Tossing and Turning! How Psoriasis Can Impact Sleep

When we analyzed the results of our Psoriasis In America 2016 survey that many of you in the community participated in, several interesting trends were uncovered.  One common problem many people with psoriasis reported dealing with is trouble sleeping.  In fact, 44% of those who participated in the survey said that psoriasis impacts their ability to sleep “often” or “always.”  This is not a small number, and illustrates a larger problem, affecting the quality of life for people living with psoriasis.  Long periods of not having restful sleep can contribute to the fatigue people with psoriasis also experience. Not much research has been done to exactly describe the relationship between psoriasis and sleep trouble, however, a lot of information points towards several factors that may be keeping you up at night2.  Whether you’re having trouble falling asleep, staying asleep, or both, your troubles could be related to these common issues!

Itching and Pain

Pruritus is the medical name for excessive itching or scratching that most frequently accompanies psoriasis.  While it may be frustrating to deal with during the daytime, it can be even worse at night, and prevent you from falling asleep.  When your mind is focused on how itchy you are, it can’t quiet itself down enough to let you get the rest you need.  Additionally, when you are in the lighter stages of sleep, your body may be more prone to trying to scratch, leading to limb movements that wake you up, even once you have drifted off3.  This same phenomenon also comes along with pain perception, something very familiar to those with painful psoriasis lesions or joint pain from psoriatic arthritis.

Depression and Other Mental Health Conditions

Many emotional factors can often accompany psoriasis.  While experts aren’t certain if one definitively causes the other, or if these conditions can exist independently in the same individual, a cycle where one condition can exacerbate the other is known to be at play2.  Mental health conditions, like depression or anxiety, often lead to poor sleep.  It can get a little complicated, but thinking about this as an interconnected circle may make sense.  If you have psoriasis that has taken a toll on your emotional health and self-esteem (as it does for many!), you may develop psychological conditions like depression, which can affect your ability to get good rest.  If your body can’t reach the deeper stages of sleep, you are more prone to wake yourself up with itching or perceiving pain.  Also, with mental health conditions, as well as with a decrease in sleep, comes a decreased pain or discomfort tolerance4.  This can further lead to a cycle of scratching, a stronger feeling of pain, and a lot less sleep.

Obstructive Sleep Apnea

More research needs to be conducted in this category, just like the others, however, there is a growing body of research that supports the idea that those with psoriasis, like those with other inflammatory conditions such as rheumatoid arthritis, are more prone to developing obstructive sleep apnea. Chronic inflammation may be the common factor responsible for the relationship between psoriasis and sleep apnea1. People with sleep apnea have increased levels of certain pro-inflammatory proteins, called cytokines. These same cytokines, which are part of the immune system response, are also increased in people with psoriasis and psoriatic arthritis.

This condition on its own can decrease slow-wave sleep, lead to periods of hypoxia (or lack of oxygen), and ultimately, lead to more disturbances during the night.  As with the pain and depression, more disturbances open the doorway for more pain, itchiness, and overall discomfort, preventing you from getting back to sleep.

It’s no surprise that many people with plaque psoriasis report having sleep difficulties and ultimately fatigue. Social isolation that many people with psoriasis feel may actually contribute to sleeplessness due to lack of interaction and stimulation that may make your brain more tired and want to sleep. But talking with online communities, friends, and healthcare providers may help you figure out what specifically is keeping you up at night.  By figuring out what is preventing you from getting good rest (or at least trying too!), you can begin the treatment journey to getting a good night’s sleep!

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