From glamour.com
By Alice Oglethorpe
The link between the skin condition and poor sleep isn’t fully understood, but it’s real. Here’s what researchers think is going on and a game plan for feeling more rested.
When you first think about it, your skin and sleep seem pretty disconnected. But if you have psoriasis, they are way more closely linked than you’d think. Research has found that about 17% of people with the skin condition experience severe fatigue. And a big reason for that is sleep issues.
“We can say for certain that patients with psoriasis have a higher risk of developing sleep problems,” says Lourdes Pérez-Chada, MD, an assistant professor of dermatology at Harvard Medical School. “And it can manifest in different ways. You could have sleep apnoea or restless leg syndrome or just have disturbances in your sleep.”
You might assume that it’s just the itching that wakes people up, but that’s only, ahem, scratching the surface. Here’s a deeper look at what’s really going on.
What we know and don’t know about the connection
People with psoriasis are four times more likely to have insomnia than those without the condition and have a 35% higher risk of developing obstructive sleep apnoea compared to the general population. So why is that?
The answer isn’t exactly straightforward.
Symptoms of psoriasis can be to blame for some poor sleep, says Tina Bhutani, MD, an associate clinical professor of dermatology at the University of California, San Francisco, and member of the National Psoriasis Foundation Medical Board. “Pain, itching, and discomfort can make you wake up in the middle of the night and have more fragmented sleep. You may not even realize it’s happening, but you could be unconsciously scratching in your sleep and not getting into the deeper sleep cycles, so you wake up feeling tired.”
But here’s the interesting thing: Take away the itching and pain, and patients with psoriasis still have worse sleep. “Even someone totally asymptomatic,” says Dr. Bhutani. And this is where the link gets a lot murkier. Researchers aren’t exactly sure what’s going on inside the body that makes getting a good night’s sleep so tough. But most experts agree that inflammation is involved.
“Psoriasis is inflammatory…and that impacts your sleep cycles,” says Dr. Bhutani. That’s because excess inflammation can impact your central nervous system, which can disturb sleep.
There’s also a mental health component. “Patients with psoriasis have a higher prevalence of mood disorders, like depression and anxiety,” says Dr. Pérez-Chada. “And those mood disorders are also associated with sleep problems.”
But the path may go the other way as well. “We don’t know which is the chicken and which is the egg. Does psoriasis lead to sleep problems, or do sleep problems lead to psoriasis?” Dr. Pérez-Chada says. “That’s what the field is trying to figure out.”
A recent study from the UK looked at almost 400,000 people without psoriasis and tracked them over 15 years. During that time span, people with sleep disorders had a much higher risk of developing psoriasis. “That’s what makes it fascinating. Previous studies looked at the association, but this looked at what preceded the other. And it showed that having a sleep disorder predated psoriasis in a large number of people,” says Ravi Ramessur, MD, PhD, a postdoctoral research fellow at the University of Pennsylvania.
But the exact reason sleep disorders can raise your risk for psoriasis isn’t known yet. “We really have very little understanding of the how, which is what we want to discover,” says Dr. Ramessur. One working theory right now involves proteins in the blood. “A study found that poorer sleep was associated with having a worse profile of proteins linked with the aging of different organs, including the skin,” says Dr. Ramessur. “And a lot of these proteins were inflammatory, so having poor sleep probably does have an effect on our systemic immunity, and one way that can manifest is with conditions like psoriasis.”
The road to being more rested
While researchers are still trying to figure out the why behind sleep issues in people with psoriasis, that doesn’t need to stop you from improving your sleep now. And this might involve seeing a few different specialists: your dermatologist, a rheumatologist, and a sleep expert.
Though your sleep issues may not all stem from psoriasis symptoms, improving them can only help things. “Psoriasis is a chronic, ongoing condition, so if you get it under better control, at least it can be less itchy and bothersome,” says Dr. Bhutani. If your symptoms are still an issue, talk with your dermatologist about your treatment plan and whether you should try something else.
Around 30% of people with psoriasis also have psoriatic arthritis, a related condition that impacts your joints and, as a result, your sleep (joint pain and stiffness can make you wake up throughout the night). That’s where a visit with a rheumatologist would come in, as they can screen you for psoriatic arthritis and make sure that, if you have it, you’re on the right treatment.
To find out what’s really impacting your sleep, you may need to do a sleep study. “I tell my patients: If you wake up not feeling well-rested and are groggy all day, you want to get into a sleep lab because there are treatments that can help,” says Dr. Bhutani. They will be able to see if obstructive sleep apnoea or another condition is causing your exhaustion and tailor your treatment to your actual condition. “For instance, there’s cognitive behavioural therapy for insomnia that’s been shown to be very effective,” says Dr. Pérez-Chada.
While it’s easy to dismiss, having good sleep hygiene can have a big impact. “This won’t be the only answer if you have other disorders like chronic insomnia or obstructive sleep apnoea, but modifying your habits can help,” says Dr. Pérez-Chada. This includes having a regular sleep schedule, avoiding caffeine in the afternoon and evening, exercising regularly, and keeping your bedroom cool and dark. “Those are good tips for the general health of people with psoriasis, and they could potentially improve your psoriasis activity,” says Dr. Ramessur. “It’s a double win.”
Whatever you do, don’t think that you have to take poor sleep lying down. If you feel tired and have psoriasis, you have options—you just need to start by telling your doctor.
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