Dr Rupert Critchley discusses the impact of sleep on the skin and how sleep deprivation can cause premature ageing
It has been reported for years that adults need between seven and eight hours of sleep a night to maintain a healthy mind and body.1 It is also recommended that we should restrict our use of electronic devices 30 to 40 minutes before bed so we don’t confuse the light sensitive cells in our eyes and stop the production of the sleep-promoting hormone, melatonin.2 But many people are guilty of neglecting themselves in the sleep department and letting the pressures of work and play take precedence. In fact, data from the Centers for Disease Control and Prevention (CDC) in the US found that 35.3% of us report sleeping less than seven hours in a 24-hour period, and 37.9% have unintentionally fallen asleep during the day.3 The CDC even considers insufficient sleep a public health problem.4
Fewer hours spent sleeping is detrimental to your physical health and has been linked to serious issues including obesity, diabetes, cancer and immune deficiency, heart disease and depression.4 More recently, sleep deprivation has also been linked to damaging the skin, our bodies’ most important barrier from external stressors such as environmental toxins and sun-induced DNA damage.
The Pittsburgh Sleep Quality Index (PSQI) is an effective instrument used to measure the quality and patterns of sleep in adults. It differentiates ‘poor’ from ‘good’ sleep quality by measuring seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction over the last month.7
The link between sleep deprivation and common skin complaints has been suspected for years,5 however, only in a 2013 study at University Hospitals Case Medical Center did scientists find a direct correlation.6 This was the first clinical trial of its kind to evidence such findings.
The study, commissioned by cosmetics and skincare brand Estée Lauder, demonstrated that poor sleepers had increased signs of skin ageing and slower recovery from a variety of environmental stressors.
The study involved 60 women between the ages of 30 and 49, with half falling into the ‘poor quality sleep’ category (according to their average duration of sleep and the Pittsburgh Sleep Quality Index),7 and the other half in the ‘good quality sleep’ category. Visual skin evaluations were conducted for each participant as well as several non-invasive skin challenge tests, including UV light exposure and skin barrier disruption.
The results indicated significant differences between the skin of the good and poor quality sleepers. Using the SCINEXA skin ageing scoring system,8 poor quality sleepers showed increased signs of intrinsic skin ageing including fine lines, uneven pigmentation, slackening of skin and reduced elasticity.6
Additionally, the study suggested that good quality sleepers recovered quicker from stressors to the skin such as sunburn. The poor quality sleepers experienced erythema (redness) that remained higher over 72 hours, indicating that inflammation is less efficiently resolved. In another part of the study, participants had a piece of tape stripped from their skin and measurements taken 72 hours later. This skin barrier stressor test showed the recovery of good quality sleepers’ skin was 30% higher than poor quality sleepers (14% repaired vs. 6% repaired), demonstrating their skin’s ability to repair damage more quickly.6
In a completely separate study conducted by Bensons for Beds,11 30 participants were asked to take just six hours sleep for five nights in a row. These participants had their skin tested by a skin-imaging system, which measured elements such as spots, pores, red areas, brown spots and bacteria. Supermodel Jodie Kidd took part in the study and found that her pores increased by 56% in number and 83% in visibility; she had 11% more spots, which were 23% more visible; and the bacteria on her skin increased by 65% after the five-night experiment.
The skin’s actual appearance is one concern and the emotional impact of less sleep is another. In the Benson for Beds test, the poorer sleepers had a worse assessment of their own skin and facial appearance, with every single participant agreeing that they felt less attractive and had lower self-esteem after the experiment. The results suggested that there was a 20% decline in self-esteem over the course of the study with participants feeling 33% less attractive at the end of the test. Participants’ perception of how others saw them also declined by as much as 35%.11
The ‘SCINEXA’ skin ageing test gives a validated score to simultaneously assess and differentiate between intrinsic and extrinsic skin ageing. The written test includes five items indicative of intrinsic skin ageing and 18 items highly characteristic of extrinsic skin ageing. These items are used to define an index that can be used to judge one person’s skin against another, or against an ideal.10
Just as your body needs food and water, it also needs rest. Sleep is a time for the body to heal, renew and eliminate toxins from the skin. During the hours you spend asleep, your body’s hydration rebalances and there’s a rise in growth hormone as it repairs itself, allowing the skin to recover moisture and for damaged cells to be repaired.12 Reducing the amount of time you sleep to below the recommended seven hours may result in a chain of health issues,4 as well as causing damage to your skin. Not only will your complexion and aesthetic appearance suffer but also the skin’s ability to retain essential moisture and protect you from environmental stressors such as the sun’s rays and everyday pollution.6
To keep our patients’ skin looking and feeling its best, it is advisable that they stick to a healthy routine of between seven and eight hours sleep every night, ban the TV from the bedroom and make sure all night screens are switched off at least 30 minutes before bed.