Understanding the experience of sleep disturbance in psoriasis: a qualitative exploration using the Common‐Sense Model of Self‐Regulation

Abstract

Summary Background Psoriasis is associated with significant morbidity, which negatively impacts upon quality of life. Sleep disturbance is reported to be common in patients with psoriasis and is associated with physical and psychological variables, although there is little published work in this area. Understanding sleep and the factors involved in its disturbance in psoriasis is a potentially important clinical area given the role of sleep in health and disease processes. Objectives To explore the experience of sleep and sleep disturbance in psoriasis using the Common‐Sense Model of Self‐Regulation (CS‐SRM). Methods Semistructured interviews were conducted with adults diagnosed with psoriasis. Interview questions were informed by the CS‐SRM and previous research. Framework analysis was applied, including coding data into the CS‐SRM dimensions and allowing additional inductive themes to emerge. Results Seventeen people with psoriasis (nine women, eight men; aged 19–86 years) were interviewed about sleep and sleep disturbance. Seven themes emerged, with six accounted for by the CS‐SRM: characteristics of sleep disturbance, change in sleep patterns, thoughts about and symptoms of disease disturbing sleep, impact of poor sleep on daily life, attempts to improve sleep, a daily battle for control and a seventh relating to metacognitive processes. A reciprocal relationship between sleep and psoriasis was evident across themes with interactions between key sleep‐related thoughts, emotions and behaviours. Conclusions This study showed that sleep disturbance is a persistent concern for people with psoriasis; it has a 24‐h impact, and interacts with the psychological and physical aspects of psoriasis. The distress and frustration felt when managing sleep disturbance perpetuated problematic sleep. Addressing this with currently available sleep treatments may therefore confer sleep and psoriasis‐related benefits for people living with this condition.

Psoriasis and sleep: unravelling the relationship

“…The linked paper by Henry et al . in this issue of the BJD employs a qualitative methodology to explore the relationship between psoriasis and sleep dysfunction established by quantitative research.…”

Take 10: ten qualitative studies on under‐researched groups and hard‐to‐reach issues in dermatology

“…Authors responded to our challenge with a wider range of submissions and almost double the number submitted last time, showing the growing interest in qualitative research in this field. Our second spotlight for summer 2019 showcases 10 studies, comprising a complementary mix of six original articles and four research letters . These papers involve interdisciplinary authorship teams from dermatology, psychology, general practice, nursing, public health and applied health services research in Australia, Germany, the Netherlands, the Republic of Ireland, the U.K. and the U.S.A.…”

“…Six papers, demonstrate qualitative methods’ capacity to access psychological and social issues that are difficult to reach with traditional questionnaire/survey research, and the capability to investigate the portrayal and experience of the skin in the online world. Fox et al .…”

“…Three studies in this group of six are informed by psychological models, and enable access to particularly sensitive issues. Underpinned by theoretical perspectives on appearance ideals and stigmatization, Pasterfield et al .…”

“…Henry and colleagues expand our understanding of the relationship between sleep disturbance and psoriasis with in‐depth interviews framed by the Common‐Sense Model of Self‐Regulation. Psoriasis and sleep disturbance were found to interact, with the frustration of sleep disturbance exacerbating problematic sleep.…”