Eczema and sleep disturbance

Sleep disturbance is one of the commonest problems in children with atopic eczema. Not only does your child become tired and irritable due to lack of sleep but parents too often loose sleep and become exhausted. It is a miserable thing for your child to wake up with an itching skin and parents often feel frustrated and helpless when they do not know how to help their child.

Here are some practical tips that might help you break the cycle of sleep loss in your family:

Treat your child's underlying eczema more aggressively

If it is your child's eczema that is causing him/her to wake at night, then it is logical to do everything you can to treat this. Even when the skin is not particularly red and bumpy, the skin of a child with atopic eczema may still be quite itchy and you should take your child seriously if they complain of an itchy skin. Telling your child to stop scratch is probably not very helpful and possibly increases his/her anxiety causing them to scratch more.

Treatment with moisturisers, topical corticosteroid ointments, and prevention of damage by keeping your child's finger nails short, wearing cotton mittens and bandages to the limbs are all part of the normal measures one can do in order to help treat your child's eczema. Itching of the scalp is an area that is often forgotten in atopic eczema and there are special scalp applications which can be applied before bedtime if this is a particular problem.

Create an environment which will reduce itching

Wrapping your child up in a thick duvet in a centrally heated bedroom will probably make the itching far worse.

Keeping the bedroom cool (50-60oF) by opening the window in the daytime and keeping the central heating on low probably helps. Keep your child's bed away from any radiators and use a fan for cooling in the summer.

Pets should be kept out of the bedroom.

Using plain cotton sheets is also better than a thick continental quilt which can often lead to overheating in the early hours of the morning. Loose fitting cotton pyjamas or cotton suites are also probably helpful.

Avoid exposing your child to cigarette smoke as this may irritate your child's eczema.

Measures to decrease the dust content in your child's bedroom may also be helpful (please see our separate information on the house dust mite). Having a bath about an hour before bed followed by plenty of moisturisers is another thing that you can do to help cool your child's skin.

Helping your child to get off to sleep and getting a night's sleep yourself

There are many tips on how to get your child off to sleep such as letting your child fall asleep downstairs, taking them for a drive, giving them a cool bath, reading books etc. and you must choose whatever you feel is most effective and right for your family.

Try to avoid your child falling asleep in the day as this will obviously affect his/her ability to sleep at night. It is also important that you are quite flexible about putting your child to bed and if he/she is not really tired, it may be wiser to allow him/her to stay up a little longer and fall asleep downstairs. Putting your child to bed when they are not especially tired may encourage further scratching as most scratching occurs in the "twilight" zone between sleep and wakefulness.

Occasionally, antihistamines are useful when used for 5-7 days in breaking a cycle of sleep disturbance due to itching. Children are often quite tolerant of these and they should be given about 1 hour before bed in order to give them enough time to take effect.

Try to avoid the common problem of letting your child climb into your bed. This may encourage an abnormal pattern of behaviour in your child whereby they learn to gain from their eczema and have little reason to stop this behaviour pattern. It is also likely that your bed will be warmer than your child's bed and this in itself may make your child itch more. It is better to go to your child's room and give them the love and care that they ask for and then have the courage to leave them to fall asleep in their own bedroom.

What can I do when my child wakes crying and scratching because of his/her eczema?

Sometimes very little is needed apart from cuddling your child and adopting simple measures such as stroking their skin and leaving them to go back to sleep. Application of a cream based moisturiser is also a useful way of cooling the skin. Removing some of the bed sheets may and giving your child a cool drink are other ways of cooling your child. If your child is visibly tearing at the skin causing it to bleed, then you need to protect that area with some form of bandaging (e.g. Tubifast) and by starting more aggressive treatment of your child's eczema in general.

If your child refuses to accept bandages or any creams, you may be able to negotiate a reward system whereby your child will be allowed to watch their favourite video or play with their favourite game after they have co-operated with treatment. It is most important that you honour this agreement otherwise you will loose your child's trust. Finally, you should bear in mind that many children without atopic eczema are poor sleepers and your child's eczema may not necessarily be the reason why your child wakes frequently. If there is no difference in your child's sleep pattern when his/her eczema is bad or good, then it is likely that other factors may be contributing to your child's poor sleep pattern.

Even when you do everything correctly, there will still be occasional bad nights but we hope that the above information will give you some guidance as to how to do the best for your child and to avoid an exhausted family.

While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. Please consult your doctor if you have any concerns about your skin health. He or she will be able to advise in greater detail.