Totally Exausted? It Might Be Your Psoriasis

When you first think about it, your skin and sleep seem pretty disconnected. But if you have psoriasis, they are way more closely linked than you’d think. Research has found that about 17% of people with the skin condition experience severe fatigue. And a big reason for that is sleep issues.

“We can say for certain that patients with psoriasis have a higher risk of developing sleep problems,” says Lourdes Pérez-Chada, MD, an assistant professor of dermatology at Harvard Medical School. “And it can manifest in different ways. You could have sleep apnea or restless leg syndrome or just have disturbances in your sleep.”

You might assume that it’s just the itching that wakes people up, but that’s only, ahem, scratching the surface. Here’s a deeper look at what’s really going on.

What we know and don’t know about the connection

People with psoriasis are four times more likely to have insomnia than those without the condition and have a 35% higher risk of developing obstructive sleep apnea compared to the general population. So why is that?

The answer isn’t exactly straightforward.

Symptoms of psoriasis can be to blame for some poor sleep, says Tina Bhutani, MD, an associate clinical professor of dermatology at the University of California, San Francisco, and member of the National Psoriasis Foundation Medical Board. “Pain, itching, and discomfort can make you wake up in the middle of the night and have more fragmented sleep. You may not even realize it’s happening, but you could be unconsciously scratching in your sleep and not getting into the deeper sleep cycles, so you wake up feeling tired.”

But here’s the interesting thing: Take away the itching and pain, and patients with psoriasis still have worse sleep. “Even someone totally asymptomatic,” says Dr. Bhutani. And this is where the link gets a lot murkier. Researchers aren’t exactly sure what’s going on inside the body that makes getting a good night’s sleep so tough. But most experts agree that inflammation is involved.

“Psoriasis is inflammatory…and that impacts your sleep cycles,” says Dr. Bhutani. That’s because excess inflammation can impact your central nervous system, which can disturb sleep.

There’s also a mental health component. “Patients with psoriasis have a higher prevalence of mood disorders, like depression and anxiety,” says Dr. Pérez-Chada. “And those mood disorders are also associated with sleep problems.”

But the path may go the other way as well. “We don’t know which is the chicken and which is the egg. Does psoriasis lead to sleep problems, or do sleep problems lead to psoriasis?” Dr. Pérez-Chada says. “That’s what the field is trying to figure out.”

A recent study from the UK looked at almost 400,000 people without psoriasis and tracked them over 15 years. During that time span, people with sleep disorders had a much higher risk of developing psoriasis. “That’s what makes it fascinating. Previous studies looked at the association, but this looked at what preceded the other. And it showed that having a sleep disorder predated psoriasis in a large number of people,” says Ravi Ramessur, MD, PhD, a postdoctoral research fellow at the University of Pennsylvania.

But the exact reason sleep disorders can raise your risk for psoriasis isn’t known yet. “We really have very little understanding of the how, which is what we want to discover,” says Dr. Ramessur. One working theory right now involves proteins in the blood. “A study found that poorer sleep was associated with having a worse profile of proteins linked with the aging of different organs, including the skin,” says Dr. Ramessur. “And a lot of these proteins were inflammatory, so having poor sleep probably does have an effect on our systemic immunity, and one way that can manifest is with conditions like psoriasis.”