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Understanding and Managing “Painsomnia”

Posted on April 06, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Victoria Menard

Nearly 90 percent of people diagnosed with psoriatic disease have trouble sleeping. In many cases, this difficulty is due to “painsomnia” — insomnia (difficulty sleeping) due to chronic pain or discomfort. The symptoms of psoriasis, including itching, burning, and soreness, as well as joint pain and stiffness from psoriatic arthritis (PsA), can cause a person to have difficulty falling and staying asleep. As one MyPsoriasisTeam member wrote, “I feel like I never sleep anymore … most nights, I’m in a lot of pain.”

Painsomnia can be frustrating. Sleep issues and sleep deprivation can have significant impacts on a person's mental health and quality of life. The good news is that there are several ways you can manage painsomnia — both at home and with your doctor. Here, we take a closer look at painsomnia in psoriatic disease and discuss what experts and MyPsoriasisTeam members recommend for managing it.

Painsomnia in Psoriasis

Many people diagnosed with psoriasis report having difficulties falling and staying asleep because of discomfort and itch. Research has found itching to be the main predictor of sleep problems in people with psoriasis. As one MyPsoriasisTeam member wrote, “My skin keeps me up, as it is itching so much.” Another shared, “As my psoriasis spreads, it’s more difficult to keep up with the pain and itch. In the past week, I’ve had about eight hours of sleep total, as it’s difficult to sleep when the itch keeps me up.”

Some people diagnosed with psoriasis or psoriatic arthritis cannot sleep because of severe or persistent discomfort and other pain, research shows. Psoriasis can cause swelling, itching, and burning, while PsA can cause joint pain and discomfort. All of these symptoms can make it hard to get comfortable enough to fall asleep. As one MyPsoriasisTeam member wrote,“I didn't fall asleep till 3 a.m. because my joints and skin were so sore.”

Some members find that they have particular difficulties with painsomnia during psoriasis flare-ups. As one member said, “I have a huge flare on my face and arms. Painsomnia!” Others experience worsened insomnia when changes in weather exacerbate their symptoms: “Another insomnia night,” wrote one member. “My pain is unreal — these storms are getting me this year.”

Poor sleep poses additional challenges, especially for psoriasis. Animal research suggests that losing sleep can even make psoriasis worse in a vicious cycle: Poor-quality sleep causes the brain to become fatigued and tired, which reduces the central nervous system’s ability to dampen pain signals. In other words, existing pain can feel even more severe, which can then make getting to sleep even more challenging. As one MyPsoriasisTeam member described, “Insomnia is the worst thing ever. It makes everything feel worse — every ache and pain.”

Managing Painsomnia With Psoriasis

Managing painsomnia in psoriasis and psoriatic arthritis generally begins with treating the underlying disease and its symptoms. If treatment isn’t enough to help improve your sleep difficulties, there are several other approaches that you and your doctor can take to help you fall and stay asleep.

Treat Your Psoriatic Disease

Treating the itching and pain characteristic of psoriatic disease can help improve rest and sleep quality. Treatments may involve prescription biologic medications. Newer biologic medications are very effective at targeting the overactive inflammatory pathways that lead to itching and pain.

You may find that topical creams applied before bedtime can help, as well. Keeping the skin moist and using medicated ointments may help relieve itching and other bothersome psoriasis symptoms, members say. As one MyPsoriasisTeam member shared, “Thick ointments help keep my skin moist for hours.” Another explained, “Lidocaine cream helps me with the itching.”

Practice Better Sleep Habits

Improving your sleep habits (also known as sleep hygiene) may make it easier to fall asleep and stay asleep long enough to get the rest you need.

Reducing caffeine intake (especially late in the day), setting a regular bedtime that you adhere to every day, avoiding electronics before bedtime, and making sure you have a dark, quiet place to sleep can make a difference in how long it takes you to fall asleep and how well you sleep.

Try Cognitive Behavioral Therapy for Painsomnia

Pain is partially psychological — pain signals in the brain can worsen if you’re on high alert. Cognitive behavioral therapy (CBT), a type of therapy, may help you learn to respond differently to pain. CBT for pain typically involves working to change your coping response to heightened pain signals and to modify the signals themselves. It focuses on changing the negative thoughts that can contribute to and worsen depression and anxiety.

Optimize Your Bed for Comfort

Your bed can have an impact on sleep quality — especially for people with psoriatic arthritis. Experts recommend a soft mattress to help cushion sore, stiff joints, although you should talk to your doctor or a physical therapist about the best mattress for you. Many people with chronic pain use weighted blankets to help settle in for sleep, but if the blanket is too heavy, it may put extra pressure on the joints, so use with caution. Sleeping with throw pillows may also help cushion joints in need of extra support.

Discuss Sleep Medications With Your Doctor

Besides those used for your psoriasis or PsA, you may need other medications to help manage pain at night. Talk to your dermatologist or rheumatologist about what medications may be right for you. Some doctors may prescribe antiepileptic drugs, such as gabapentin, or muscle relaxers, such as Flexeril (cyclobenzaprine) or tizanidine, for better sleep.

Other Tips for Managing Painsomnia

The National Psoriasis Foundation offers some tips to help fall asleep and get better quality sleep:

  • Don’t go to bed unless you are sleepy. If you can’t fall asleep within 20 minutes, get out of bed.
  • Use your bed only for sleep and sex.
  • Avoid eating a large meal or drinking a lot of fluids before bedtime.
  • Set a relaxing bedtime routine. As one MyPsoriasisTeam member wrote, “I soak in the bathtub to help myself fall asleep.”
  • Get regular physical activity and eat a healthy diet.

Of course, getting regular exercise is ideal, but the symptoms of psoriasis and PsA can sometimes make exercising a challenge. As one MyPsoriasisTeam member wrote, “It would be hard with the pain I’m in. I do some exercise on my better days.” If you find it hard to exercise with psoriatic disease, talk to your health care provider or a physical therapist about how you can incorporate more activity while staying comfortable.

Meet Your Team

Managing the symptoms of psoriatic disease can be a challenge. The good news is you don’t have to go it alone. MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. Here, more than 90,000 members come together to ask questions, share advice, and connect with others who understand life with psoriatic disease.

Have you found ways of managing painsomnia with psoriasis or PsA? Share your experience with others in the comments below or by posting on MyPsoriasisTeam.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Victoria Menard is a writer at MyHealthTeam. Learn more about her here.

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