Psoriatic Arthritis, Psoriasis, and Sleep Disorders

Lana Barhum
·8 min read

Why Joint and Skin Symptoms May Keep You Up at Night

Medically reviewed by David Ozeri, MD

For those with psoriatic arthritis and psoriasis, sleep disorders are common. The main symptoms of psoriatic disease, including dry, itchy skin and joint pain, might be keeping you up at night.

Psoriatic disease can occur along with sleep apnea and restless legs syndrome, two common sleep disorders. Anxiety and other conditions that occur with psoriatic arthritis can contribute to sleep disruptions, too.

This article explains why psoriatic disease might be causing you to toss and turn at night and how you can get a better night’s sleep.

10'000 Hours / Getty Images 
10'000 Hours / Getty Images

Sleep Disorder-Psoriatic Disease Connection

Psoriatic disease is an autoimmune disease, which includes two specific inflammatory conditions: psoriatic arthritis (PsA) and psoriasis. People with psoriatic disease have overactive immune systems in which inflammation attacks their skin and joints.

According to a 2018 report in the medical journal Reumatologia, poor sleep quality was found in 67.7% of the PsA patients and 57.7% of people with psoriasis. The researchers further note sleeping disorders in people with PsA and psoriasis are related to poor quality of life and severe fatigue.



Takeaway

Sleep disorders are common in people diagnosed with psoriatic disease and considered co-morbidities (co-existing conditions). However, more study is needed to understand how psoriatic disease might cause any specific sleep disorder or if sleep disorders contribute to progression of psoriatic disease.



Related: Psoriatic Arthritis Progression and Stages

Sleep Apnea and Psoriatic Disease

Sleep apnea, a condition where a person repeatedly stops breathing during sleep, is associated with psoriatic disease. One 2016 Danish study reported that psoriatic disease was associated with an increased risk for sleep apnea and sleep apnea was associated with an increased risk for psoriatic disease, but researchers don’t actually know why this connection exists.

In addition to breathing troubles, sleep apnea causes:

Related: What Is Sleep Apnea?

Restless Legs Syndrome and Psoriatic Disease

A 2015 study reported in the European Journal of Dermatology finds an increased frequency of restless legs syndrome (RLS) in people living with psoriasis, especially those with more severe disease.

It was based on a comparison of 300 healthy people and 300 people with RLS, a sleep disorder and a disorder of the nervous system that causes itchy, pins-and-needles sensations and an urge to move the legs.

These symptoms cause nightly sleep struggles significant enough to impair quality of life. A 2018 study reported in the journal Zeitschrift für Rheumatologie additionally found that RLS in psoriatic disease was related to impairments in sleep and quality of life and is a contributor to fatigue and depression.

Related: Restless Leg Syndrome

Insomnia and Psoriatic Disease

Pain, anxiety, and other factors contribute to poor sleep quality in people diagnosed with psoriatic arthritis. A 2023 study of 247 people found nearly two thirds, or 63%, had sleeping problems. Risk factors appeared to include the number of affected joints and higher levels of anxiety.

While multiple studies point to psoriatic arthritis as a cause of insomnia, the reverse also may be true. Some researchers suggest insomnia contributes to disease progression with psoriatic arthritis.

There's still much to learn about why psoriatic disease and sleep disorders are related, but causes include the symptoms of pain and itching, as well as the role of other health conditions that coexist with psoriatic arthritis.

Causes of Sleep Disorders Related to Psoriatic Disease

Inflammation

The inflammation that causes psoriatic disease is a likely culprit for problems with sleep quality.  Research has shown sleep loss can cause a person’s immune system to turn on itself.

When the immune system overacts, it causes the tissue-damaging inflammation that psoriasis and PsA are known for. Biologic therapies may help to improve psoriatic arthritis.

Related: Getting Started: What to Know About Biologics for Psoriatic Arthritis

Pain and Itching

It's hard to sleep when you're in pain and your body itches. Poor sleep affects quality of life in people diagnosed with psoriatic arthritis, and this can lead to social function and mental health challenges.

Researchers are still working to understand how the physical manifestations of psoriatic arthritis (like joint pain), or the anxiety and other psychological impacts, are what cause sleep problems.

Co-Occurring Health Conditions

Some people living with psoriatic arthritis also are diagnosed with conditions that can disrupt sleep. It's common, for example, for depression and anxiety to affect people with psoriatic arthritis.

These conditions can contribute to problems sleeping. Some of the other coexisting health risks that researchers reported in the journal Dermatology include:

  • Being overweight

  • Smoking

  • Having sleep apnea

  • Having moderate to severe psoriasis

The study found people who are female may be at greater risk of sleep disruptions but age did not appear to be a factor.

Untreated, psoriatic arthritis also can lead to health conditions that include:

Metabolic syndrome is common with psoriatic arthritis, with conditions that include obesity, high blood pressure and poor cholesterol levels. Some of these issues can disrupt sleep.



Stress and Psoriatic Disease

Stress may be contributing to your sleep problems. If you are feeling stressed, you are not going to sleep well. Stress and poor sleep can worsen the symptoms of psoriatic disease.



Related: Can Stress Cause Psoriasis Flare-Ups?

Tips for Better Sleep

It will take some lifestyle and bedtime routine adjustments, but it isn’t impossible to get better quality sleep with psoriatic disease.

Talk to Your Healthcare Provider About Sleep Disorders

Since sleep apnea, restless sleep syndrome, and other sleep disorders are associated with psoriatic disease, you should talk to your healthcare provider about the possibility of a disorder affecting your sleep.

Some sleep disorders, including sleep apnea, may not cause obvious symptoms, so you may have a sleep condition without realizing it. Report any fatigue during the day or always waking up tired.

Try Hot and Cold Therapy for Joints

Temperature therapy might give your joints some relief before bed. You will need to try different methods to figure out what works for you.

For example, you may prefer a warm shower, using an ice pack, or sleeping with a warming blanket. Include the method that seems to give the most relief to your bedtime routine to help you fall asleep quicker.



Takeaway

You should avoid long, hot showers and baths because hot water can aggravate the skin. To prevent dryness, choose warm water over hot, and limit showers and baths to ten minutes. When you are finished bathing, gently blot dry skin with a towel.



Related: Joint Pain Causes and Treatment Options

Moisturize Skin

One of the easiest ways to keep your skin calm is to regularly moisturize, and this is something you can add to your evening routine. Apply lotion to your skin just before bedtime to manage itchiness that might keep you awake.

Make sure you are using a product that is specifically made for dry skin. You may also consider alternatives to lotion, such as coconut oil or aloe vera oil.

Related: How Psoriasis Is Treated

Keep a Regular Sleep Schedule

Keeping a consistent sleep schedule helps to regulate the body’s circadian rhythm, the body’s biological mechanism that helps you drift off to sleep at night and keep you asleep all night.

You can keep your circadian rhythm in check by choosing an early bedtime and sticking to it. Even if it takes you long to fall asleep, you can allow your body time to relax and you can wind down at your own pace.

Related: What Is Sleep Hygiene?

Cut the Caffeine

If you are drinking caffeine too late in the day, it affects how well you are sleeping at night.  Generally, no more than 200 milligrams (mg) of caffeine per day is recommended. A cup of brewed coffee can have up to 350 mg, while plain tea can have up to 70 mg. Chocolate contains caffeine, too.



Takeaway

The National Sleep Association recommends avoiding coffee, tea, soda, other caffeinated beverages close to bedtime.



Limit Alcohol

Sleep experts recommend that you avoid alcohol use for at least four hours before trying to sleep. A drink or two may help you to relax and fall asleep at first but it's likely to keep you awake later in the night, along with causing night sweats and headaches. Binge drinking also can disrupt the melatonin levels in your body that help you to regulate sleep.

Unplug

The sooner you get yourself off the electronic devices, the sooner you can get to sleep. Using electronic before bedtime can be harmful to your sleep quality. You should start powering off electronic devices at least 30 minutes before you go to bed.

Related: How Screen Light From Devices Affects Your Sleep

Try Meditating

Stress makes PsA and psoriasis worse, and it can also keep you up at night. Try some calming meditation exercises to relax your mind before going to bed. You can start by simply closing your eyes and focusing on inhaling and exhaling. Keep your body still and try to enjoy the quiet.

Summary

Psoriatic arthritis, with its symptoms of pain and itching, can play a role in sleep disruption and sleep disorders. However, it's common for co-occurring health conditions to contribute to poor sleep quality. These can include sleep apnea, restless legs syndrome, anxiety and depression, and more.

There are steps you can take to relieve symptoms and improve sleep quality. But if you can't sleep well due to psoriatic disease symptoms, talk to your healthcare provider about your treatment plan.

Read the original article on Verywell Health.