The Surprising Link Between Sleep Disturbance and Atopic Dermatitis (AD)

If you have atopic dermatitis (AD), also known as eczema, then you know the struggle: You climb into bed ready to catch some zzz’s, but can’t sleep because of the intense, relentless itching. Thanks to my current flareup (courtesy of the dry, cold weather), symptoms that are usually just minor irritations during the day have suddenly become hard to ignore at night. It’s an exhausting, frustrating cycle.

As I’m drifting off, I feel that tell-tale irritation and urge to scratch. And while itching offers a brief reprieve, the cycle soon repeats (often more than once). The result? Problems falling and staying asleep, followed by daytime exhaustion.

According to Dr. Alex Dimitriu, a double board-certified psychiatrist and sleep medicine specialist, sleep and eczema have a bidirectional relationship. “Sleep and eczema are closely linked, and one can feed off of the other,” he explains.

Keep reading to learn more about why AD can make sleeping so tough, factors that might make your nighttime symptoms worse, and–last, but certainly not least–how to find a nighttime routine that will manage your symptoms and help you get the sleep you need to feel refreshed.

The Connection Between Atopic Dermatitis and Sleep

Research has shown that people with AD are more likely to have sleep problems–including trouble falling and staying asleep. Estimates suggest that between 33% and a whopping 90% of adults with atopic dermatitis also experience sleep disturbances as a result of their condition.

While falling asleep with eczema might seem like a losing battle (trust me, I’ve been there), the good news is that there are steps you can take to ease your symptoms and get a better night’s rest. “Good sleep and reduced stress can improve eczema. Improved eczema and reduced itching can improve sleep, creating a virtuous cycle,” says Dr. Dimitriu.

Trying to sleep when you have atopic dermatitis can leave you feeling like you’re waging a battle against your own body. The constant itching creates discomfort and irritation that leaves you tossing and turning–which is why so many people with AD report having sleep difficulties.

The itching that characterizes the condition is a major culprit behind such sleep disturbances, but AD can also affect sleep in other ways, including how much sleep you get and how restorative that sleep actually is.

How Eczema Affects Sleep Quality

Atopic dermatitis is an inflammatory disease. That means it doesn’t just affect the skin but the whole body–including sleep. The itching and discomfort make it harder to fall asleep. And even after you drift off, the urge to scratch may jolt you awake repeatedly throughout the night. 

Sleep deprivation can then increase inflammation, leading to further flare-ups and, you guessed it, even worse sleep. I’ve also noticed that as I become more sleep-deprived, I find myself increasingly bothered by my eczema symptoms during the daytime, too.

Common Sleep Disturbances Associated with Eczema

Folks with atopic dermatitis often deal with:

• Problems falling asleep, since itching and discomfort make it hard to relax
• Frequent waking due to skin irritation
• Decreased sleep quality: Even when we technically get the recommended hours of sleep, the irritation caused by our skin condition may prevent us from getting the deep sleep we need
• Daytime sleepiness and fatigue: A poor night’s sleep often leaves people feeling irritable, sluggish, and unable to concentrate the next day

It can be a frustrating cycle, the result of which is often chronic problems with sleep deprivation. This can create further issues with mood, energy levels, focus, and overall well-being.

Why Eczema Symptoms Worsen at Night

When my symptoms felt worse at night, I initially gaslit myself into thinking it was all in my head. It seems worse, I told myself, because you have less to occupy your thoughts. Of course, that unhelpful way of thinking did absolutely nothing to make my symptoms any more bearable. But, while lack of distractions does play some part, symptoms do actually peak at night, for a few different reasons.

The Body’s Natural Sleep-Wake Cycle

Your body’s circadian rhythm (that natural, internal clock that helps regulate your sleep-wake cycle) also plays a role in inflammation. During the night, your body’s cortisol levels naturally drop. 

Cortisol is a hormone that plays a role in the stress response, but it also has anti-inflammatory effects on the body. Cortisol production tends to peak in the morning, then decline gradually throughout the day, reaching its lowest point around midnight.

Increased Skin Temperature and Moisture Loss

“Hot sleeping environments can trigger sweating, which make itching worse,” says Dr. Amy Huang, board-certified dermatologist with Medical Offices of Manhattan.

Because body temperature rises at night–especially when lying under blankets–it can make irritated skin even itchier and more inflamed. If you get too hot while you’re sleeping, you may also wake up and then struggle to fall back to sleep as your AD-related itching intensifies. 

Being too hot can reduce sleep quality, but research has found that being too cold at night can cause problems. In one study, kids with lower nighttime body temperatures experienced more scratching while asleep.

“Environmental factors directly influence eczema symptoms, especially at night when the skin is more prone to water loss and sensitivity,” says Dr. Asmi Berry, a board-certified dermatologist in Los Angeles. “Low humidity and cold temperatures can dry out the skin, leading to increased itchiness and flare-ups, making it more difficult to sleep,” she says. “On the other hand, excess heat and high humidity can trigger sweating and irritation, making eczema-prone skin even more inflamed.”

Environmental Triggers

Your environment also plays a big role in how well you sleep–especially if you have eczema. Common triggers that might make itching worse include mold, pet dander, dust mites, harsh fabrics, and detergent residue on your sheets and blankets.

Fewer Distractions Lead to More Scratching

Because there’s less to focus on at night, it’s only natural that our minds zero in on *every* possible irritation and discomfort. The quiet, distraction-free nighttime hours make all those dry, irritated, scratchy sensations on your skin stand out. Contrast that to during the day, when we’re inundated with all kinds of distractions since our minds are busy juggling work, school, family, friends, and other attention-grabbing activities.

Dr. Dimitriu notes that diminished sleep quality can affect the brain in ways that worsen both symptoms and sleep at night and during the day. “Poor sleep quality fundamentally increases impulsivity, so thoughts are more intense, more loopy, and more bothersome,” he explains. 

Preparing for a Better Night’s Sleep

Unfortunately, there is no easy way to control how your skin behaves. However, you can take steps to improve your chances of sleeping well, even when you have atopic dermatitis. A good skincare routine is a biggie, but it’s also essential to focus on other key areas, such as creating a conducive sleep environment and making minor lifestyle adjustments that promote better rest.

Create an Optimal Sleep Environment

The goal is to make your bedroom a place where your skin feels soothed, not irritated. Some fairly simple changes can go a long way toward easing skin irritation.

• Choose the right room temperature: Make sure you’re not getting too hot or cold at night. Experts suggest the ideal nighttime bedroom temperature is between 65–70°F (18–21°C) to help minimize itching.
• Use a humidifier: Dry cold air worsens eczema symptoms, often a major problem during the winter and for people in cold climates. Running a humidifier in your bedroom at night can help keep the air (and your skin) less dry. Dr. Berry recommends keeping the room between 40% and 50% humidity to prevent skin dryness. “Smart humidifiers can detect the humidity of the room and adjust to match a set humidity level,” she suggests.
• Limit dust and allergens: Dust mites can trigger eczema symptoms, so ensure you regularly wash your bedding in hot water with fragrance-free detergent. Dr. Berry also recommends using hypoallergenic pillowcases and mattress covers to reduce irritation.  
• Choose the right bedding: Choose bedding that helps minimize allergies. Soft, breathable fabrics including cotton and bamboo are a good choice. When washing your bedding, be sure to use a hypoallergenic, fragrance-free detergent.

While these changes won’t eliminate the problem, making your bedroom a comfortable place free of major triggers can help.

Stick to a Soothing Skincare Routine

For my own symptoms, nighttime skincare is a must. Avoid very hot showers and baths (which may trigger symptoms for some people), stick to a gentle cleanser, and keep your skin well-hydrated. Be cautious of sun exposure and be sure you are wearing adequate SPF that is made for sensitive skin.

“Apply moisturizer liberally to skin before bedtime, especially cooling and anti-itch moisturizers like Sarna lotion,” Dr. Huang recommends.

And since moisture loss naturally accelerates at night, it’s more important than ever to make sure you have your hydration locked-in before you call it a day. A good moisturizer can help repair the skin’s barrier, protect it from irritants, and boost those hydration levels during sleep.

Recommended Products and Application Techniques

A word of caution: not all skincare products are friendly to eczema-prone skin. It’s no fun to invest in a hyped-up new cream or lotion only to suffer later when it leads to irritation, itching, and redness. 

While it might take some trial-and-error to figure out which products work best for you, here’s what typically works best:

• Skip the hot water: “Take a lukewarm bath or shower. Avoid hot water, which can strip the skin of its protective lipids. Adding colloidal oatmeal can help soothe irritation and support the skin barrier,” Dr. Berry recommends.
• Use gentle cleansers: Avoid any harsh soaps and stick to hydrating, fragrance-free products.
• Apply a thick moisturizer or barrier cream: Lotions often don’t have the staying power you need to relieve dryness and itching, so look for creams or ointments that can boost hydration.
• Apply moisturizers to damp skin: You also need to make sure you’re using products correctly. “Use an emollient-rich moisturizer within three minutes after bathing to lock in hydration,” Dr. Berry says. “Look for products that contain ceramides or shea butter, or use petrolatum-based creams.”
• Spot treatments for flareups: When you’re dealing with an active eczema flareup, consider using a medicated cream–such as a mild steroid cream like hydrocortisone or a prescribed treatment–before you apply your moisturizer. Dr. Berry suggests looking for a topical corticosteroid or soothing balm with ingredients like pramoxine or colloidal oatmeal.
• Be consistent: “A consistent, soothing nighttime routine can make a huge difference in managing eczema-related itching and improving sleep,” Dr. Berry says. While you might be tempted to skip your routine, particularly when you’re tired, doing so can lead to problems. Instead, try to make your routine a habit and stick to it consistently.

Dr. Huang also recommends keeping your fingernails trimmed short and applying a cool, damp towel to itchy areas instead of scratching.

Clothing Considerations for Sleep

If your nightly uniform consists of an old tee and sweatpants, you might want to reconsider your PJ options. If you have eczema-prone skin, spending the night in the wrong fabrics can lead to significant irritation and poor rest. On the other hand, the right sleepwear can help soothe the skin, regulate body temperature, and reduce irritation.

Best Fabrics for Eczema-Friendly Sleepwear

For a good night’s sleep, look for sleepwear made from:

• Cotton or bamboo: These fabrics are natural and breathable, which helps wick away moisture to keep your skin cool.
• Silk or silk blends: These smooth fabrics help reduce friction and irritation, which is a great option if you have very sensitive skin.
• Loose-fitting clothing: Tight clothing not only creates friction, it also traps heat. Stick to sleepwear that is looser fitting for greater nighttime comfort and rest.

What to Avoid

The following sleepwear options can contribute to poor rest:

• Wool and synthetic fabrics: Besides trapping heat, these materials tend to be rough and scratchy.
• Clothing with seams or tags: While it might not seem like a big deal, sleepwear with scratchy tags or rough seams can become a major annoyance when your skin is already sensitive and irritated.
• Excessive layers: Piling on heavy pajamas and thick blankets might seem cozy, but it also raises your body temperature and triggers the urge to itch. Stick to lightweight layers that you can easily adjust as needed.

Behavioral and Lifestyle Adjustments

In addition to making sure your skincare and sleepwear are on point, it’s also important to take a look at some of your daily habits. Lifestyle factors can play a *big* role in the symptoms of atopic dermatitis. 

Quality sleep habits, Dr. Dimitriu says, are key. “Healthy sleep hygiene as well as care for eczema symptoms is essential to ensure the best sleep you can get,” he explains.

That includes things like stress, nutrition, and even screentime can impact your skin and your sleep quality. If you regularly deal with irritating, uncomfortable nighttime flareups, a few small changes in your daily habits might help. 

Relaxation Techniques to Reduce Stress Before Bed

Stress is a known trigger for eczema symptoms. Because stress elevates the body’s cortisol levels and suppresses the immune system, it leads to increased inflammation. Not only can higher stress levels trigger eczema symptoms; having eczema symptoms contributes to high stress levels.

Easing stress is absolutely essential if you want to get a good night’s sleep. Strategies that can help include:

• Deep breathing or meditation: Before bed, spend a few minutes breathing slowly and deeply. This helps trigger the body’s relaxation response and may help reduce stress-related inflammation.
• Progressive muscle relaxation: This stress-relieving technique involves tensing and relaxing different muscle groups. When you practice this regularly, it feels like a wave of relaxation pouring through your entire body.
• Journaling: Expressive writing can be a valuable tool for combatting stress, so take a few minutes at the end of each day to jot down your thoughts and worries. Or, try writing a gratitude list to help clear your mind and focus on positive thoughts before you go to bed.
• White noise or calming music: As you wind down for the evening, try a white noise machine, soothing nature sounds, or a calming playlist to help signal to your body that it’s time to rest.

Avoiding Stimulants and Screen Time Before Sleep

What you eat, drink, and do before bedtime can either help or hurt your ability to sleep well.

• Limit your alcohol use: Even if alcohol makes you feel sleepy, it can also be dehydrating and tends to disrupt your sleep quality. Consider a cup of chamomile tea before bed instead.
• Watch your caffeine intake: You might not necessarily feel wired, but caffeine still lingers in your body for hours after you consume it. Skip caffeine in the afternoon, including coffee, tea, and energy drinks.
• Minimize screen time at night: The blue light emitted from phones and tablets interferes with your body’s melatonin production, the hormone that helps regulate your sleep-wake cycle. Try a book, podcast, or relaxing music instead.

Creating a Wind-Down Routine

A good night’s sleep often hinges on what you do before you go to bed. A consistent pre-sleep routine can help signal to your body that it’s time to wind down and relax. It’s not just about what you do right before you get tucked in–it’s a pattern that begins at least an hour before you go to bed. For example, you might dim the lights, put on your comfortable pajamas, and engage in a relaxing activity to help calm your mind and body.

The goal is to make your nighttime routine as soothing and stress-free as possible. It’s good for your body *and* it helps keep your skin calm and comfortable.

When to Seek Professional Help

If your eczema is still wreaking havoc on your ability to sleep, it’s time to get some help from the professionals. Skincare and lifestyle changes can help, but there are times when eczema-related sleep problems need medical treatment.

Signs That Eczema Is Severely Affecting Sleep

If you’re experiencing the following symptoms, it’s time to talk to your healthcare provider:

• Frequently wakings: Waking up multiple times each night and struggling to fall back to sleep is a sign that your eczema is not well-controlled.
• Bleeding or infections: Persistent nighttime scratching that leads to broken, bleeding skin or infections suggests other interventions are needed.
• Daytime tiredness: Fatigue that affects your mood, energy levels, and ability to focus can make it hard to function.
• Over-the-counter treatments aren’t getting the job done: If your fave moisturizers, hydrocortisone creams, and antihistamines aren’t helping, it’s a sign that you need a more potent treatment.

Treatment Options and Adjustments with Healthcare Providers

Your doctor or dermatologist can work with you to develop a treatment plan for your unique needs. That might include:

• Prescription creams and ointments: OTC options are often effective, but you may need a stronger alternative such as topical steroids, calcineurin inhibitors, or non-steroidal treatments that can help control skin inflammation.
• Oral medications: In some cases, your doctor may recommend immunosuppressants, antihistamines, or biological treatments such as Dupixent (dupilumab) to control your symptoms.
• Light therapy: Phototherapy, which involves controlled exposure to UV light, can sometimes be useful for stubborn eczema.

Your doctor may also talk to you about ways you can address underlying triggers that might be contributing to your flareups. Such triggers can include allergens or might be related to stress or diet. They can help you pinpoint which ones might be a problem for you and suggest steps you can take to manage them.

Takeaways

Struggling with eczema can be incredibly frustrating because even if your symptoms are manageable during the day, they can really take a toll at night. Between the itching, irritation, and constant waking, it’s perhaps not surprising that so many people with atopic dermatitis struggle to sleep. If eczema is making a good night’s sleep seem impossible, you don’t have to suffer in silence.

Understanding why eczema symptoms tend to flare at night is the key to finding an effective solution. You might need to adjust your sleep environment, or you might need to make some tweaks to your nightly skincare routine. 

“By making these small adjustments, many people with eczema find that itching decreases, skin stays calmer overnight, and sleep improves significantly,” Dr. Berry says. And if your symptoms are still making sleep impossible, don’t be afraid to talk to your doctor or dermatologist for extra support.