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How to Catch Zs

There is no easy fix, but better sleep is possible.

A routine lack of sleep “demolishes your immune system” while disrupting blood sugar levels and even increasing the likelihood of blocked and brittle coronary arteries, according to the writing and research of Matthew Walker, Ph.D., author of the New York Times bestselling book “Why We Sleep.”

OK, enough of the scary stuff. We all know we need sleep. We also know that understanding the importance of sleep does not make it any easier to find the time, environment, and circumstances that allow for quality sleep.

Several factors can impact the duration, quality, and regularity of your sleep, and people who experience psoriasis or psoriatic arthritis (PsA) have even more things to consider. So take a look at some of the sleep disrupters that might be getting in your way. [1]

Why Can’t You Sleep?

Itch

Itch impacts the quality of life for 70–90% of people living with psoriasis. [2] Some people describe this itch as a burning or stinging sensation, which can be frustrating and hard to ignore. Unfortunately, itch can worsen in the evening, which can further disrupt sleep. [3]

Pain

Pain related to psoriasis and psoriatic arthritis can also impact the quality of sleep. [3] [4] Research suggests poor sleep can worsen pain for those living with psoriatic arthritis. [4] This can become a difficult cycle, as pain can lead to poor sleep, and poor sleep can make pain worse.

Depression and Anxiety

People living with psoriatic disease are more likely to have depression and anxiety. [5] Those living with psoriasis have a 39% increased risk of being diagnosed with depression and a 31% increased risk of being diagnosed with anxiety compared with people without the disease. [6] Research has found that rates of depression and anxiety may be even higher in people living with psoriatic arthritis. [7] In turn, depression and anxiety may affect your sleep because difficulty falling asleep and staying asleep are symptoms of these conditions. [8]

Obstructive Sleep Apnea

There is a connection between psoriasis and obstructive sleep apnea (OSA), a potentially serious sleep disorder in which breathing repeatedly stops and starts when the muscles in your throat relax and block your airway. Signs of sleep apnea include snoring, gasping, and “snorting” sounds, and excessive daytime sleepiness. [9]

People living with psoriasis have an increased risk of developing OSA, while those living with OSA are at an increased risk of developing psoriasis. [10] Obesity is a possible comorbidity of psoriatic disease, and those with obesity have an increased risk of OSA. [5]

Scientists do not yet know the exact reason for the connection, but you should talk to your health care provider if you have any signs of OSA.

Restless Leg Syndrome

Restless leg syndrome (RLS) is a tingling or prickly feeling in your legs that sometimes makes you feel like you must move your legs. Limited research shows an increased frequency of RLS among people living with psoriasis. In one study, 17% of people living with psoriasis had RLS, while only 4% of the general population had RLS. [11] RLS may increase the risk of disrupted sleep. [12]

Have you ever heard of suggestibility? It’s the phenomenon that has you feeling like your leg is starting to twitch right now because you just read about RLS. Let’s take a deep breath together. For real. And then let’s focus not on what could happen but instead on what you can do about getting more sleep. [1]

10 Ways to Get Those Zs

1. TALK WITH YOUR DOCTOR

Only a health care provider can help you address issues like restless leg syndrome, obstructive sleep apnea, and anxiety and depression. You deserve a good night’s sleep every night. Do not delay care.

2. TREAT YOUR PSORIATIC DISEASE

Treating your psoriatic disease effectively can help manage factors that are disrupting your sleep. For example, research has found that psoriasis patients had less fatigue and insomnia when using a treatment that improved joint pain and skin symptoms. [2]

3. SET A SCHEDULE

A consistent bedtime teaches your body to release melatonin – a natural hormone that helps with sleep – at the same time every night.

4. DON’T SCRATCH!

Yes, this is easier said than done. Scratching may provide short-term relief, but it can cause the skin to itch more. Scratching the skin can also trigger the Koebner phenomenon, where skin injuries trigger a psoriasis flare.

5. WEAR THE RIGHT STUFF

Clothes made with scratchy fabrics can irritate skin and increase itch. Fabrics such as cotton or silk may be more soothing. Consider using soft bedsheets too.

6. MOISTURIZE

Moisturizing your skin daily reduces discoloration and itching and helps the skin heal. The National Psoriasis Foundation Seal of Recognition highlights over-the-counter products and recognizes products that have been created or are intended to be nonirritating and safe for those living with psoriatic disease. psoriasis.org/seal–of–recognition/

7. SET THE MOOD

Before you crawl under the sheets [13]:

• Make sure your room is dark and quiet.

• Keep the room at a comfortable, cool temperature.

• Limit exposure to bright lights in the evening.

• Dim lights or turn off overhead lights 30 minutes before bedtime.

• Turn off electronics 30–60 minutes before bedtime.

8. RELAX

Stress can worsen the symptoms of psoriatic disease and impact your sleep. Try reading, listening to music, or meditating to lower stress.

9. TOO HARD, TOO SOFT, OR JUST RIGHT?

Find a mattress that is comfortable for your body. Look for a mattress that is firm enough to support your joints but not so firm that it causes joint pain. If you have pain in your knees, you might try placing a pillow under or between your knees for extra support.

10. TAKE A BATH

A bath can help prepare your body for rest as well as relieve symptoms of psoriatic disease. Some people enjoy bath solutions (oil, oatmeal, Epsom salts, Dead Sea salts) to remove psoriasis scales and soothe itchy skin. Soak in a bath for a short amount of time and then apply a moisturizer or oil on your skin right after you get out of the bath.

Healthy Sleep Guide

Request the Healthy Sleep Guide from the Patient Navigation Center and learn more about how a good night's sleep can make a big difference.

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References

1. National Psoriasis Foundation. Healthy sleep quick guide. psoriasis.org/pnc.

2. Elewski B, Alexis AF, Lebwohl M, et al. Itch: an under-recognized problem in psoriasis. J Eur Acad Dermatol Venereol. 2019; 33(8): 1465-1476. doi:10.1111/jdv.15450.

3. Gupta MA, Simpson FC, Gupta AK. Psoriasis and sleep disorders: a systematic review. Sleep Med Rev. 2016; 29: 63-75. doi:10.1016/j.smrv.2015.09.003.

4. Haugeberg G, Hoff M, Kavanaugh A, et al. Psoriatic arthritis: exploring the occurrence of sleep disturbances, fatigue, and depression and their correlates. Arthritis Res Ther. 2020; 22(1): 198. doi:10.1186/s13075-020-02294-w.

5. Elmets CA, Leonardi CL, Davis DMR, et al. Joint A AD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019; 80(4): 1073-1113. doi:10.1016/j.jaad.2018.11.058.

6. Kurd SK, Troxel AB, Crits-Christoph P, et al. The risk of depression, anxiety, and suicidality in patients with psoriasis: a population-based cohort study. Arch Dermatol. 2010; 146(8): 891-895. doi:10.1001/archdermatol.2010.186.

7. McDonough E, Ayearst R, Eder L, et al. Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol. 2014; 41(5): 887-896. doi:10.3899/jrheum.130797.

8. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). 5th ed. 2013. Arlington, VA.

9. Centers for Disease Control and Prevention. Key sleep disorders. cdc.gov/sleep/about_sleep/key_disorders.html.

10. Ger TY, Fu Y, Chi CC. Bidirectional association between psoriasis and obstructive sleep apnea: a systematic review and meta-analysis. Sci Rep. 2020; 10(1): 5931. doi:10.1038/s41598-020-62834-x.

11. Schell C, Schleich R, Walker F, et al. Restless legs syndrome in psoriasis: an unexpected comorbidity. Eur J Dermatol. 2015; 25(3): 255-260. doi:10.1684/ejd.2015.2525.

12. National Institute of Neurological Disorders and Stroke. Restless legs syndrome fact sheet. ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet.

13. American Academy of Sleep Medicine. Healthy sleep habits. sleepeducation.org/essentials-in-sleep/healthy-sleep-habits

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