Bedtime Habits Dermatologists Wish People With Eczema Knew About

If your eczema itch worsens at night, there are many simple steps you can take for better sleep. Not only will the urge to scratch lessen, but you’ll also benefit from uninterrupted snooze time. From nighttime skin care to the right PJs and linens to the temperature of your bedroom, you can set the stage for slumber. Here are the bedtime habits that can help, according to Smita Aggarwal, MD, a board-certified pediatric and adult dermatologist specializing in eczema at Rush University System for Health in Chicago.

“Eczema is an extremely itchy condition. This relentless itch can make it difficult to fall asleep,” says Aggarwal “It can also cause frequent awakenings throughout the night. Some of these awakenings may only be partial — someone may not recall waking up but they feel fatigued in the morning.” It’s a vicious cycle. “It is common for people with uncontrolled eczema to have decreased sleep quality, which can then affect concentration and productivity the following day,” she explains.

To prevent itch and other symptoms that keep you up or wake you up, try the soak and smear approach. “This is a popular technique to soothe the skin and calm down flares,” says Aggarwal. “You bathe or shower and then, within a few minutes of coming out, you apply a thick moisturizer to the entire body or at least affected areas. Doing this before bed allows your moisturizers and/or medications to absorb and heal the skin overnight.”

Skip the thin lotions. “When it comes to moisturizers, using a cream-based or ointment-based product is typically best,” says Aggarwal. “I recommend creams that are fragrance-free, free of botanicals in case of sensitivity, and ideally one with added ingredients such as ceramides and lipids. These help restore the natural skin barrier, which is an important part of treating eczema.”

“Ointments are clear greasy products, such as Vaseline, that are very helpful for especially dry areas or on areas where a barrier is needed,” says Aggarwal. One such area is the face, especially on the cheeks and around the mouth. “These are common areas for irritation from saliva and foods, more often in infants and children,” she explained. “Recently, there has been increased concern for lanolin sensitivity, which is found in many popular ointments including Aquaphor. For this reason, I tend to recommend plain original Vaseline or Cerave Healing Ointment, neither of which contain lanolin.”

“Wet wraps are an old remedy, which we still often turn to,” says Aggarwal. “Even though they can initially sound cumbersome and time consuming, many children and adults find them very soothing. They can be left on overnight or for as little as 20 to 30 minutes to be effective.” They work by helping to humidify the skin and increase absorption of both medications and moisturizers, which are applied first, followed by a layer of slightly damp clothing, and then a second layer of dry clothing. “This can be done for the entire body using pajamas, or on focused areas like gloves and socks for the hands and feet to create a wrap. There are many wrap products on the market, such as eczema sleeves, to simplify the process.”

To prevent sleep-scratching, try keeping your nails short and try lightweight anti-itch gloves. “Cotton gloves can be helpful for all ages, but they can be difficult to keep on. And in children we sometimes worry about them affecting sensory development,” says Aggarwal. She also importantly points out that “if there is significant scratching overnight, that tells me that the eczema is not well controlled and we need to adjust our therapies.”

Get rid of scratchy, heavy fabrics. “100% cotton is ideal for clothing and linens,” says Aggarwal. “Ensure clothing is lightweight and avoid unnecessary layers. For some, a cooling mattress or mattress pad can help, too.”

“Everyone regulates temperature differently, but in general a cooler sleeping environment is best,” says Aggarwal. “Heat or feeling warm tends to aggravate itch. To help combat this, a room fan can be helpful. A humidifier can help in the wintertime when the air is dry.” Even if you have a whole-house humidifier, an additional smaller unit in the bedroom can make a difference overnight, she added.

Behavior changes can help break the scratching habit. Investigate cognitive behavioral therapy or CBT, a problem-focused type of talk therapy. It teaches you to reframe your thinking and in turn change your behavior. “CBT can be very helpful for children and adults with chronic eczema,” says Aggarwal. “A fidget toy or even wearing beads on your wrist can be a useful distraction for your fingers.”

Though being woken up by itchiness is a sign that your eczema treatment needs tweaking, in the moment, you have options. “Anything cool will generally help,” says Aggarwal. “That could be an ice pack, a moisturizer that has been kept in the fridge, or even a bag of frozen veggies. Practicing meditation also helps some people fall back asleep. There are cooling tools now specifically made for people with eczema, such as the Cosi Care Scratch Star, which is a favorite of several of my patients.” The hand-sized star has cooling gel and an aluminum underside with bumps that provide a safe scratch.

“The relationship between water intake and dry skin is still under debate,” says Aggarwal. “People with eczema hold less moisture in their epidermis and stratum corneum than those without eczema. For this reason, hydrating emollients and avoidance of drying agents are key when treating eczema. These measures add hydration from the outside. It is still unclear how much [drinking] water affects these top layers of skin, but it certainly cannot hurt.”