In a systematic review published in Sleep Medicine Reviews, researchers found people with psoriasis and psoriatic arthritis had an increased prevalence of obstructive sleep apnea (OSA), a condition in which normal breathing is impeded by an upper-airway obstruction during sleep. It is caused by temporary relaxation of muscles that support the soft tissue in your throat during sleep, leading to a closing or narrowing of the airways, causing breathing to be momentarily cut off.

In adults, the most common cause of OSA is excess weight and obesity. Although the link between psoriasis and excess weight isn’t clear, and weight alone doesn’t cause psoriasis, some research does show that being overweight or obese increases the chance of developing psoriasis, and can make symptoms worse if you have it. Chronic OSA also has similar comorbidities to psoriasis including hypertension, heart disease, diabetes, obesity, asthma, acid reflux, and chronic fatigue.

The review also found an increased prevalence of restless legs syndrome (RLS) in people with psoriasis. RLS is a condition that causes an uncontrollable, uncomfortable sensation and urge to move one’s legs, usually in the evening or at bedtime. Generally, symptoms of insomnia in psoriasis are believed to be directly connected to pain and itch.

How to Improve Your Sleep

If you have psoriasis and sleep issues, the most important thing to do is to get your psoriasis under control. If you don’t have a treatment plan in place, or don’t think your current treatments are working for you, check in with your dermatologist. “There are so many treatments available to help patients with psoriasis, including topical and systemic therapies,” Nino says. “And as psoriasis research advances, we have multiple options to help patients with therapy targeting the psoriasis immune pathways.”

If you use topical treatments, Ahmed suggests applying them to your skin an hour before bedtime, to give them plenty of time to absorb. She also recommends sleeping in a slightly cool environment—if your bed is too hot, try filling a hot water bottle with cold water or freezing it and placing it under the bed sheets to stay cool.

To aid sleep, wear loose, comfortable clothing to bed, add a few drops of a calming essential oil (such as lavender, as long as it has not known to cause you irritation or skin allergies) to your bed clothes. If sleep disruption is a regular occurrence due to psoriasis itch, you might consider taking an antihistamine, Ahmed suggests, with your doctor’s approval.

“Practice good sleep hygiene by avoiding screen time for an hour before bed and removing distractions from the bedroom,” Ahmed adds. “Relaxation techniques like muscle relaxation or breathing exercises can be done in bed to soothe the mind and promote sleep.”

And if you think your sleep disruption is caused by or connected to anxiety or other mental health concerns, you should discuss the issue in detail with your healthcare professional.

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