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Sleep is widely recognized as an essential component to good health. As with most fundamental aspects of health, if sleep is disrupted, there can be many impacts on the mind and body, including the skin.
Good sleep is even necessary to minimize aging, a “disease” that is universal. Indeed, poor sleep habits correlate with accelerated signs of aging in the skin, suggesting that even outside of specific skin conditions, sleep is critical to skin health.
Importantly, sleep disturbance is reported in many, perhaps more than half of children and adults with atopic dermatitis, and these include difficulty falling asleep, frequent nighttime awakenings, and daytime sleepiness. One can quickly see that this can create a vicious cycle: if poor sleep can impair skin health and if a skin disease can impede sleep, one can become trapped in a worsening cycle that can be very difficult to break!
There are several mechanisms that may explain this fascinating connection between sleep and skin disease. First, it is well known that stress can fuel inflammation and worsen many skin diseases. It turns out that lack of sleep can be considered a form of stress. Moreover, stress itself can drive insomnia, so again we have a vicious cycle! Poor sleep leads to stress which leads to more poor sleep! Add on a stressful skin condition, and one can see how this can all escalate quickly!
Next, the symptoms of a skin condition such as the itch or even pain of atopic dermatitis can certainly disrupt sleep. The so-called “itch-scratch cycle” seems to be one of the components of disrupted sleep, at least in some patients, and there is no doubt that when I see a patient in follow up, asking about the quality of sleep gives me a very good window into how the skin is doing overall.
There may also be alterations of circadian factors such as melatonin in certain disease states. Melatonin production, which helps regulate sleep and keep the circadian rhythm seems to often be abnormal in patients with atopic dermatitis, and perhaps in other inflammatory disease states as well–this could also be playing a direct role in disrupting sleep.
Therefore, sleep remains an important indicator in many conditions, including atopic dermatitis. At the very least, improving sleep should improve quality of life overall, and generally correlates with improving the skin so is a reasonable target.
In addition to directly working to improve the underlying skin condition, sometimes it can be helpful to target sleep directly, although there are often mixed results and it is not without some risks and potential issues.
Melatonin supplementation is a relatively safe treatment that can occasionally be used to help improve sleep. It still can cause issues such as drowsiness the next day, nausea, and headaches to name a few.
There are some behavioral approaches that also may be helpful for some, including relaxation therapy, cognitive behavioral therapy (CBT), and meditation. There are many resources online to help guide interested patients, and there are certified practitioners who can also help discuss which one might be best for a given individual.
Finally, good overall sleep hygiene tips generally include maintaining a regular sleep routine, avoiding daytime naps, and avoiding all screens and caffeinated drinks in the later evening before bed. With good treatment and some luck, most patients are able to get proper sleep restored and they often feel better overall, not just in their skin!