Severe eczema, also known as atopic dermatitis (AD), is a chronic inflammatory skin condition that causes itchy, sore, and inflamed skin. While managing eczema is challenging during the day, it can become even more frustrating at night when itching intensifies, leading to disrupted sleep and a cycle of worsening symptoms. Night after night of poor rest can have serious consequences for overall health, mental well-being, and skin recovery.

This article explores how eczema affects sleep, why symptoms worsen at night, the best treatments available, lifestyle adjustments that can improve sleep quality, and how nutrition plays a crucial role in managing the condition.

Why Does Eczema Get Worse at Night?

Many people with eczema notice that their symptoms flare up when they lie down to sleep. Several factors contribute to increased nighttime itching and discomfort, including:

1. Fewer Distractions at Night

During the day, distractions like work, social interactions, and entertainment keep the mind occupied. At night, when everything is quiet, the focus shifts to the itch, making it feel more intense.

2. Body Temperature Fluctuations

Eczema-prone skin struggles to regulate temperature. At night, body temperature naturally drops, which can increase dryness and sensitivity, leading to more itchiness.

3. Decreased Hydration Levels

Skin loses moisture overnight due to reduced sweating and lower humidity levels. This can make already dry, damaged skin feel even worse, triggering the urge to scratch.

4. The Itch-Scratch Cycle

Scratching provides temporary relief, but it damages the skin further, leading to more irritation, inflammation, and a greater urge to scratch. This cycle can be difficult to break, especially when it's done unconsciously while sleeping.

5. The Role of Sleep in Skin Repair

Quality sleep is essential for the immune system and skin regeneration. Lack of sleep due to eczema can lead to increased inflammation and delayed healing, making symptoms worse over time.

The Vicious Cycle: How Poor Sleep Worsens Eczema

Chronic sleep disruption doesn’t just impact mood and energy levels—it directly affects eczema by:

• Increasing inflammation: Poor sleep weakens the immune system, triggering more severe flare-ups.
• Drying out the skin: Lack of rest affects the skin barrier, leading to more moisture loss and irritation.
• Worsening mental health: Sleep deprivation contributes to stress and anxiety, which are known triggers for eczema flare-ups.
• Lowering pain tolerance: When sleep-deprived, the body becomes more sensitive to itching and discomfort, making the condition feel even worse.

Medications for Eczema Relief at Night

There are several medications and topical treatments that can help soothe eczema symptoms and promote restful sleep.

1. Topical Moisturizers

Moisturizers help lock in hydration and strengthen the skin barrier. The National Eczema Association (NEA) recommends fragrance-free products containing ceramides, hyaluronic acid, and glycerin. Apply thick moisturizers before bedtime to keep the skin hydrated overnight.

2. Over-the-Counter (OTC) Treatments

• Hydrocortisone creams: Reduce inflammation and itching.
• Antihistamines: Some antihistamines, like diphenhydramine (Benadryl), can help with both itching and sleep induction.
• Colloidal oatmeal baths: A warm oatmeal bath before bed can soothe irritation and hydrate the skin.

3. Prescription Medications

For severe eczema, doctors may prescribe:

• Topical corticosteroids: Help control inflammation and itching.
• Calcineurin inhibitors (Tacrolimus, Pimecrolimus): Reduce immune response and prevent flare-ups.
• Biologic treatments (Dupixent): Work by targeting immune system pathways involved in eczema.

If over-the-counter treatments aren't providing relief, consult a dermatologist to explore stronger prescription options.

Non-Medicated Ways to Improve Sleep with Eczema

Aside from medications, several lifestyle and environmental adjustments can help promote better sleep.

1. Improve Sleep Hygiene

• Limit screen time: Blue light from phones and laptops disrupts the sleep cycle.
• Stick to a sleep schedule: Go to bed and wake up at the same time every day.
• Darken the room: Use blackout curtains and remove unnecessary light sources.
• Reduce noise: Use a white-noise machine if external sounds disturb your sleep.

2. Keep the Bedroom Cool and Comfortable

• Maintain a stable temperature: A cooler room (65-70°F) prevents overheating.
• Use breathable fabrics: Soft cotton pajamas and bed linens reduce irritation.
• Wash bedding frequently: Dust mites and allergens can worsen eczema.

3. Avoid Common Triggers

• Skip scented products: Fragrances in lotions and laundry detergents can irritate sensitive skin.
• Avoid harsh soaps: Opt for gentle, hypoallergenic cleansers.
• Limit hot showers: Warm, short showers prevent skin from drying out.

4. Use Protective Measures

• Wear cotton gloves at night: Prevents unconscious scratching.
• Apply thick moisturizer before bed: Seals in hydration for overnight repair.

The Role of Diet in Eczema Management

Nutrition plays a significant role in reducing inflammation, improving skin hydration, and strengthening the immune system.

1. Anti-Inflammatory Foods

A diet rich in antioxidants and omega-3 fatty acids can help reduce eczema flare-ups.

Include:

• Fatty fish (salmon, sardines)
• Nuts and seeds (flaxseeds, walnuts)
• Green leafy vegetables (spinach, kale)
• Turmeric and ginger (natural anti-inflammatory properties)

2. Foods That Worsen Eczema

Some foods may trigger or worsen symptoms in sensitive individuals.

Avoid:

• Dairy products (milk, cheese)
• Processed foods (high in refined sugar and artificial additives)
• Gluten (for some individuals with eczema and gluten sensitivity)
• Spicy foods (may cause inflammation and irritation)

3. Hydration

Drinking plenty of water helps keep the skin hydrated from within. Coconut water, herbal teas, and fresh fruit juices (without added sugar) can also contribute to hydration.

Managing Eczema for Better Sleep and Skin Health

Eczema can make sleep challenging, but with the right combination of medications, skincare, lifestyle changes, and nutrition, relief is possible.

Key Takeaways:

• Identify triggers: Avoid harsh products, allergens, and temperature extremes.
• Hydrate the skin: Use gentle, fragrance-free moisturizers and humidifiers.
• Improve sleep habits: Maintain a cool, dark, and quiet sleeping environment.
• Follow an anti-inflammatory diet: Eat foods rich in omega-3s, antioxidants, and hydration.

By taking proactive steps, people with eczema can break the cycle of itching and sleep loss, ultimately improving their quality of life and skin health. If symptoms persist, consult a dermatologist for advanced treatment options.