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Managing Sleep & Reducing Psycho-Emotional Stress for Eczema & Atopic Dermatitis

In terms of interventions, the patient should employ a well-rounded approach that includes:

  1. Identifying and avoiding triggers – click to access article
  2. Addressing the itch, reducing inflammation, maintaining moisture levels and managing barrier dysfunction – click to access article
  3. Managing sleep and reducing psycho/emotional/social stress

This article (3) covers the topic of managing sleep and reducing psychosocial stress.

Managing Sleep & Reducing Psycho-Emotional Stress for Eczema & Atopic Dermatitis

Sleep Aids

In the acute phase, the most common sleep aids like magnesium and melatonin at low doses may not help at all. However sleep is crucial for the body to repair itself. In desperation, some patients use drowsy antihistamine Atarax aka Hydroxyzine to both reduce the itch as well as induce a drowsy state.

As the individual is recovering and past the acute flare stage, use of tryptophan-rich food can be considered. They include:

  1. rice, oats
  2. chicken and turkey
  3. dates
  4. bananas

In addition to using that magnesium supplement (do consider MegaMeg liquid magnesium for convenience), do remember that green leafy vegetables are also rich in magnesium! Avoid caffeine after the early afternoon and use chamomile tea or lavender tea closer to bedtime.

Invest in pyjamas with hand covers (to prevent unconscious scratching at night). As relieving as it is in the moment, scratching can cause skin cells to produce more quickly, and patches of eczema to widen. Encourage compresses instead – such as oatmeal in cheesecloth, rooibos tea bags, or just a wet washcloth – to provide immediate relief.

Psycho/emotional/social Support

Psychology is an oft-neglected component in the treatment of dermatoses. The role that stress and other psychological issues play in eczema is considerable. Inflammation, itch and pain are part of it. And then there is the social anxiety, depression and other psychological issues that may arise with the skin condition.

For many people with eczema, emotions and stress can worsen their skin condition or initiate flare-ups. The severity of an eczema flare is a function of the patient’s emotional world.  Signs and symptoms of eczema can possibly be improved upon through simple psychological techniques.

Psychotherapy

Look out for good personal chemistry: someone you feel can understand you. Look for a depth of experience working with eczema and scratching. Someone can be a great therapist for people with other problems, yet ignorant and ineffective in this area. Ideally a therapist should be competent to address behaviour change, cognitive (thinking) issues, and also the emotional side of the problem and relevant personal history. A therapist who is too strictly committed to one approach or technique may have major blind spots.

Hypnosis & Self-hypnosis

You may learn to actually change your skin from within. Here are some videos provided by one patient of mine who used it during the acute flare stage of Topical Steroid Withdrawal:

I know there will be people who will laugh at the idea of using these youtube videos to help them along their journey. However, for those who are suffering from TSW and truly unable to have a full night of sleep, these videos are good for three reasons.

  1. When you listen to these videos and intend to focus on the voice, you use that audio stimuli to override the sensory signals of itch.
  2. You are actually engaging in mindful focus, which can help train your brain for discipline not to relent into an itch fest.
  3. It is either you concentrate on the video or you loose concentration and go into slumber, even if for a while. Both are good for different reasons, certainly better than having nothing to focus on and only lapsing into itch fests.

Manage Pent-up Emotions

Emotional stress can keep the most effective medical treatment from working. Yet, on the other hand, it can produce the most dramatic improvements.

If it is any encouragement at all, try reading this article by Ted Grossbart.

Ted Grossbart goes a little further to propose this: “If you don’t allow yourself to ‘feel your feelings’ you are more likely to develop physical symptoms.” He is suggesting that eczema can be the results of suppressed emotions.

How can you let your emotions out? There are several ways and if I do get a chance to, it would be an honor to introduce you to some of them.

[See video above] New technologies for Virtual Reality, as evidenced by Snow World, add fuller dimension to the evolving idea of pain relief.

Understanding Counter Stimulation

The idea of counter stimulation – where sensory stimulation reduces our perception of pain, either locally or distally – is not new. We do it all the time, clenching our faces in pain or wriggling our toes when the masseur presses down hard at one spot. It’s instinctive for most of us to rub our bruises as if that act of rubbing takes the pain away. But it does – most of the time – until we stop rubbing or putting pressure on the spot. And remember how you would slap that itch away.

Today, we understand it as a crowding out of pain, where we interfere with the sensation of pain by creating other sensations that our sensory nerves detect and send to the brain. These sensations may include different types of touch (rubbing, pressing, slapping) or different temperatures (hot, cold). That’s how it works, but let’s move on to review some approaches developed through the centuries.

Counter Irritants

Counter-irritants, liniments or ointment that are rubbed on painful parts of the body, also work through the same principle, although there may also be active ingredients of an anti-inflammatory nature, e.g. from herbal sources like calendula, neem and lemongrass.

In general, application of a counter-irritant will not only crowd out the primary course of pain (e.g. arthritis) but will also induce inflammation. Inflammation involves vasodilation, blood moving in with oxygen to nurture the local area and with neutrophils and macrophages to get rid of any byproducts, and perhaps other chemical mediators that will assist in healing.

So, the idea here is that inflammation is inadequate in certain kinds of pain e.g. chronic pain. We may thus need to induce inflammation – in moderation – to aid healing.

This may be over-simplifying it, but counter-irritants are:

  • analgesic: by crowding out the primary source of pain.
  • vasodilating: by inducing benevolent inflammation.

These principles of counter-stimulation and counter-irritation are also applicable to the management of skin diseases and the associated itch. Acupuncture may provide not just some form of counter stimulation, but also works on the down-regulating the central nervous system as well as bringing down systemic and local inflammation. Suitable herbal liniments and ointments provide counter-irritant effect and can provide short term relief.

Acupuncture as Counter-stimulation

One would postulate that massage and acupuncture probably came about as described above, when parts of the body that were painful were rubbed to ease the pain. These points – called A-shi points – are still indicated in massage or acupuncture treatment, and we understand intuitively that most times it makes sense to stimulate the spot that is painful. The pricking of the skin with a needle is understood to give this effect.

But I think it’s often more than this. Rubbing your bruised arm is not just counter-stimulation – it may also relax the muscles by creating warmth, or help disperse chemical mediators in the area. In a similar way, the effect of acupuncture is much more. Some say it causes the brain to release enkaphalins (endorphins) or regulates the release of neurotransmitters as serotonin, dopamine et al. Some points certainly have more marked endocrine effect, and may cause a variety of changes in our body chemistry, dilating vessels and bringing in the healing salvation of blood to the area, or boosting the production of hormones that the body is in need of but not making. It runs a large gamut, and may not be as easy to pin down as we’d like.

Gate theories are also used to explain the effect of acupuncture on pain perception and on motor function.

Gate control theory sees pain perception as controlled by a gate between the place you’ve been pricked (location of impulse generation) and the brain. We know that pain travels via sensory nerve fibers to be relayed to the brain. But this gate closes up and blocks off the transmission of pain IF the pain impulses are getting through too much too quickly. The thin C fibers have been found to exhibit such a “gate” function.
Gates may not just exist in sensory fibers. When implicated in motor fibers, stimulation of the fibers – whether by massage, acupuncture or exercise – reopens a closed gate, hence enabling motor impulses from the brain to reach muscles or internal organs. This is not just useful for treating impaired muscle function, but may also be helpful when we think that nerves leading to certain organs are “blocked.”

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