128: Eczema Sleep Problems w/ Christa Biegler, RD

Many people with eczema have trouble sleeping restfully through the night because their skin becomes much more itchy. My guest today will offer some reasons why this may occur, and some tips to address sleep problems.      

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My guest today, Christa Biegler, is host of the Less Stressed Life podcast and has an integrative nutrition private practice focusing on skin, digestive, autoimmune and allergy issues.

She started The Less Stressed Life as a play on words for anti-inflammatory life. She lives with her unicycling husband and kids in the rural Midwest.

Join us as we discuss how eczema and other itchy skin conditions can affect sleep quality, and some ways to combat this.

Have you dealt with restless sleep because of itchy skin? Let me know in the comments!

In this episode:

• Why are there so many issues around people who have eczema around sleep time?
• What makes the itch worse at night?
• What are inflammatory cytokines?
• Tips for better sleep with eczema

Quotes

“Inflammatory cytokines are going to upregulate certain processes that would increase itching, which would disrupt sleep.” [12:44]

“There's many ways you can experiment with food, but don't get into a hole of restriction. And I know you shout that out loud and clear and I just wanted to echo that.” [19:24]

Links

Find Christa online

The Eczema Relief Diet: Short-Term Plans to Identify Triggers and Soothe Flareups 

Christa's free online training

Christa's guide of things not to do if you have a child with eczema

Healthy Skin Show ep. 042: How Sulfur Can Trigger Skin Rashes w/ Christa Biegler

Jennifer's appearance on the Less Stressed Life podcast: Why you shouldn't use coconut oil on your skin

Follow Christa on Facebook ǀ Instagram

128: Eczema Sleep Problems w/ Christa Biegler FULL TRANSCRIPT

Jennifer: Hi everyone. Welcome back. Today I have a guest who's back with me. I'm super excited to talk to her about this particular topic. Her name is Christa Biegler. You guys probably remember her. I was on her show. She's been on the Healthy Skin Show and now she's back. She's the host of the Less Stressed Life podcast. And she also has an integrative nutrition private practice which focuses on eczema, digestive, autoimmune, hormone and allergy issues. She started the Less Stressed Life podcast as a play on words for anti-inflammatory life. She lives with her unicycling husband and kids in the Midwest. And between all of her resources, her podcasts, her practice, her eczema, different things that she has available for you, everything is live at lessstressedlife.com. But also she's got a new book out which I'm super excited about, so we're going to talk about sleep today. And I'm so glad that you're here Christa. Thank you so much for joining us.

Christa: Thank you for having me back. I just have a little smile on my face. I'm glad there's that weird unicycle tidbit in there because it kind of just makes me giggle. It's a little, you know, this is for memory. I'm just… Oh, it's that weird dietician that unicycles.

Jennifer: Love it. I love it.

Jennifer: So, all right, let's talk about sleep, sleep and eczema. I feel like this is one of the most aggravating things that can happen. I remember for myself, when I was dealing with hand eczema, I would, first of all, the itching would get worse at night. It felt like when I was trying to go to bed, the itching gets worse. And then there was also this simultaneous issue where I would wake up in the middle of the night, super-itchy and couldn't go back to sleep or I had been itching in my sleep almost to the point of scratching myself bloody at times. So what is the deal with this? Why are there so many issues around people who have eczema around sleep time?

Christa: That's a good question and I have some science on it. But first of all, it's one of the biggest problems. I work with a lot of kids and actually a lot of the research around sleep and eczema is in kids, and it's probably because it's a larger population and it's easy. So I talk to parents that, they might not even mind if their child has eczema, they just want to sleep. It's the thing that's making everyone crazy. So it's a pretty bad hamster wheel too because when you're not sleeping it actually can stunt linear growth. So basically height, like growth in people. Short stature has literally been described in kids when we're talking about insufficient sleep. So not only that, but it's like really… When you don't sleep, you don't have, I mean you can't do anything, right?

Christa: So what's exactly going on? I think it's interesting, and I don't have exactly why, why would it uptick right before bedtime? Because I've heard that before. When we're talking about circadian rhythm in general, I just thought I'd talk about that in general. Circadian rhythm is basically your own unique 24-hour internal clock that's running in the background of your brain. And it's a cycle between sleeping and alertness. So to improve your circadian rhythm, if you're an adult and you're having trouble getting out of bed in the morning, that's your cortisol awakening response. Your cortisol, which is this, that's the kind of stress hormone we usually talk about. It should want to rise in the morning. By the way, coffee increases it in some people too, but it should want to rise in the morning in that first 30 minutes, so as that specifically cortisol awakening response.

Christa: And to improve it, like if it gets off… And we're coming out of the season in the spring, but we're coming out of this deep dark time in winter where there's less daylight. And so people get this a little bit messed up where we have more trouble getting out of bed. And I think it has a lot to do with the actual daylight time. So actually to improve that whole awakening response, you can go look at the sun in the morning and it helps try to set that. And when your eyes take in… I know it sounds kind of funny, but it works. It works really well for mood and just overall feeling better. And if you do that for a while, during the first 30 minutes of when you wake up, you can reprogram your wake time cycles.

Christa: Now let me go back, I guess let's talk about kids and, is it okay? Can I talk about how big of a problem that this is?

Jennifer: Yeah, yeah absolutely.

Christa: Okay cool. So again, most of the research is really with kids and sleep. The American Academy of Allergy, Asthma, and Immunology had a study in 2015 where they talked about sleep and eczema in kids. Basically it was estimated that 60% of kids with eczema or atopic dermatitis had sleep issues. So okay, this is a problem. 60% have problems with sleep. It's very, we know it was a problem, but this is where it gets better, or worse actually.

Christa: So when people have a flare, when these kids are having a flare, 83% of them report sleep issues. I mean this is absurd. This is like-

Jennifer: Yeah I was just going to say, another-

Christa: Four out of five.

Jennifer: … study that I looked at, it was up in the 80s, 80% of people in the study had issues with sleeping which is really… I mean, I can't function, I don't feel well. And then if it happens night after night after night after night, it's like you don't feel like a human being anymore. You feel awful.

Christa: Yeah. It is bad, bad news.

Christa: So actually some other really interesting things about it, are that when you don't have good sleep, you have other problems that start to happen. So this is a fun one. Let's talk about… So they don't really note this in the study, but it's comorbid or it's associated with restless leg syndrome. So that's like… I haven't experienced this personally, but it's actually a really common problem, having restless legs. I don't know, like they jerk in the night. And I've had some parents complain about this, but adults will see this on and off through life. Now, if you say to an adult who's had this, “Is this after a stressful period?” because usually we think with restless leg, balancing electrolytes like magnesium can help with that.

Christa: So let's talk about the physiology. So if you don't have sleep, you have stress, and when stress is up, then we dump magnesium. And when magnesium would be low, then you would have restless legs syndrome, maybe some twitching eyelids, things like that. So I just think that's, it makes perfect sense to me I guess. When I read that it's like, “Oh, at the same time you cannot sleep, you have…” I mean in restless leg, I think people think that's what's waking me up and that makes sense. But I always think this stuff is like a hamster wheel, one plays into the other plays into the other.

Christa: Another fun stat is that it's been associated that ADHD has been linked to those with atopic dermatitis. But it's only in the kids with issues sleeping, which makes so much sense. But how sad is this whole story? So you're not sleeping and so you have behavior and discipline problems now, essentially. So, it's associated with eczema, but apparently only in those that are having sleep issues, which is the majority of them. So take that for what it's worth.

Christa: But I think it's just, oh gosh, that's really hard. And it's also associated with more likeliness to have fractured bones and other injuries just because sleep is our restoration. It's how we recover, how we do well. But as far as how, why is it, why does it, why does the skin itching uptick at night? I think there's like, I don't know, probably a good reason that I don't know what it is. I don't know why it's completely upticking at night, but I guess researchers do have some idea so I'll share their ideas instead.

Christa: It's coming from very much a dermatology perspective. So they talk about maybe it's skin temperature, or… I always think this is how you know… Of course, in dermatology research you're reading research written by dermatologists which is just great. But usually the foundation of that is always about poor barrier function, right? So meaning your skin is your shield or your cover or your coat, and it's compromised. And so their thought is that because it's compromised, you have increased water loss and so you're more susceptible to infections. And so they're saying this linear process you have, you're more infected and so then it becomes more itchy. I just don't understand how that is different than the daytime. You know what I mean?

Jennifer: I don't either.

Christa: I don't-

Jennifer: I've read that too, that there's an increase in the, essentially like the water loss, that you can't maintain that moisture within the skin. But then I've talked to other people, and I'll be honest with you, one thing that I have also wondered too is, is there a new… And I've talked about liver issues before, but I also wonder too, is it possible that you're experiencing challenges with phase two detox? Or could it be that there is some sort of underlying dysbiosis or hidden infections that could be… I've had some guests on the show, even doctors who've said, “Yeah, sometimes when you've got unwanted bugs they can become more active at night and we experience more symptoms at night.” So I just wonder, like you, I mean, we don't have any hard, hard proof, but I do wonder if there are some other pieces to this that play a role in wrecking your sleep.

Christa: Well, let's just even compare this to people that have regular sleep disturbances that don't have eczema, and those that have sleep disturbances with eczema. So there's a large number of people that also don't sleep well or have trouble falling asleep. And let's just take out eczema for a moment and then let's add it back in. So if it's just a person coming to me who maybe wakes up in the middle of the night often, or as you just said, depending on what's going on with the liver and/or… We didn't mention right there, but cortisol, there's different times you might wake up. So is people are waking up about four in the morning unnaturally, I think of blood sugar and cortisol and things like that. Your body's trying to help keep blood sugar up, and/or there is some stress component or cortisol is rising too early because of a variety of things. Which is why I was talking about resetting. There's several possible interventions there.

Christa: Now, another one, the liver stuff, it's thought that that occurs after midnight I would say. That's like what I've seen/heard. I don't have hard evidence on that either. I just look for patterns. And at the end of the day all's I'm looking to is improve sleep so it doesn't totally matter to me if that's perfectly correct. And then as far as gut bugs, that's the first thing I actually look at if someone who doesn't have eczema. Because if most serotonin, which is a calming neurotransmitter, is produced in the gut, so 70% of serotonin is produced in the gut, and now it's a precursor to melatonin which is our sleep hormone, then if the gut is disturbed, you wouldn't produce great calming serotonin before bed.

Christa: Now, this is the deeper stuff after you've dealt with good sleep hygiene. You're not all jacked-up before bed. You're not running around the house or looking at blue… There's other things, there's a lot of sleep hygiene things. But I'm just talking after you… Like make sure that that's good to go. That whole serotonin piece.

Christa: So actually fun fact, I, so when you fix gut bugs, that's helpful. But something that can be immediately helpful and something I'll do with kids and adults alike, is I'll do a bunch of high quality probiotics right before bed to support… I actually learned this because my husband dealt with it. He realized through some trial and error when he was dealing with a bunch of stuff, that if he was doing a few different probiotics before bed, he could go to sleep easier. And then I started experimenting on this. Don't use certain things too close to bed that would disrupt this, and use things that are really supported closer to bed.

Christa: So just to make that really clear, taking in good bacteria, that may not stick longterm but at that moment are going to help with natural gut processes and maybe serotonin production. It seems to work. Now it varies on the person. But in general, when you correct gut imbalances, sleep gets better. Now I think there's a few other reasons that can be going on too. Because in general, okay, so I want to make sure that's really clear, in general, in eczema and in any type of inflammation, we're talking about inflammatory cytokines, which are chemical messengers that happen. And they can come from activity and food and stress and just lots of things, like whatever could cause inflammation. The list is pretty long. So inflammatory cytokines are going to upregulate certain processes that would increase itching, which would disrupt sleep.

Christa: And I just have to bring this up, sometimes the tricky part is, are we trying to reduce an actual itch or has this become habitual? Now I'm sure in your case like totally, it's like it is itching. But sometimes in little kids it's become part of their life, that you actually can't even figure out if it's a habit at a certain point. Because let's say their eczema is clearing and it looks really good and they're like, “Gosh, they're still scratching a little bit.” And so I just ask parents to be the detective, like what do we think? Has it become… It's sort of like biting your nails. It's a habit that you've just done for so long, you do it without thinking. And some people, you ask them if they bite their nails and they say no, and then you see them biting their nails. You know what I mean? So the same thing could be considered with scratching.

Jennifer: So what do you think, if you have somebody come into your practice and they're really struggling? For me, I want to try to, I'm like, “Okay, what's the lowest hanging fruit here?” I think sleeping, getting a good night's sleep is so important to feeling better. Even if you're still dealing with rashes, if you're at least sleeping first, that can be a huge win for a lot of people because like-

Christa: That would be the first.

Jennifer: … at least I'm feeling better. So what would be some of the things that you're going to suggest to people to try or consider or do? I think that would probably be helpful for everybody to hear that.

Christa: Right. Well one, before I even go into that, I think assessing this is important. Because sometimes when you're so sleep-deprived, if you aren't really keeping track or keeping data, there's no way you're going to remember it because you were sleep deprived in the first place. Like you're a hot mess. So you have to catalog this. In fact, you were just saying, “Hey, winning on sleep is a win,” and you're exactly right, and it's one of the three areas that I have in my symptom journal, prefigured in this little spreadsheet: rate your sleep 1 to 10, and your mood and your sleep and your itch. Because those are… I'm sorry, mood, sleep, itch, eczema. Because, just how it looks on a 1 to 10 scale every day. That's a really simple thing to jot down that doesn't take too much time and allows you to quickly see differences. Because if you start to see a little bit of improvement in sleep or itch, you are winning. That is the first thing that was going to calm down before things heal.

Christa: So, sometimes I think people, that's the hardest part about skin stuff, is that the skin heals a little bit later. And I think people are like, “Gosh, everyone wants that done a long time ago,” but if you can get sleep and itch looking good, you're in the, lean in harder because you're in the right place for the most part. Okay. So that's a big question.

Christa: Let me finish talking about, really quickly like what, because it'll help answer the question. Researchers say temperature, skin temperature, barrier function, allergens, irritants, those are the big ones. So let's talk about simple stuff, and in the environment first, right? So you can consider…

Christa: So this actually goes back to general eczema stuff. So are we having issues with a detergent or something? I've had people that say, “My kid's only itchy after this nap.” Okay. Is there something going on in that bedroom? We're just going to consider, if you're only itchy after this nap or after bed or when you wake up in the morning, if those are the only times, is there something funny in your bed? Is there an irritant, an allergen? Did you change something? Is there something with that?

Christa: Kids pajamas, and we've got a lot of adults here obviously, but I just have to mention, kids pajamas are made out of weird material. These are not the same material sometimes that they might wear during the daytime. They're like, I don't know, just different, right? So that may be an option too. So I think about all that stuff in that irritant bucket. It's a big old list, right?

Christa: It depends on what that skin also looks like. If it's more of a allergy-type profile where it's bright red and inflamed, I am going to go about that first. So this is not a simple answer. It depends on how it looks and how it behaves. If it's just that we're having trouble falling asleep, I'm going to look at that gut microbiome first because that's how I think. I think about gut stuff first. And if that is not improving well enough, I'll make some tweaks first to my protocols there before I even go anywhere else. Because if I just jump to, I guess that's what I want to say, if I just jumped to other things that are sort of a bandaid for it… I mean I'm totally fine with melatonin sometimes, and if you need sleep I think that's okay to use. But we want to be able to produce good melatonin on our own. But if I would jump straight to that I'm not going to fix the underlying gut issue. Or we could insert any type of thing there. So those are some pieces.

Christa: I have had some… Like if, depending on what people are doing in the evening, I'm going to look at night hygiene. I'm going to look at… I actually… If people… I think this is a good time to possibly, if people are using a limited amount of steroids and it's a good fit for them, then I think that's probably the place to use it because you need sleep. So if this is the only way you get sleep for a little while, that's going to help you heal in general anyway, if that makes sense? So if you need some at that time, that might be the best time. Because no one's winning when there is no sleep. So those are some things I guess. I mean-

Jennifer: Christa, I also wanted to mention too is that, people might not realize is melatonin is a hormone, right? But it's also made from tryptophan, which is an essential amino acid. So if you're not bringing in enough tryptophan, that can also be an issue. And we all know turkey. But chicken, dairy products, which a lot of people with eczema avoid. Fish, seeds like sunflower, pumpkin, sesame, and even peanuts, believe it or not. It's unfortunate that a number of these are considered high allergen foods and oftentimes are removed. But I think it's important to keep in mind that we… And I always try and stress this and I think you do too, is we want to be careful eliminating too many foods from the diet because they do actually serve a purpose. There are nutrients in them that serve a purpose. And we do need to have ample supply of tryptophan coming in in order to make things like melatonin.

Christa: Mm-hmm (affirmative). I have had people make some diet alterations and have improved sleep. And the only reason I'm saying that is because if you've made some changes and you're not really seeing a change, then you probably, like stop, don't restrict too hard, or don't… You know, whole food, good food, whole unprocessed great food. That's really a bottom line. There's many ways you can experiment with food, but don't get into a hole of restriction. And I know you shout that out loud and clear and I just wanted to echo that. Like, you might see some improvements from that, but if you're not, then don't hang out in restriction land. I think it's a big topic in general. But that's a great point.

Christa: Fun fact, actually about melatonin that I learned from an integrative pediatrician that I interviewed recently, is that they're finding that melatonin actually helps with reflux, but they don't know why in kids, which is interesting because that will keep kids up. So they found that out accidentally. So they're not actually sure what the mechanism is there.

Christa: I think it's interesting because if I go back one step, this doesn't make perfect sense. Improving serotonin can improve bowel motility. So I just wonder if in general, the motility of the gut going in the proper direction is being assisted or something because serotonin's a step before melatonin. I don't know. It doesn't make perfect sense to me. It's the only thing I can think of. But I think they don't really know the reason. Like, “We don't know why this helps, but it seems to be helping.” So it's sort of… Melatonin's a really unique hormone because it's actually protective. It's like a protective antioxidant too, like in fertility and whatnot. So it's just a really, kind of a weird, it's like vitamin D, it's weird. It's like a vitamin and a hormone.

Jennifer: And I think too, I've talked about melatonin on the podcast but I would love to hear your thoughts on supplementing with it, if you have experience with it, if you have ever recommended it. I will say as a general rule of thumb, there are a lot of things, a lot of medications that it conflicts with. And there are certain conditions that it does not mix well with. So before you go and pick it up, just because it's sold over the counter does not necessarily mean that it's right for everybody, that you should talk to your doctor or your practitioner first. But Christa, what's your feelings on supplemental melatonin?

Christa: Well, I have a lot of… I don't recommend it too often to clients, but I have a lot of personal and family experience. I have several kids and my child with gut issues did really poorly on melatonin. She had sleep issues when she had gut stuff going on and she would not go to sleep, and melatonin did pretty-much, it didn't help at all, it was the opposite.

Christa: So something that… So let me see here. Melatonin in general I think can be okay for short-term use. Or I really like to take it along on trips where you're crossing time zones so you can get reset. I think that that's totally appropriate to try to improve that. Or if something really funny is happening, to use it as a crutch forever, I would step back and say what other pieces are there? And the other thing just personally that we like a little bit better in our household that supports melatonin production, is a nice magnesium before bed because that's also a nervous system relaxer. So you're just looking for like that. If you're just having trouble getting, let's say you're all wound up for some reason. Magnesium would relax it, like GABA and L-Theanine. Those are really safe things that we give our kids that our family will take that we can use. And it doesn't, I mean we're not doing a hormone… Like, melatonin is a hormone replacement so I think it's totally fine, short term, intermittent, whatever. Sometimes it doesn't work, and it's not something you rely on. So that's kind of my thought-

Jennifer: Yeah, and I agree. I think you have to do everything else. Melatonin is last resort and it's not a longterm solution. You can't just go, “Oh this is great!”

Jennifer: And I have actually worked with a number of clients who had been on melatonin for 10 years and no one had ever said anything otherwise and they figured, “Well I can buy it in a store so there must not be anything wrong with it.”

Jennifer: And the more research that I looked into it, I was like, “Ooh, you actually have to be quite careful.” And if you're under, at least the advisement that I read, if you're under I think 20, 18, 20 years old, you really have to check with a doctor because it's not advised to take it when you're young. So, if you're listening, you're a mom with young kids, I don't know that that's something you should just go off and test out on your own. That's something you should really, again, that's, hormones, you don't mess with. That's always a good rule of thumb. Don't mess with hormones. Get help.

Christa: Yeah, that's a true statement and pretty-much most… And the other thing about in general to backup and not to say much about hormones, but in general with hormones, at a certain age you should be able to produce all of what you need at the right time. So if you step back and say, “How come I'm not doing this very well,” then that's probably a great, I mean that's really like longterm health when you address… Because if you're not sleeping well, that's like an alarm clock going off and like, kind of an essential, this is about one third of your life. And if it's out of order, maybe let's pay a little bit closer attention to it instead of trying to just make it work.

Jennifer: Yeah. And so for people who check out your book, please tell us what is the name of the book. And I assume there'll be able to find out a lot more information about things like the sleep piece that we've just talked about in the book?

Christa: Yeah, I do try to address sleep and a lot of it. Because as you know, eczema is a big topic. So the book is called, it just addresses a piece of a topic. And the reason I did this book was because everyone is interested in this topic. Everyone is interested in this aspect, before I get into the title. But there's a lot of other pieces too. So I wanted to give lip service to all the other pieces, and I wanted to give people a plan to attack or to try all this area without this longterm restriction.

Christa: So, it's called The Eczema Relief Diet: Short-Term Plans to Identify Triggers and Soothe Flareups. And the goal here is I want it, I want to be really clear about how long you would play with certain foods if you want to, and what that should look like and what results you should see. And whose eczema seems to respond better to it and who's doesn't. And I wanted to talk about many of the other pieces. I know you have a radial and I use a radial, like here's all the things that can be going on. And of course sleep is a big… I don't know. I mean it's definitely not like, poor sleep is not a cause of eczema in my opinion. I don't really see that. It's more like eczema is a cause of bad sleep.

Christa: But we talk about all those pieces. And of course you have to talk about sleep. We talk about a bunch of things with kids because that's where a lot of that research is. We talk about gut stuff. We talk about liver a little bit. We talk about environment, irritants. Just to try to tell people it's like more… Because you know how it is. You're in a Facebook group and someone says, “Do this.”

Christa: And then it's like, “Sorry, that was not enough information.”

Christa: So people are interested in this and I want to give them a resource for it without saying, “Hey, just do this forever and ever.”

Jennifer: Right. And also to not saying that there's a guarantee that this is going to work for you. I think that's another… You make a good point, that Facebook groups are great for support, but a lot of times people will become very discouraged when they see other people getting results from something, they don't feel any results or they feel worse and they think “What's wrong with me?” And you begin distrusting your body. You feel very out of sync with it. And I think what you're offering to people, this is such a great, amazing resource and I highly recommend for anybody who's still in the midst of this trying to figure it out. This is a great book for them to check out. And this is available pretty-much everywhere, Amazon et cetera?

Christa: Mm-hmm (affirmative). It is on Amazon, which is where most people pick up their books. And I believe it is, I don't know if it's in Barnes & Noble today, but it should be there as well. So anywhere else you get books.

Jennifer: Cool. We will put a link so that everybody can go check it out.

Jennifer: And if you are not tuning into the Less Stressed Life podcast by the way, you better go do that. This is my little plug for your show. It's such a great show and I'm so honored that I got to be on it. You have great guests and I love what you're doing. So I hope we can have you back because I would love to talk more about all these little nitty gritty pieces that you discuss in your book. So yeah, thanks Christa. I really appreciate this.

Christa: Thanks so much, Jen.