Lack of Sleep Is Your Skin’s Worst Nightmare

Photo: Westend61/Getty Images

EEveryone knows what a tired face looks like. Hanging eyelids, dark circles under the eyes, pale skin, droopy mouth corners, wrinkles, and fine lines—these were some of the cues a group of volunteers interviewed during a study associated with tiredness. The participants were shown photos of 10 individuals, each photographed while well-rested and while sleep-deprived, and were able to judge with a fair amount of precision the level of fatigue of the people in the headshots.

It shouldn’t come as a surprise that lack of sleep has such a visible impact on one’s face—more specifically on the skin. “Sleep is our most important behavior; the one that occupies most time and is responsible for maintaining the internal balance, a state called homeostasis. And the skin is the largest organ in the human body, so it is definitely affected when sleep is disturbed,” says sleep researcher Monica Andersen, associate professor at the Department of Psychobiology at the Federal University of São Paulo.

As our society becomes chronically sleep-deprived, with one in three adults not getting the recommended seven hours or more a night, researchers are beginning to investigate what exactly happens to people’s skin when they don’t sleep enough.

A Korean study from 2017 evaluated the skin condition of 24 healthy women in two situations: after a night of normal sleep and after being kept awake for 24 hours. In the sleep-deprived scenario, skin was less hydrated, with areas around the eyes and cheeks showing increased water loss. The researchers figured that in those places, the skin barrier, which is meant to keep moisture in and irritants out, was impaired. The facial skin was also less elastic and more prone to scaling, changes that were attributed to dehydration. Pores looked bigger too, which the researchers hypothesized was due to the coarse skin texture left by scaling, which made pores appear enlarged. The researchers also found that skin under the eyes had decreased blood flow.

The study’s findings manage to explain some of the typical features of a tired face. Skin dehydration leads to increased fine lines and wrinkles. Decreased blood flow contributes to paleness and dark circles under the eyes.

Another classic feature of a sleepless face, the hanging eyelid, is explained by professor of physiology Mark A. W. Andrews in a Scientific American article. According to Andrews, the muscles that open the upper eyelids can get tired like any other muscle in the body, and after prolonged hours of use, they tend to get heavy and droopy, which could also help explain the drooping mouth corners.

It all adds up to a crappy look.

Your skin’s worst nightmare: Lack of sleep and stress

It is not easy to tease apart the impact of a sleepless night from that of stress. As the authors of the Korean study pointed out, sleep deprivation can be quite stressful, so the changes seen in participants’ skin could have been influenced by stress as well. In fact, the relationship between sleep and stress is bidirectional because people living under stressful circumstances are also more prone to having sleep problems.

While a single sleepless night can have a noticeable impact on how your face looks, chronic sleep deprivation and stress can lead to even more significant changes. The exact mechanism behind those changes has not been completely figured out, but studies suggest it involves multiple body systems.

Andersen and her team proposed that, as sleep plays a role in restoring the immune system, a lack of sleep—even for one night—could cause a decrease in the body’s immune response. In a scenario of prolonged sleep deprivation, immunosuppression could affect the production of collagen, a protein that provides structure to the skin. When the quality or amount of collagen is impaired, the skin may lose elasticity and firmness, leading to wrinkles.

“Sleep is our most important behavior. And the skin is the largest organ in the human body, so it is definitely affected when sleep is disturbed.”

Both lack of sleep and the stress it comes with have also been found to alter the production of certain hormones, including cortisol. “There is evidence that sleep deprivation leads to increased cortisol levels, a hormonal imbalance that may increase inflammation and affect the skin barrier,” says dermatologist Ellen Xerfan, a researcher at the Department of Translational Medicine at the Federal University of São Paulo. Increased levels of cortisol have been linked with skin conditions like acne as well as the arrival of early signs of skin aging.

“We know that sleep is needed to repair the organ systems. One of the things it does is to clear the free radicals formed during the day,” says Cameron Rokhsar, associate professor of dermatology at Mount Sinai Hospital and a practicing dermatologist in Manhattan. Free radicals are formed when the oxygen in our body splits into single atoms that contain unpaired electrons. Since electrons like to be in pairs, this atom goes out looking for other atoms to bond to. This process, which can damage the body’s cells, is called oxidative stress and has been associated with skin aging as well. Without enough sleep, free radicals tend to increase, triggering this damaging process.

Sleep deprivation and stress are not only responsible for aesthetic skin problems, but they are also associated with the worsening of skin diseases such as psoriasis and atopic dermatitis, according to dermatologist Flor Mayoral, head of Mayoral Dermatology in Miami.

Xerfan, who is currently studying the potential impact of sleep deprivation in vitiligo, a condition in which white patches form on the skin, says there may be a two-way relationship between lack of sleep and skin diseases. While lack of sleep may worsen skin conditions, this aggravation increases psychological stress, which may, in turn, lead to more sleeping problems. “It’s a vicious cycle,” she says.

When it comes to premature skin aging, prevention is key

If you have a single night of bad sleep, the best strategy to treat a tired face is to moisturize and use a topical antioxidant, such as vitamin C, in addition to your everyday sunscreen, Mayoral suggests. But when it comes to combating the effects of chronic sleep deprivation and stress, things get complicated. According to studies, there is no proven medical treatment that can reverse skin aging caused by stress and sleep deprivation. Therefore, prevention is the key.

For people who are chronically stressed or sleep-deprived, experts recommend lifestyle changes. “Exercising on a daily basis, taking a few minutes out of your day to do relaxation breathing, meditating, doing yoga are all things that can help,” says Rokhsar. To improve sleep, Andersen recommends adopting a routine of healthy sleeping habits. “We all know what we need to do to improve our sleep, but few of us do it: things like avoiding stressful activities at night, not bringing phones and tablets to bed, not eating heavy meals at night and turning off any electronics two hours before sleeping.”

These measures are important to overall health, of course, because the impact of stress and lack of sleep goes beyond the skin. “Stress doesn’t affect only your skin, but it can trigger cardiovascular problems, diabetes, migraines, seizures. It affects multiple organ systems mainly through cortisol, the stress hormone,” Mayoral says.

Having a tired-looking face could also have important social consequences. Tina Sundelin, a sleep researcher at Stockholm University and one of the authors of the Swedish study about the facial cues of fatigue, says there is a lot of research on first impressions and how they may shape how other people perceive and interact with you.“If someone is perceived as tired, it may affect others’ impressions of their intelligence and health as well,” she says.

Science and health journalist with a special interest in evidence-based medicine and epidemics. Columbia Journalism School alumna. mari.lenharo@gmail.com.

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