Why can’t you just tell yourself to stop scratching? Very simple: you never told yourself to start. Your conscious willpower self isn’t running the show.
Published On: Sep 15, 2017
Last Updated On: Sep 1, 2021
Sleep is as important to humans as breathing, eating and drinking. Yet for patients and families dealing with eczema, sleep often comes in short bursts between itching and scratching cycles. As a doctor, I want to help you better understand why sleep is so challenging when eczema is in the picture and offer tips for how to get a better night’s rest.
We go through different stages of sleep. The first part of the night is spent in our deepest sleep and the last part of the night in dreaming (rapid eye movement or REM) sleep, with the rest of the night spent in lighter stages of sleep.
In children, sleep cycles are about an hour. In adults, they are 90 minutes to 2 hours. At the end of every sleep cycle, we have a short arousal where our brain wakes up briefly and then returns to sleep.
Most people are not aware of the fact that they wake at least two to six times a night. In terms of eczema, this is important for two reasons. First, during these brief arousals, the itch sensation may kick in and the reflex of scratching begins.
Unfortunately, the reflexive scratching will often result in increased itching/scratching and may even result in bleeding. Remember that a sleep cycle is shorter in children, so it may appear as if your child is scratching in their sleep every hour on the hour.
The other reason it is important to understand that we all wake multiple times per night is related to how we fall asleep. We all have favorite ways of falling asleep: a teddy bear, a fan, or some type of white noise.
For me, it is pillows. I put my head on these two pillows and fall asleep easily at bedtime. But when I wake in the middle of the night and find my pillows on the floor I can’t go back to sleep. The pillows falling off the bed did not wake me, but when I had a normal arousal, I couldn’t go back to sleep without my pillows. I scoop my pillows up, put my head on them and return to sleep.
The moral of the story is if you help your child fall asleep at bedtime by lying with him, he will then need you to return to sleep following normal nighttime arousals. All that said, if you need to monitor your child for health reasons (such as to keep them from scratching), then you need to share a bed or room with them.
However, if medical supervision is not necessary, then you may want to consider the benefits of teaching them to fall asleep independently at bedtime (i.e., no more helicopter kicks in the middle of the night!). Over time, they will learn to return to sleep in the middle of the night on their own.
Our internal clock, or circadian rhythm, is a strong factor in helping us sleep. The funny thing about our circadian rhythm is that it runs on a clock that is slightly more than 24 hours. That means we can adapt when we cross time zones or at the start/end of daylight saving time.
Our internal clock is regulated by light and dark, as darkness is a cue for our brains to produce the hormone melatonin. Naturally produced melatonin doesn’t make us sleepy at the onset of darkness, but instead prepares our body for sleeping by doing things like cooling our core body temperature.
However, this means that in the hour or two before bedtime, heat escapes our body through the periphery, in particular extremities and skin. This is believed to be one factor that contributes to increased itchiness right before bed.
In fact, studies have shown that children with eczema sleep soundest between 2 and 4 a.m., when they reach their coolest body temperatures, both internal and external. This is contrary to what we know about sleep physiology, as our deepest (and soundest) sleep occurs in the first part of the night, usually at a time when we find many children with eczema to be the most restless.
We find that once eczema improves, so does sleep. But that is pretty obvious and not necessarily the answer you are looking for. So here are some other suggestions to ensure healthy sleep practices for every member of your family.
Although some of these recommendations can be difficult to follow when eczema is flaring, stick to them as much as possible, in both good and bad times, to increase your family’s chances for better sleep quality and longer sleep duration.
Dr. Lisa Meltzer is an 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. Visit www.nationaljewish.org/doctorsdepartments/providers/physicians/lisa-j-meltzer for more information.