Eczema and sleep: how to break the night-time itch

If your child has eczema, you probably know the sound: the scratch-scratch-scratch from the next room at 2 a.m. Night is when eczema often feels worst, and when everyone in the house pays for it. The good news is that there’s a lot you can adjust in the bedroom and the bedtime routine. The most important fix, though, is getting the eczema itself under better control. Here’s how the pieces fit together.

Why is sleep such a problem with eczema?

Children with eczema really do sleep worse, and it isn’t just the bad nights you remember. A large UK study that followed almost 14,000 children to age 16, published in JAMA Pediatrics in 2019, found that children with active eczema had about 1.5 times the odds of poor sleep quality compared with other children. Interestingly, their total hours of sleep were similar. The problem was broken, poorer-quality sleep, not simply less of it.

That held even for milder eczema. Children with mild active eczema, and even those whose eczema was inactive at the time, still had higher odds of sleep problems. Children with severe eczema, or with asthma or hay fever as well, had the highest odds.

A 2023 review by Canadian researchers, which pulled together 31 studies, described two kinds of trouble. One is losing sleep: taking longer to fall asleep, waking more often and for longer. The other is unusual sleep: restlessness, scratching, snoring, nightmares, bedwetting and night sweats were all more common in children with eczema.

Part of the reason is simple. Heat is a common itch trigger, and the UK’s National Eczema Society points out that overheating is a common cause of night-time itching and scratching. Under a warm duvet, with nothing else to focus on, an itchy child scratches.

What does poor sleep do to a child?

More than make mornings hard. The American Academy of Dermatology warns that sleepless nights can lead to a child being misdiagnosed with a behaviour problem or a learning disability. A tired child may be irritable, restless or struggling to concentrate at daycare or school.

The 2023 review also noted links between poor sleep in children with eczema and longer-term concerns, including growth, mental health and thinking skills. Those links come from observational studies, so they don’t prove sleep loss is the cause, but they’re a good reason to treat sleep as part of eczema care rather than a side issue. And parents lose sleep too, which makes everything harder.

How cool should the bedroom be?

Cooler than you might think. The National Eczema Society suggests keeping the bedroom at about 16 to 18°C, a little cooler than your main living areas. The American Academy of Pediatrics recommends a dark, quiet room with a steady, cool temperature, and suggests a cool-mist humidifier to keep the air moist.

That’s especially relevant in a Canadian winter, when indoor heating dries the air and many homes run warm. A few practical ideas:

• Turn the thermostat down at bedtime rather than keeping the whole house toasty all night.
• Use lighter layers of bedding instead of one heavy duvet, so it’s easy to adjust.
• Keep the bed away from heat vents and radiators.
• For babies, follow safe-sleep guidance on clothing and bedding; your public health nurse can help you balance warmth and eczema.

What bedding and pyjamas help?

Fabric sits against your child’s skin all night, so it matters.

• Bedding: the National Eczema Society recommends 100% cotton bed linen, because it’s soft, cool, absorbs moisture and can be washed hot. It also suggests avoiding feather bedding and choosing synthetic duvets and pillows with cotton covers.
• Pyjamas: the American Academy of Pediatrics recommends sleepwear that’s cool, loose and free of irritants, with tags removed or seams covered. If your child sweats at night, moisture-wicking fabric and cooling sheets may help.
• Scratch protection: for younger children, the National Eczema Society suggests sleepsuits with built-in feet and mittens, plus short, filed nails, so night-time scratching does less damage.
• Laundry: washing bedding and pyjamas in a fragrance-free detergent removes one more possible irritant.

What does a good bedtime routine look like?

A predictable routine helps any child sleep, and for a child with eczema it’s also a chance to treat the skin. A routine that works for many families:

1. A short, warm (not hot) bath.
2. Pat the skin partly dry.
3. Apply any prescribed medicated cream first, exactly as your doctor directed.
4. Then a generous layer of moisturizer everywhere else. The National Eczema Society recommends thorough moisturizing before bed.
5. Cotton pyjamas, teeth, a story, lights out.

The American Academy of Pediatrics adds some general sleep habits that matter just as much: keep the bed for sleeping only (no screens, games or homework), keep regular bedtimes, naps and wake-up times, avoid naps close to bedtime, and wind down stimulating activities an hour or two before bed.

If your child’s doctor has recommended wet wraps for a bad flare, bedtime is often when they’re used. The American Academy of Pediatrics mentions them as an option for moderate to severe eczema, but they need your doctor’s plan.

What about sleep medicines?

This is a question to bring to your doctor, not the pharmacy aisle. The American Academy of Dermatology says a dermatologist may recommend a sedating antihistamine (an allergy medicine that causes drowsiness) to help some children sleep. That’s a medical decision that depends on your child’s age and other medicines. Don’t give any sleep aid or supplement to a child without asking your doctor or pharmacist first.

When should you talk to your doctor?

The American Academy of Dermatology’s advice is clear: when you see the doctor, tell them your child has trouble sleeping. Sleep loss is one of the best signals that the treatment plan needs adjusting, and a doctor can build a plan that targets it. Book a visit if:

• your child is waking from itch several nights a week, or you are
• you’re seeing daytime tiredness, crankiness or trouble concentrating
• night-time scratching is leaving the skin raw or bleeding
• the bedroom and routine changes haven’t helped within a couple of weeks

Eczema and sleep are tangled together: itch breaks sleep, and poor sleep makes everything harder. A cool room, cotton bedding, a steady routine and moisturizer at bedtime all help, but they work best alongside eczema that’s properly treated. If nights are rough, don’t just push through. Tell your doctor, because better sleep is a fair and reachable goal.