Ask the Ecz-perts: Sleep

In Ask the Ecz-perts, leading medical experts answer your most pressing questions about eczema and its related conditions.

In this edition of Ask the Ecz-perts, sleep expert Dr. Lisa Meltzer answers your questions about eczema-related sleep issues. Meltzer is board certified in behavioral sleep medicine by the American Board of Sleep Medicine and directs the Pediatric Behavioral Sleep Clinic at National Jewish Health.

Why do many people with eczema seem to be able to sleep in the daytime but have so much trouble at night?

There are several reasons. One is that skin temperature gets warmer around bedtime and the first part of the night, making itching worse. Another reason is that when we are tired, the part of the brain that controls our ability to keep ourselves from scratching goes to sleep first. Finally, some people develop insomnia from the itching, and then take naps to try and catch up on some missed sleep. However, this reduces the ability to sleep at night, perpetuating the insomnia. It can become a terrible cycle.

Do you have any recommendations for habitual itchiness in children? My son is 6 years old, and while we keep escalating his nighttime medications, it does not seem like it is helping.

It is important to make sure the daytime itchiness is well controlled, otherwise it will only get worse at night. It also may be time to try a different nighttime medication if that one is not effective.

What are your suggestions for keeping your hands busy while you are falling asleep? I find that since my hands are “free,” I sometimes scratch habitually, especially if I can’t fall asleep. I’ve tried gloves and wraps already. 

Consider holding something in your hands while falling asleep (e.g., soft squeeze toy). If you have not yet tried it, consider using an app for meditation/relaxation to help keep your focus on something other than the itching behavior.

What is the best alternative medication for a teenager to help them sleep through the night? We have tried melatonin, but it doesn’t keep her asleep during intensive itch.

As a psychologist, I do not prescribe medication. Melatonin has a very short half-life (45 minutes), which means it is effective in helping you fall asleep, but it does very little to help you stay asleep. Alternatives are using time-release melatonin that provides a second dose in the middle of the night or taking a second small dose during the night. Please check with your medical provider about alternative medications that may help with sleep. For those with younger children, know that time-release melatonin must be swallowed whole as a pill and cannot be taken in a liquid form.

For parents wanting to explore melatonin for a 1-year-old child, what are the risks involved? Is it even recommended for one so young?

Melatonin is a naturally produced hormone. There are no studies in children that age, but there are several studies showing effectiveness in older (school-age and adolescent) children with eczema. There are concerns that melatonin may interfere with hormonal development, although there are no long-term studies showing that (only in animals). You should check with your pediatrician, but I generally do not recommend melatonin in a child that young.

What is the best dosage of melatonin for adults and the best time to take it?

If you are using melatonin as a hypnotic (to make you fall asleep faster), you should start at one milligram. If that is not effective, after a few days, go up by one milligram. every few days. Most adults find three to six milligrams to be most effective. There is no evidence that higher doses are any more effective, so if that isn’t working, it might be time to try something else. Also, try to find “pharmaceutical grade” melatonin, as melatonin is an over-the-counter and unregulated supplement, it is not clear that the dosing will be what is promised on the package.

Are there any concerns for using antihistamines like Benadryl long term to help my little one to go to sleep?

I’m not aware of any science showing that there are concerns with long-term use. That said, for many children, antihistamines are only effective for a few days, so they may not get continuous benefit from them.

Is there anything other than antihistamines like Benadryl to control itch while sleeping?

I do not prescribe medications, but you could check with your provider about more sedating antihistamines or other sleep medications (we often call them “the Z drugs” like zolpidem, zaleplon, etc.).

Do you have any advice on what to do when scratching seems to be more of a reflex than from an actual itch sensation? We’ve tried multiple medications (both for sleep and itch) at different levels of potency, and my son still comes in and out of sleep cycles rubbing and scratching himself bloody.

Sleep cycles in children are only about an hour, and at the end of every sleep cycle, there is a brief arousal when the itch sensation will often kick in. So, you are right that your child is basically scratching in his sleep. Unfortunately, the medication that may help him sleep does not always suppress the itch sensation.

The best way to manage this is to ensure that the eczema is under control (I know, easier said than done), but also to ensure the sleeping environment is as cool as possible and to cover his hands. At National Jewish Health, we recommend the use of wet wrap therapy to help manage the skin. Just know that the itch sensation will continue once the skin is clear. Unfortunately, the itch takes a lot longer to improve than the skin.

Have you heard of cooling pillows, and do you think they help for a good night’s sleep?

I have heard of them, and while I haven’t seen any studies showing their effectiveness, based on my own clinical experience, I think cooling the body may be very effective. As melatonin is released in the early evening, core body temperature decreases, and thus heat is release through the skin and periphery (hands, arms, feet and legs), which is why you see increased itching at bedtime and the first half of the night. Thus, I believe that if you are able to provide some cooling it may relieve some of the itching.

Is eating/drinking a little something (carbs, milk, turkey, etc.) to encourage sleep good or bad in your opinion?

Unless you have reflux, eosinophilic esophagitis or any other gastro-intestinal concerns, I’m a big fan of a light snack before bed. It is a nice start to a bedtime routine (for children or adults). However, if you are thinking that the tryptophan from milk or turkey will help, you would need to drink a gallon of milk and eat two pounds of turkey, so go with something like yogurt, a granola bar, etc., instead.

Dr. Lisa Meltzer is associate professor of pediatrics at National Jewish Health in Denver. She is board certified in behavioral sleep medicine by the American Board of Sleep Medicine and directs the Pediatric Behavioral Sleep Clinic at National Jewish Health.

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