• People with atopic dermatitis often have difficulty sleeping due to itching.
• Sleep loss and poor quality sleep can have a marked effect on quality of life.
• Several treatment options can reduce itch in people whose atopic dermatitis is keeping them awake at night.
• Lifestyle changes may also help people with atopic dermatitis get a better night's rest.

Atopic dermatitis (AD) is a chronic skin condition that affects approximately 16.5 million adults in the United States. In people with AD, the immune system triggers inflammation that damages the skin barrier, leaving skin dry and itchy.

Itchiness (also known as pruritus) in atopic dermatitis has a marked effect on sleep duration. In fact, disrupted rest is typical for members of MyEczemaTeam, who often struggle to fall asleep due to itchy, dry skin. They also find themselves being woken up by the itch.

"No sleep due to severe itching last night," one member wrote. "I’m probably getting three hours of sleep on a good night," shared another. Another member commented, "I couldn't sleep last night. I stayed up itching and changing the ice pack every couple of hours for my scalp."

The broader health impact of poor sleep can be significant for people living with atopic dermatitis. Sleep disturbance can result in daytime fatigue, disturbed cognition, and decreased motor performance, and it generally worsens quality of life. It also increases the risk of psychological disorders, car accidents, and workplace injuries.

People who experience sleep disturbance due to AD have several options for relieving itch so that they can rest. They may need to try different treatments before finding the right one for them, but it's worth it when they finally get a good night's sleep.

Improving Sleep With Atopic Dermatitis, Naturally

There are many medicines on the market to help people sleep, in both prescription and over-the-counter forms. Before trying those, people with AD may wonder if there's anything they can do on their own to address sleep impairment.

The good news is that there are several changes people can make to effectively address the itch that's keeping them awake. These lifestyle changes and other minor fixes have been shown to significantly benefit people with AD-related itch.

Bedtime Skin Care Routine

MyEczemaTeam members suggest bedtime routines that have worked to improve their chances of enjoying a restful night. These tried-and-true methods may help others with atopic dermatitis get to sleep and stay asleep.

“Coconut oil as a moisturizer at night helps me sleep through the night without itching,” said one member.

Another suggested pouring one mug full of Epsom salts into a warm bath before bed: “Stay in the bath for 20 minutes. Use clean flannel to gently rub away dead skin.”

Bedroom and Sleepwear Tips

Bedrooms should be places where people rest, but many people with atopic dermatitis may engage in behaviors that work against them when it’s time to sleep. Specifically, if their bedrooms are not free of television and smartphone screens, they will have a more difficult time getting to sleep.

The light that emanates from these devices can disrupt circadian rhythm and inhibit the body’s release of melatonin, a hormone that regulates the sleep cycle. For that reason, it is recommended that these devices are turned off 30 to 60 minutes before going to bed. The National Eczema Association also recommends keeping bedrooms cool, dark, and comfortable.

As far as what to wear to bed, people with eczema have said that loose-fitting clothes prevent the type of topical friction that can trigger itching. Others have said that the best outfit to wear to bed for people with eczema-related itch is no outfit whatsoever.

People with AD should also avoid wearing clothes to bed made of wool or synthetic fibers like acrylic, nylon, or polyester.

Sleep Hygiene

Getting a good night’s sleep, free from atopic dertmatitis-related itching, doesn’t just start at bedtime. People can engage in good sleep hygiene habits throughout the day to promote sleepiness at night.

Recommendations for good sleep hygiene include:

• Limiting caffeine — People who have trouble sleeping due to AD-related itch should be aware that if they consume anything with caffeine, the chemical remains active in their brains for as long as four to six hours.
• A consistent bedtime routine — Bedtime routines allow people to gradually relax into a state in which they’re more likely to fall asleep. Setting aside 15 to 30 minutes every night to repeat the same habit-reinforcing behaviors can lead to a restful night.
• Waking and sleeping at the same time each day — Getting on a consistent sleep schedule will make it easier to fall asleep and wake up every day. This includes weekends.

The Centers for Disease Control and Prevention (CDC) recommend avoiding large meals and alcohol before bedtime to promote sleep hygiene. The CDC also suggests people get regular exercise, as daytime physical activity can cause more sound sleep at night.

Medications for Improving Sleep

If your current treatments for atopic dermatitis are not controlling nighttime itching, talk to your doctor about finding a more effective regimen. It’s important to stress that once a treatment plan is in place, sticking with it is critical.

People with atopic dermatitis sometimes have difficulty with treatment adherence, or taking all prescribed medicines as directed for the specified length of time. The reasons include price concerns, confusing regimens with multiple medications, and worries about side effects. However, people who are prescribed these medicines must stick to their health care provider’s instructions if they hope to benefit.

Medications for atopic dermatitis include:

• Antihistamines — Antihistamines are often used by people with AD who are having trouble sleeping, thanks to their sedative effects. Sedating antihistamines include Hydroxyzine and Diphenhydramine.
• Dupixent (Dupilumab) — Dupixent is a relatively new treatment for moderate to severe atopic dermatitis, having only been approved by the U.S. Food and Drug Administration (FDA) in 2017. In clinical trials, it was shown to improve sleep significantly within two weeks.
• Melatonin — Melatonin supplements have been proposed to treat atopic dermatitis because of their ability to regulate sleep and enhance immune function.
• Methotrexate — Methotrexate is used to treat moderate to severe AD. It may help people with AD get a better night’s sleep, not because of any sedative effects, but because it produces a marked improvement in the itching that keeps people awake in the first place.

Always talk to your dermatologist before taking new medicines or supplements, or making changes to existing treatment regimens.

What Helps MyEczemaTeam Members Sleep?

MyEczemaTeam members share tips about what they do to get to sleep and stay asleep when their skin disease acts up. One member experienced good outcomes with Dupixent and advised another member to ask her doctor about it. "See if the doctor will prescribe something to ease the itchiness so you can sleep," the member said. "I have had it all my life and am now on Dupixent injections, which I love and which have changed my life!"

Another member had been prescribed the hay fever medicine Levocetirizine, which made an enormous difference, both when she was awake and when she was asleep. "I started taking [Levocetirizine] before bed," she said. "I am now free and clear of itching, cuts, and pain. I no longer wake in the middle of the night scratching. So with no scratching, my hands are finally clear. I started this two nights ago, and it worked the very first night."

Another member said, "I take Hydroxyzine at night. Most nights, I get sleepy and sleep all night long."

Read more about atopic dermatitis.

Read about the connection between atopic dermatitis, allergies, and asthma.

By joining MyEczemaTeam, the social network and online community for those living with eczema, you gain a support group of over 32,000 people who understand what it's like to lose sleep quality with atopic dermatitis.

Here are some conversations on MyEczemaTeam about sleep and atopic dermatitis:

• “I get very little sleep because of chronic itching.”
• “One spot on my leg started itching. I scratched it, and scratched it, and scratched it … and I got no sleep.”
• “Itchy and can’t sleep.”

Here are some question-and-answer threads on MyEczemaTeam about sleep and atopic dermatitis:

• “No sleep due to the severe itching at night. … Has anyone else experienced such a sudden onset like this?”
• “What kind of creams do you use to help the irritation?”
• “What kind of medication should I use?... I can't sleep at night.”

Does itching from atopic dermatitis keep you awake at night? Have you found any medications or lifestyle changes that work to manage itching and improve sleep? Share your tips and experiences in a comment below or on MyEczemaTeam.

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