Sleep and Psoriatic Disease

If you are living with psoriatic disease and have problems falling asleep, staying asleep, or feeling refreshed from sleep, you are not alone. While psoriatic disease may not be a direct cause of sleep problems, the main symptoms of psoriatic disease, including dry, itchy skin and joint pain, might be keeping you up at night. Additionally, psoriatic disease is also associated with two common sleep disorders: sleep apnea and restless leg syndrome.

Read about why psoriatic disease might be causing you to toss and turn at night and find out what you can do to get a better night’s sleep. 

Sleep Disorder-Psoriatic Disease Connection

Psoriatic disease is an autoimmune disease, which includes two specific inflammatory conditions: psoriatic arthritis (PsA) and psoriasis. People with psoriatic disease have overactive immune systems where inflammation attacks their skin and joints. 

According to a 2018 report in the medical journal, Reumatologia, poor sleep quality was found in 67.7% of the PsA patients and 57.7% of people with psoriasis. The researchers further note sleeping disorders in people with PsA and psoriasis are related to poor quality of life and severe fatigue. 

Because sleep disorders are common in people living with PsA and psoriasis, they are considered co-morbidities (co-existing) conditions of psoriatic disease. However, researchers don’t know if psoriatic disease is a direct or contributing cause of any specific sleep disorder or if sleep disorders contribute to progression of psoriatic disease.

Sleep Apnea

Sleep apnea, a condition where a person repeatedly stops breathing during sleep, is associated with psoriatic disease. One 2016 Danish study reported that psoriatic disease was associated with an increased risk for sleep apnea and sleep apnea was associated with an increased risk for psoriatic disease, but researchers don’t actually know why this connection exists.

In addition to breathing troubles, sleep apnea causes: 

• Loud snoring
• A very sore or dry throat upon waking up
• Occasionally waking up to choking or gasping sensations
• Sleepiness and lack of energy throughout the day
• Restless sleep
• Morning headaches
• Forgetfulness
• Mood changes
• Decreased sexual interest
• Recurrent awakenings and insomnia 

Restless Leg Syndrome

Evidence suggests some people living with psoriatic disease may also have restless leg syndrome (RLS). RLS is both a sleep disorder and a disorder of the nervous system that causes an urge to move the legs. People with RLS have uncomfortable sensations in their legs—and sometimes, their arms or other parts of the body—and the urge to need to move to relieve sensations. These sensations can be described as “uncomfortable,” “itchy,” “pins and needles,” or “creepy crawling.” They are worse when a person is at rest, sitting or lying down. For many people with RLS, their symptoms cause nightly sleep struggles significant enough to impair quality of life. 

One 2015 study reported in the European Journal of Dermatology finds an increased frequency of RLS in people with psoriasis. The German sleep study compared 300 patients with psoriasis and 300 healthy controls for RLS symptoms. Up to 17% of the people with psoriasis reported symptoms of RLS, while only 4% of people without psoriasis reported RLS symptoms. And the people with psoriasis reporting RLS symptoms were also reporting higher symptom severity of RLS.

A 2018 report in the journal Zeitschrift für Rheumatologie looked at a study where RLS was found to affect people with PsA at a higher rate than it did for people with psoriasis. Further, the presence of RLS in psoriatic disease was related to impairments in sleep and quality of life and is a contributor to fatigue and depression.

Inflammation

The inflammation that causes psoriatic disease is a likely culprit for problems with sleep quality.  Research has shown sleep loss can cause a person’s immune system to turn on itself. When the immune system overacts, it causes the tissue-damaging inflammation that psoriasis and PsA are known for. Additionally, the newest research shows compelling evidence that insomnia and other sleep problems significantly and adversely influence an increased risk for inflammatory diseases and even increase a person’s risk for death.

While this information is concerning, there is some good news. The medications you take to treat psoriatic disease have a positive impact on your sleep. Studies on biologic therapies have shown significant improvement in the quality of sleep of people whose psoriatic disease symptoms have improved as a result of these treatments. One study reported in 2012 in the Journal of Clinical Sleep Medicine finds sleep apnea is less common patients with another inflammatory arthritis—spondyloarthritis­—because these patients were on TNF-inhibitor drugs, a type of biologic therapy.

Other Causes 

In addition to inflammation, other co-morbidities are also believed to play a role in both sleep disturbance and psoriasis. Research reported in the journal Dermatology finds sleep disturbances and low sleep quality in PsA are related to being female, being overweight, having moderate to severe psoriasis, sleep apnea, and smoking.  Age, alcohol consumption, and itching were not considered to be related sleep difficulties in people with psoriatic arthritis, although they can be associated with sleep problems. 

Finding Solutions

It will take some lifestyle and bedtime routine adjustments, but it isn’t impossible to get better quality sleep with psoriatic disease.

Talk to Your Healthcare Provider About Sleep Disorders

Since sleep apnea, restless sleep syndrome, and other sleep disorders are associated with psoriatic disease, you should talk to your healthcare provider about the possibility of a disorder affecting your sleep. Some sleep disorders, including sleep apnea, may not cause obvious symptoms, so you may have a sleep condition without realizing it. 

Talk to your healthcare provider if you are waking up feeling unrefreshed from sleep or if you are feeling fatigued during throughout the day, as a sleep disorder could be to blame.

Try Hot and Cold Therapy for Joints

Temperature therapy might give your joints some relief before bed. You will need to try different methods to figure out what works for you. For example, you may prefer a warm shower, using an ice pack or sleeping with a warming blanket. Include the method that seems to give the most relief to your bedtime routine to help you fall asleep quicker.

Moisturize Skin

One of the easiest ways to keep your skin calm is to regularly moisturize, and this is something you can add to your evening routine. Apply lotion to your skin just before bedtime to manage itchiness that might keep you awake. Make sure you are using a product that is specifically made for dry skin. You may also consider alternatives to lotion, such as coconut oil or aloe vera oil.

Keep a Regular Sleep Schedule

Keeping a consistent sleep schedule helps to regulate the body’s circadian rhythm, the body’s biological mechanism that helps you drift off to sleep at night and keep you asleep all night. You can keep your circadian rhythm in check by choosing an early bedtime and sticking to it. Even if it takes you long to fall asleep, you can allow your body time to relax and you can wind down at your own pace.

By going to bed at the same time every night, you can stabilize your body’s circadian rhythms and drifting off will get easier.

Cut the Caffeine

If you are drinking caffeine too late in the day, it affects how well you are sleeping at night.  A study reported in 2013 in the Journal of Clinical Sleep Medicine found consuming caffeinated beverages six or fewer hours before going to bed can rob of at least an hour of sleep.

Unplug

The sooner you get yourself off the electronic devices, the sooner you can get to sleep. Using electronic before bedtime can be harmful to your sleep quality. You should start powering off electronic devices at least 30 minutes before you go to bed.

Try Meditating

Stress makes PsA and psoriasis worse, and it can also keep you up at night. Try some calming meditation exercises to relax your mind before going to bed. And meditation doesn’t have to be hard. You can start by simply closing your eyes and focusing on inhaling and exhaling. Keep your body still and try to enjoy the quiet.

A Word From Verywell

If you have tried all the tips above and others for getting better sleep and still can’t seem to sleep well due to psoriatic disease symptoms, it may be time to talk to your healthcare provider about your treatment plan. It is also a good idea to keep a journal noting sleep habits, symptoms and other sleep and disease-related issues. Then, discuss these with healthcare provider and ask if there are any new or alternate therapies that can offer you some relief and help you to get to sleep, stay asleep, and wake up feeling refreshed.