Introduction

Nearly everyone has felt a zombie-like state after a night of little or no sleep. We can feel drowsy during the day with slowed thinking, lack of energy, and an irritable mood after just one night of not getting enough sleep. Imagine going to bed, getting ready for a good night's sleep, and then experiencing pain, burning sensations, or, in the case of damaged tissue or joints, an inability to move. The previously stated subjective symptoms can make it difficult to fall asleep, make you wake up during the night, or wake up too early and tired. 

What is psoriasis?

Psoriasis is a life–long skin condition resulting in thick, red patches of skin within silvery scales that are itchy or painful. The patches are commonly found on your elbows, knees, scalp, back, face, palms, and feet, but they can appear anywhere on your body. Psoriatic arthritis is a type of joint disease that affects some patients with this disease.

This condition is caused by an immune system problem. Skin cells that grow deep within your skin undergo cell turnover when the cells rise to the surface. This normally takes a month. Because your cells grow too quickly in psoriasis, it happens in just a few days.¹

There are several types of psoriasis, and each one has its signs and symptoms:

• Plaque psoriasis
• Nail psoriasis
• Guttate psoriasis
• Inverse psoriasis
• Pustular psoriasis
• Erythrodermic psoriasis

Symptoms

As previously stated, there are several types of psoriasis, and the symptoms may differ depending on the type. However, the main symptoms of psoriasis are: 

• Dry patches of skin covered in scales
• Itching
• Soreness

The patches on brown, black, and white skin can appear pink or red, and the scales white or silvery. However, the patches on brown and black skin can appear purple or dark brown, and the scales can appear grey.

Psoriasis is classified into several types. Many people only have one type at a time, but you can have two different types at the same time. One type may transform into another or become worse.

Most psoriasis causes a cycle, causing problems for a few weeks or months before easing or fading away.²

Lack of sleep often worsens psoriasis symptoms

When you have a wound that won't heal, it is natural to feel defeated, especially if you have tried everything to get things on track and find relief. But whatever you do, try to incorporate more sleep into your lifestyle. As surprising as it may seem, there is a connection between sleep and wound healing. If you get enough sleep, you might notice some improvements, but if you do not, the healing process will most likely take much longer. Although it is difficult when you have a skin condition that makes you itch and makes falling asleep nearly impossible, it is manageable, and it will greatly benefit your psoriasis.³

When you do not get enough sleep, your immune system's antibodies and cells decrease. As a result, your body requires sleep to fight pathogens. Boosting your immune system may help reduce symptoms and reduce the likelihood of flare-ups. 

Pro-inflammation

We have already mentioned how getting too little sleep makes you groggy, disoriented, or can even aggravate your psoriasis, but do you know how it triggers a pro-inflammatory state? When you do not get enough sleep, it causes an accumulation of damage to proteins and DNA, leading to cellular stress.⁴ Cellular stress is linked to cytokine release (small proteins that are important in controlling the growth and activity of other immune system cells and blood cells), and some cytokines make diseases worse; these cytokines are known as proinflammatory cytokines – this causes a pro-inflammatory state, which is the last thing you need if you have psoriasis.⁵

Hormonal dysregulation

This occurs when your body produces or reduces hormones more than normal, and it controls everything. Lack of sleep can affect your hormonal balance; for example, cortisol, known as a stress hormone, can have a variety of effects on the human body. Cortisol can affect nearly every organ system including:⁶

• Nervous 
• Immune
• Cardiovascular 
• Respiratory 
• Reproductive
• Musculoskeletal
• Integumentary

So how is this important hormone associated with sleep? 

The nadir (lowest concentration) of cortisol usually occurs around midnight. Cortisol levels rise 2-3 hours after sleep begins and continue to rise throughout the day. The peak occurs between 9 a.m. and 10 a.m.⁷ 

Many studies have found an increase in cortisol levels during total sleep deprivation at night and the following day's prolonged wakefulness. This is most likely due to the stress of staying awake.⁸ When you sabotage your circadian rhythm, your cortisol rhythm begins to shift, and it can remain elevated for longer than your body requires. Furthermore, as previously stated, high cortisol levels can be the cause of a variety of unpleasant health issues.⁹

The cycle of psoriasis and lack of sleep

No sleep equals worsening psoriasis symptoms. These symptoms make falling asleep difficult, and when you are getting less sleep, your symptoms get even worse!

No sleep = worsening symptoms = no sleep due to symptoms = even worse symptoms!

You may begin to feel as though you are in a nightmare that never ends. If you feel you are stuck in this cycle of stress, pain, and worry, there are a few things that can be done to help alleviate symptoms.

What can you do to improve sleep quality during a psoriasis flare-up?

Before we talk about how a person with psoriasis can manage their flare-up, we have to mention what causes it. Symptoms may get worse due to certain triggers. Knowing these triggers will help you avoid a flare-up. These triggers can include:

• Lack of sleep
• Smoking
• Stress
• Cold weather

So how can we manage these symptoms, and what can help? 

Moisturise before bed

Do not forget your topical treatments – they are typically the first line of treatment for mild to moderate psoriasis. These include creams and ointments that are applied to the affected areas. Some people discover that topical treatments are sufficient to control their condition. 

Emollients are moisturising treatments that are applied directly to the skin to reduce water loss and provide a protective layer. If you have mild psoriasis, your doctor will most likely recommend an emollient.

The primary function of emollients is to moisturise the skin while also reducing itching and scaling. Other topical treatments are thought to be more effective on moisturised skin. After applying an emollient, wait at least 30 minutes before applying another topical treatment.¹⁰

Wet wrapping

For erythrodermic patients, wet wrap dressings offer an additional treatment option. Topical corticosteroids are applied to the affected surfaces, and then a warm, moist cotton cloth is applied, followed by a dry cotton cloth. This procedure is known as wet wrap therapy. 

The benefits of this procedure include both its safety and the rapid and noticeable improvement of the erythroderma. Wet wrap dressings are a crucial form of rescue therapy for erythrodermic psoriasis.¹¹

Find out whether your psoriasis prefers warmth or cold at night

Observe if your flare-up is associated with weather, and find out which one is more comfortable for you – warmth or cold at night. In most cases, cold weather is the main trigger for a flare-up because heated and dry air makes the skin crispy. However, some people prefer the cold more than warmth, so find out what is best for you.¹²

Smooth sheets

High-quality cotton sheets naturally wick away moisture, so they won't obtain moisture over time. Sateen cotton and organic cotton sheets are the two types of cotton you should consider if you have sensitive skin. Since harmful chemicals and dyes can irritate sensitive skin, you should ensure your cotton sheets have not been treated with them.

Silk, another natural fibre, has long been prized by sensitive skin sleepers. It has a smooth feel to the touch and controls temperature. This implies that it can keep you cool in hot weather and warm when the temperature drops. Your skin will be much less likely to become irritated with the right temperature regulation.¹³

Conclusion

An individual’s quality of life is affected by psoriasis. Sleep disorders are among the most prevalent psoriasis-related disorders, although most quality-of-life scores do not directly assess them. Since sleep disorders affect people's physical and mental health, a specific evaluation of sleep disorders using specific scores is required. Numerous studies have demonstrated the connection between psoriasis and sleep disorders. 

It is important for people who suffer from this skin condition to gain knowledge about the link between sleep deprivation and psoriasis.¹⁴