Connecting the Dots: Atopic Dermatitis, Mood Disorders, and Sleep

Atopic dermatitis (AD) is a common inflammatory skin disorder which often starts in childhood and may persist into adulthood. Though controlled by medications, stress or exposure to common triggers can cause relapses. The itching in AD can lead to scratching that damages the skin, spawning even more itching.

Living with the perpetual itch

Some with AD experience persistent itching at bedtime and throughout the night. They may awaken to discover they’ve scratched enough to damage their skin as they slept. The concern, of course, is the potential for infection and, secondarily, problems with daytime fatigue due to lost sleep.

For many with AD, this cycle of discomfort can also lead to mood disorders.

Atopic dermatitis and mood disorders

In 2017, links between AD and mood disorders were determined through data published in the Journal of the American Academy of Dermatology, which found that people with AD reported a much higher incidence of mood disorders (anxiety and depression) than those without AD. Overall, these outcomes indicated the presence of a “hidden” mental burden manifested by a decreased sense of vitality, avoidance of social activities, and poor emotional health. In tandem with reports on dysfunctional mood were indicators that sleep disturbance was a significant problem for people with AD.¹

Insomnia: the sleep connection

More recent research published in JAMA Dermatology found people with moderate to severe AD to be more likely to develop mood and sleep disorders. Those unable to control their symptoms through typical treatments reported sleep problems such as sleep-onset insomnia, sleep fragmentation, and reliance on sleep medications to achieve restful nights.² Intense itching caused by the AD inflammatory response may be the obvious culprit, but unfortunately, sleep problems may also lead to less tolerance for AD symptoms.

Insomnia and pain sensitivity

There are established bidirectional links between insomnia and pain intolerance. Science Daily reported on a Wolters Kluwer Health study³ in 2015 that “people with insomnia and other sleep problems have increased sensitivity to pain… The effect on pain tolerance appears strongest in people who suffer from both insomnia and chronic pain.”⁴

Pain and sleep

Also, as noted on the “Pain and Sleep” page at the National Sleep Foundation website, “those with acute or chronic pain are more likely to have sleep problems impact their daily lives...People with pain are also far more apt than others to report that lack of sleep interferes with their mood, activities, relationships and enjoyment of life overall."⁵ In addition: “People with pain also feel less control over their sleep, worry more about lack of sleep affecting their health and exhibit greater sleep sensitivity.”

Preventive care for better sleep

Achieving eight hours of rejuvenating sleep will be challenging for those with pain and discomfort. However, extra effort to protect sleep from disruptive itching and discomfort is worth it for those with AD. Consider these solutions.

Sleep hygiene

Sleep hygiene refers to all the practices, habits, and behaviors you engage in to prepare for sleep. These specific best practices may help those with AD get better sleep.

• Bedtime baths. Besides hydrating the skin, warm (not hot) water relaxes the body and mind.
• Moisturizers. Try those which include pure lavender essential oil. Not only is it a great hydration agent, but it has antibacterial and anti-inflammatory properties and its aromatherapeutic qualities encourage sleep.
• Humidifying. A nightstand humidifier promotes sleep by generating moisture to soothe the skin and to replenish dry heated air, making breathing while asleep easier. Tip: Use lavender essential oil in a humidifier designed for aromatherapy.
• Room temperature. It is healthier to sleep in a cool room, with layers of bedding to stay warm. Overheating creates excessive sweating which irritates AD. Also, an elevated core body temperature works against the circadian system; it requires a cooler core body temperature to maintain sleep. Tip: A glass of cold water at bedtime can cool you down.
• Be comfortable in your own skin. Pick lightweight, smooth, breathable, and comfortable fabrics for bedding and pajamas. You want to avoid excessive sweating, abrasive or scratchy textures, and manmade fibers. Tip: 100 percent cotton, bamboo, or silk provides warmth without trapping heat.
• Avoid allergens. Choose pillows, duvets, and comforters made from hypoallergenic materials. Stick to lighter weight quilts and blankets made from natural fibers. Wash these items using gentle, non-irritating cleaners.

Mindfulness

• Relaxation. Practices include yoga, meditation, progressive muscle relaxation, or breathing exercises. Listening to soft music, reading a book, journaling, knitting, jigsaw puzzles, or coloring books also give many a feeling of calm.
• Cognitive behavioral therapy (CBT). CBT has recently been researched as a potential means for improving the quality of life in people with AD. CBT promotes mindful behaviors that may improve one’s tolerance for discomfort during flareups while improving symptoms and sleep quality.⁶ Note: CBT for insomnia (CBT-I) is currently the gold standard treatment for insomnia.

Medication

• Topical medications. Apply right after a warm bath, or right before you put on pajamas. Consider following applications with “wet wraps” composed of moistened cotton bandages worn under dry pajamas. These help the skin better absorb medication and protect against nighttime irritation.
• Antihistamines. These may control itchiness, but beware; some may be sedating, while others can be stimulating. If your treatment is keeping you up at night, ask for a different prescription.
• Sleep aids. These may help, but they’re meant only for occasional, short-term use due to risks for dependency and adverse side effects. Since AD is a lifelong concern, explore nonpharmaceutical approaches to better sleep first, and turn to drugs only as a last resort.
• Allergy medications. AD compromises the skin’s natural barrier abilities, making it hyper sensitive to allergens (chemicals, smoke, cleaning products, etc.) Don’t neglect your allergy treatments; follow doctor’s orders and actively avoid triggers.

For people with chronic health concerns, improving sleep can yield multiple benefits, such as improved mood, symptom relief, and remission.