11 January, 2013

Rosacea and flushing during sleep

Do you wake up with a calm or with a red face usually? Some people with rosacea find that sleeping triggers their flushing and flare ups, while others get a well deserved break from it during the night. There are explanations for both phenomenon, that will be discussed later. First a bit about the importance of sleep itself. For the body as a whole in general and more specific for a body dealing with an inflammatory disease. 

Many rosacea patients have reported that getting adequate amounts of sleep can help with their rosacea symptoms. And that not getting enough sleep can set them up for a red day, especially in terms of flushing. While there could be many reasons for this, recent research suggests that sleep can shift the balance of Th1 and Th2 cytokine activity; hormonal messengers responsible for most of the biological effects in the immune system, such as allergic type responses. Although they are numerous, cytokines can be functionally divided into two groups: Th1 are pro-inflammatory and Th2 are essentially anti-inflammatory. And research has shown that sleep can also stimulate a pronounced decrease in production of TNF-alpha; one of the cytokines that is involved in systemic inflammation. Firstly: when you have had lack of sleep and are low on energy, the body acts different from normal. When the body is tired, production of the chemical cortisol is dramatically increased to help give you the energy you need to stay awake. Among many other things, cortisol actually increases the volume of the blood in your body, which causes the blood vessels (including the ones below your eyes and in your face) to engorge to accommodate it. When the blood vessels are engorged, they’d be easier to see, and more prone to make our faces red.

Sleep deprivation has been associated with a general increase in pro-inflammatory cytokines:

*The effects of 40 hours of total sleep deprivation on inflammatory markers in healthy young adults Source. “Alterations in circulating levels of pro- and anti-inflammatory cytokines and cell adhesion molecules during sleep deprivation were consistent with both increased and decreased inflammation. These findings suggest that one night of sleep loss triggers a stress response that includes stimulation of both pro- and anti-inflammatory proteins in the healthy young subjects tested under our experimental conditions.”

The relevance of sleep abnormalities to chronic inflammatory conditions (source)

“We found a substantial body of published evidence that sleep disturbances can worsen the course of Chronic Inflammatory Conditions, aggravate disease symptoms such as pain and fatigue, and increase (inflammatory) disease activity and lower quality of life. The mechanism underlying these effects probably involves dysregulation of the immune system.”

Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation (source)

“Sleep loss induces a functional alteration of the monocyte pro-inflammatory cytokine response. A modest amount of sleep loss also alters molecular processes that drive cellular immune activation and induce inflammatory cytokines.” So losing a lot of sleep overnight, WILL set you up for more inflammation. And sleep patterns have an actual role in changes within the immune system. More research is needed, but scientists suggest that sleep patterns can in fact be used to set up new strategies to lower inflammation for patients of inflammatory diseases. Read more about this here.

The Body's Themoregulation During Sleep

The temperature of both the brain and the body falls during NREM (non rapid eye movement) sleep; one of the deepest of all stages of sleep. The longer the NREM-sleep episode, the more the temperature of the body and brain falls. By contrast, brain temperature increases during REM sleep (a kind of sleep that occurs at intervals during the night and is characterized by rapid eye movements, more dreaming and bodily movement, and faster pulse and breathing). The control of body and brain temperature is closely tied to sleep regulation. The hypothalamus (a specific part of the brain) regulates body temperature between 96.8 and 100.4 degrees Fahrenheit (36 - 38 degrees Celsius) over each 24 hour cycle. Normally, you fall asleep when the core temperature of your body starts to drop at night. Sleep usually begins when the rate of temperature change and body heat loss is maximal. The average adult’s lowest temperature is at about 5 AM, or two hours before waking time. In one study, subjects were exposed to a range of temperatures during sleep. Based on animal models, the researchers expected REM sleep to cause difficulty in thermoregulation (a process that allows your body to maintain its core internal -basic- temperature), but test results showed that there was very little disruption of this basic core temperature of the body during REM and other sleep stages. The subjects shivered slightly in cold temperatures during sleep stages 1 and 2. Although skin temperature increased as the subjects were exposed to higher temperatures, their core body temperature readings did not change. So if you overheat at night, for instance by packing on the blankets, or wearing woolen pyjamas, then the excess heat that your body generates is only measurable in the skin. The core of your body stays a stable temperature. The body releases the extra heat all through the skin. Which is something to be aware of when you suffer from rosacea! We don't want to put even more stress on the blood vessels in our faces, after all. If you had to choose between being too warm or too cold at night, apparently cold is the wiser choice. 

When the core body temperature is too high when we sleep, blood vessels in the skin dilate and heat is lost through their walls. (This is hardly news to observers; in Ancient Greece Hippocrates speculated that sleeping bodies feel cool to the touch because blood flows away from the skin) Sweat is also produced; it evaporates and lowers temperature. If a human is too cold, the blood vessels constrict, conserving heat. Blood is preferentially concentrated around the internal organs and away from the skin and peripheral structures like limbs. However, don't make yourself too cold at night, because that might interfere with deep peaceful sleep. A recent Dutch study fitted people in a test group with thermosuits, which allowed the scientists to increase skin temperature of the test persons less than a degree Centrigrade without affecting core body temperature (because when the core body temperature increases, then this has an energizing effect on the body). The changes were dramatic. People didn't wake up as much during the night and the percentage of the sleep spent in stages 3 and 4 (deep sleep) increased. The effects were most pronounced in the elderly and in people who suffered from insomnia. A 0.4 C increase in skin temperature caused a decline in the probability of early morning waking from 0.58 to 0.04 SourceThe ideal temperature for falling asleep is in the mid-60 degrees Fahrenheit – between 60 and 67 degrees (15,5 - 19.4 degrees Celsius). Find the temperature that works best for you. It should be cool enough to help you fall asleep without waking up a few hours later shivering, but also not so warm to cause you to wake up from sweating.

Throughout the day, your body temperature rises. When you wake up, your body temperature is at its baseline of 98.6 degrees (37 Celsius). Over the course of the morning through the late afternoon, your hypothalamus works to drive that up to 100.4 degrees (38 Celsius). This rise in body temperature gives you energy, helping you stay alert. This partly why working out is so energizing – the rise in body heat makes you feel awake. It also makes us more prone to flushing and burning of the skin however. Later in the day your body starts to lower your body temperature again to prepare you for sleep.

What Happens When You Sleep well?

When we sleep well, we wake up feeling refreshed and alert for our daily activities. Sleep affects how we look, feel and perform on a daily basis, and can have a major impact on our overall quality of life. To get the most out of our sleep, both quantity and quality are important. Adults need between 7 and 9 hours of uninterrupted sleep to function well. Teens need at least 8½ hours—and on average 9¼ hours—a night of uninterrupted sleep to leave their bodies and minds rejuvenated for the next day. If sleep is cut short, the body doesn’t have time to complete all of the phases needed for muscle repair, memory consolidation and release of hormones regulating growth and appetite. Then we wake up less prepared to concentrate, make decisions, or engage fully in school and social activities.

How Does Sleep Contribute to All of These Things?
Sleep architecture follows a pattern of alternating REM (rapid eye movement) and NREM (non-rapid eye movement) sleep throughout a typical night in a cycle that repeats itself about every 90 minutes. What role does each state and stage of sleep play?
NREM (75% of night): As we begin to fall asleep, we enter NREM sleep, which is composed of stages 1-4
Stage 1
* Between being awake and falling asleep
* Light sleep
Stage 2
* Onset of sleep
* Becoming disengaged from surroundings
* Breathing and heart rate are regular
* Body temperature drops (so sleeping in a cool room is helpful)
Stages 3 and 4
* Deepest and most restorative sleep
* Blood pressure drops
* Breathing becomes slower
* Muscles are relaxed
* Blood supply to muscles increases
* Tissue growth and repair occurs
* Energy is restored
* Hormones are released, such as: Growth hormone, essential for growth and development, including muscle development
REM (25% of night): First occurs about 90 minutes after falling asleep and recurs about every 90 minutes, getting longer later in the night
* Provides energy to brain and body
* Supports daytime performance
* Brain is active and dreams occur
* Eyes dart back and forth
* Body becomes immobile and relaxed, as muscles are turned off
In addition, levels of the hormone cortisol dip at bed time and increase over the night to promote alertness in morning.
Sleep helps us thrive by contributing to a healthy immune system, and can also balance our appetites by helping to regulate levels of the hormones ghrelin and leptin, which play a role in our feelings of hunger and fullness. So when we’re sleep deprived, we may feel the need to eat more, which can lead to weight gain.
The one-third of our lives that we spend sleeping, far from being “unproductive,” plays a direct role in how full, energetic and successful the other two-thirds of our lives can be. Source.

Explanations for good, cool skin after waking:
-A proper night of sleep not only help to reduce stress – an important rosacea trigger – it allows your skin to rejuvenate. Some may notice that their skin looks better in the morning and maybe you don’t even have any redness when you wake up. During the night, your skin barrier has a chance to rebuild without any aggression from the outside world. On top of that, your metabolism is less active: your heart rate slows down and your body is a lot more relaxed. Rosacea being linked a lot with stress and the cardiovascular system, you can see the positive impact sleeping has on your rosacea. During sleep your body temperature drops, which is good when you have rosacea. Source

Explanations for Bad, hot skin after waking:
-eating heavy or sugar loaded meals shortly before going to bed can spike blood sugar levels during the night and stimulate flushing. It will also activate your digestion system and this can create heat in the body.

-your position during sleep can stimulate flushing: when you sleep on one side, the cheek that is pressed on the pillow can get more red and flushed. Your skin might react to the pressure or to the substances in the washing powder with which you have washed the bed linen and pillow cover. When you have subtype 2 rosacea you might also suffer from demodex mites, and then it is extra important to wash your bed linen regularly and at high enough temperatures (at least 60 degrees Celsius) to kill mites and their eggs, which can be in your pillow and blankets. However, some people have the opposite reaction and find that the cheek that is slept on is more pale than the other cheek. I think this might be because the blood flow causes the blood volume in the lower cheek (the one you sleep on) to go down, towards the ears, but the blood in the upright cheek to go to the inner cheek area, hence more redness heat and flushing there. I alternate the sides I sleep on simply to avoid one cheek becoming much worse than the other. I am doing best when I prop some pillows up and sleep not entirely flat, but with my face a little bit lifted. I always use a small fan at night set on lowest speed. Over the years I subconsciously managed to not twist and turn too much during my sleep, but I still wake up on the wrong side and out of the fan’s reach sometimes. Another down side of all these weird and staged angles of sleep is some head aches now and then and need for physiotherapy massages of my neck and upper shoulder area. Not a massive punishment :)

-Some rosaceans might have flushing or outbreak issues from small mites that nest in the mattress, cover and blankets. Taking antihistamine medication should put a dent in these type of skin problems but I think it is a good thing at all times to wash your bed linen every week at 60 degrees at least. Only from 60 degrees and upwards the mites and eggs will be killed in the washing machine.  Ventilate the bed during the day and make sure your bedroom has plenty of fresh air circulation as well. I am also sensitive to dust and try to keep my bedroom dust free (or as much as possible) and put my clothing in closed closets instead of hanging all over the place; they collect both dust and dust mites. My cats are at no point allowed in the bed room. I also have a special allergy cover for my pillow that seals it off completely for mites. It was very expensive at the time so never bought the bed sheet allergic cover, but maybe should.

-Despite your body temperature dropping at night, you might be overheating yourself in bed. I don't pun just at sex, but more so on using thick heavy sheets and bed covers and wearing warm night clothing. It might feel nice when you just stepped into bed and have to warm up, but during the night you might get overheated from all those layers of fabric, and what body parts sticks out as an outlet above the covers? Yep, your face and head. I notice a pretty clear difference myself between having double blankets and a proper winter’s night gown on at night or just a thin cotton flimsy thing and single blankets. This might be one of the several reasons why many rosaceans state that their rosacea is usually better during summer than in winter; the light bed sheets and lack of heavy gear in bed then keep us cool and makes it easier for the full body to radiate heat, instead of just the face.
-In winter the use of a fan seems to be able to worsen the redness and flushing, when the temperature gets too cold. This could be contributed to the Warm Room Flush (see pdf on this weblink). A very interesting read on how being in a room that's too cold, might stir up your flushing and lower your flushing threshold. Australian research.

I was asked if I usually wake up flushed or not?

Despite taking anti flushing medication, and despite using a ventilator to keep my face cool, do I wake up red in the morning? No I don't usually. But it depends on factors like my hormonal state of the month and whether or not I ate pro-inflammatory foods the days prior. But normally I try to stick to my  still healthy diet and am not red when I wake up. My skin is cool and pale. I have a special construction made, which looks pretty stupid probably haha, but it allows me to clip on two small clip on fans on both sides, blowing cool air on both cheeks. Otherwise I always wake up with one red cheek (not the one I sleep on strangely enough, but the one that faces the ceiling, as I can't sleep on my back and always sleep on my side). This way I no longer have structurally one red cheek to cater to during the day, depending on what side of the bed I slept on. I make sure the temperature in the bedroom is not too high but also not too low. It is tempting when you are sore and burned up to have a winters breeze cool you down, but when the air is too cold, I get extra red and inflamed. So I would say the air is between 13 - 20 degrees, depending on the season. This way I sleep really well actually, without having to get up to cool my face. This was very different in the past, before I started anti flushing medication, and after a botched IPL treatment which spiked my redness and flushing and burning tenfold. I would have a hard time sleeping and have an airconditioning system running plus fans plus cold packs, and still be very red, on fire and in a bad state of pain. The redness in this photo was just mild, compared to how bad it would get.

I do get more flushy in the evenings, but as soon as I lay in bed and make sure to have the clip on fans on and don't overheat my body with layers of night wear and blankets, then my skin is usually relatively pain free (I always ' feel'  my skin however, it always feels a bit uncomfortable, tight, on the verge of a burn) and flush free. Our body temperature reaches its lowest point when we sleep, and that might help me to not be flushed usually. However, in the evening our body temperature is higher than normal, and the blood flow to our skin also increases in the evening, warming the skin and possibly triggering our blood vessels to dilate more, as rosacea skin tends to have weaker, more easily dilated blood vessels. In the evening our body also releases more cytokines, which increase inflammation. Meanwhile, production of corticosteroids — hormones that reduce inflammation — slows down in the evening. On top of these factors, your skin loses more water at night. All of this could make people with rosacea more easily flushed in the later afternoon and early evening. Add to that also that often we eat the largest meal of the day in the evening (not everyone and not in all countries/cultures though), and aside from possible food triggers, big meals set off heat in the body once the digestive system goes to work. And we also have been building up possible triggers all day, from traveling to public transport to work places that might not be favourable for rosacea  to sun exposure etc

A summary of forum topics and statements from rosaceans who wrote about this

Meg101 wrote on May 22nd 2018: "Flushing a lot when laying down at night? Hi, so I recently found out I have rosacea (started when I did hot yoga several times, I think that was what set it off and ever since my skin is not the same). Recently, I have noticed that my face flushes when at night laying down in bed :\ Anyone else experience something similar? I'll be walking around the house fine with minimal to no redness and as soon as I lay down within several minutes I feel this hot uncomfortable sensation on my chin area (this area seems to be my biggest one) but eventually also my cheeks. I think it happens throughout the night, idk what to do. I wake up and my cheeks are quite rosy too, this fades down eventually, but anyone ever find a way to avoid this? Getting a Vbeam consultation in two weeks, did anyone find Vbeam to ease their flushing? Thank! This is my first post btw!"

Laser_cat wrote on May 22nd 2018: "Hi Meg - Flushing when lying down + trying to sleep used to be a huge problem for me. Taking mirtazapine at night (15, 22.5, or 30 mg I think would each be effective) resolved this completely for me and I no longer have to sleep in a recliner. The only side effect I've had is reduced satiety after meals. Lots of info on this forum about mirtazapine (and other helpful meds). I did not get relief from laser personally but everyone's different. Best wishes, Lizzy
I don't feel full from eating my usual breakfast for example. When I was at 15 mg for a while, I remember making and eating a bowl of cereal, then making and eating another bowl, and then one more time  I wasn't hungry, but I wasn't getting that fullness signal telling me to stop (antihistamine qualities). Bumping up my dose to 22.5 mg helped (and I know some people do great at 30 mg) -- less antihistamine effects. But I think this is better than being actually hungrier, if that makes sense -- I just needed to find better hobbies than eating lol. Which was/is doable.  Being aware of this potential side effect early on helped me to nip that issue in the bud. I've been on ~8 months so far. I'm probably not going to get off anytime soon. I've never slept better in all honestly  (And maybe the benefits of regular good night's sleep in turn helps my flushing/burning/inflammation??? I'd like to think so anyway) I used excel v and vbeam. Yeah, wish it would have been the answer for me too! oh well. Some people do very well though. I haven't found a laser doc who could give me a meaningful/confident answer as to why some people do better than others. One derm said my problematic blood vessels might be too deep for laser ... but who knows. I hope you find something to help you with your anxiety soon. Good luck! Lizzy"

Pleatherpants wrote on May 22nd 2018: "I used to get this as well, the burning would wake me up at night! I was prescribed Clonidine and it has helped reduce my flushing since. Good luck!"

Flemmo wrote about flushing during sleep: I've noticed recently, after getting up in the night to go to the toilet, my nose and cheeks are bright red and hot. I try to keep cool during the night with my window open and a thin duvet.When I wake up for work the extra redness has done, but I'm sure it can't be helping.Is there any way I can control this? Why does this happen? I'm not on any medication as I recently had an ulcer caused by doxycycline so I had to stop taking them.

Princess_illusion wrote: Hi, I'm not sure why this happens but I always wake up really hot and my face is really red to, it's really uncomfortable!

Froggirl wrote; This is a problem for me too, it seems really hard to do much about. I sleep without many covers, use a chillow and sleep on my back and still find the same thing, if i wake up in the night i find i'm flushed. Laser stopped it for a while but it seems to be back now. There have been so posts on this previously that might be worth looking up, as that's where i first heard about chillows.

Moka wrote; I found that eating close to bedtime time made my face red in the morning, so now I try to stop eating 2-3 hours before bedtime. (and that's hard cause i'm addicted to midnight snacks.
I also found that sleeping with my head lifted a little (so that it is not horizontal) helps a lot. i use a large stiff pillow to supports my head and although at first it wasn't comfortable, now i'm completely used to it.

Scarlett wrote: I have this problem too. I am flushed when I get up. Usually I have a window open in the other room but this problem gets worse when the temps are 70 and above. When I have breakfast and start getting ready for the day I have to have the fans on in my kitchen, BR and everywhere otherwise it will progress.

Flemmo wrote: The last few nights have been terrible. Within 5 minutes of my head hitting the pillow I can feel my nose tingle and the inevitable flush sets in. I've tried 3 pillows, rapid cooling by opening all the windows, taking off the duvet and wearing... not much. If I get out of bed and stand for a while and get cool I can prevent the flushing. However I have to sleep sometime so I'm only delaying it. This is very strange because it doesn't happen at any other time of day. I can lay down at any time and not get any flushing, but when it's bedtime 9/10 times it happens. My nose is a real mess because of it! I might try putting a bag of frozen peas on as soon as I lay down and/or take antihistamines 1 hour before bed?

Scarlett in reply: I have the similar scenario esp after a hot shower. I've been trying to take cooler showers but it is hard for me to do that. I've purchased a few small fans and now right before I sleep I put the fan on till I significantly cool down before sleep. it has helped- still have 20% of the flush but it's not as bad as it used to be. This is a new thing with all of these fans. right now I am so so sick of flushing that I will try to avoid it at all costs.

SoSickofthis wrote: Hey, I used to have this problem also, but I got a fan and put it on the desk right next to my bed. This helps keep me cool through the night, and I usually wake up completely pale. I used to look like a tomato when I woke up. I always put on a moisturizer right before bed and this seems to help keep my skin from drying out.

PA Dancer wrote: When I wake up in the morning my face usually looks "good". It isn't until after I get out of bed, use the bathroom, and have my coffee that the pink starts creeping up on me. Years ago, I would wake up and the first thing I would grab before my glasses would be the tissue box. Miserable allergies. I invested in dust mite covers for my pillows. 100% cotton zipper cases that go on the pillow then the pillow case. I think they were about 5 bucks each at walmart. I started washing all my bedding in ALL Free and Clear laundry detergent. The other thing I would suggest is an air condition for your bedroom and try to stay as cool as you can while you sleep. Every now and then I wake up in a sweat...but I have a feeling it's my hypoglycemia (low blood sugar). I wish you all the best of luck.

Flemmo: Thanks Ann. It's a mystery why it happens. I have the windows open all night. In the past I've been freezing in bed and still flushed like crazy . I'm thinking of ordering one of these pillows to keep me more upright in bed.
-And: Had my 1st treatment with Dr Crouch today and the Gemini laser. He really is a great bloke and very understanding. I asked about my bad night flushes which have spread from the nose to the nose and cheeks. I also told him how I prop myself up in bed because I can feel the blood rushing to my face if I lay flat. He thinks because I have used cooling masks, fans, sprays etc frequently to get rid of the flushing (albeit temporarily) I'm now having rebound flushing. Apparently my vessel 'gates' are swinging from closed (forced with rapid cooling methods) to open - basically they are confused. His advice is to let the flushing run its course and with time, and further treatment, the flushing should stop and that forcing the vessels to contract won’t help. What he says does seem to make sense as I had a feeling unnatural cooling was having negative effects. I've got so worried about flushing in my sleep I keep waking up and checking my face, so I don’t get a good nights and end up flushing badly anyway.

Guest wrote: "I find that during sleep, is the only time i have relief from flushing."

Pro-Inflammatory Cytokines And Sleep

This article mentions how sleep effects Pro-Inflammatory Cytokines and is later discussed by members of the Rosacea Forum in this thread:

-Melissa W responded; Very interesting. So basically too little and too much sleep is bad for you. This is just another mechanism explaining why.  Thanks for all your interesting research articles Kiss From a Rose.

Eric wrote: this is very interesting as sleep has a huge influence on my skin. The common wisdom is that not enough sleep makes our Rosacea worse but i have noticed that when i oversleep my skin can be more sensitive than when i sleep my 'normal' amount. Also, the quality of my sleep is often more important to how my skin will be the next morning than quantity. I think our skin is still subject to stress and mood (and blood sugar changes) when we sleep and that has an impact on our Rosacea. At least it does on mine.

Helpforrosacea wrote: for me, i realized that when i have bad sleeping habits, sleeping very late or too little hours, I wake up with my skin looking like crap. If I sleep enough, my skin wakes up calm and rested. the Chinese believes sleeping late or sleeping too little, creates heat in the body, thus making us red, irritated and angsty and that is esp true for me. Works for me, but no harm trying out if you like!

Freeme3: Thanks helpforrosacea, That does make sense that sleeping too long or too little can wreak havoc on our skin. I especially notice when I do not get ENOUGH sleep that my skin feels more irritated and icky. Interesting how the Chinese believe that bad sleeping habits can create heat in the body. I'm going to research that- I wonder how true that is-- probably very much so! I am glad that it works for you and I am in the process of getting on a better sleep schedule. Remeron was helping me for awhile (I struggle with some insomnia issues)-- I may have to talk to my dr. about upping my dose. Thanks again!

Tmon912 wrote: Ya, you're not alone. I flush at night too and I think that most with rosacea do. The mechanisms/categories for rosacea are not well understood. Maybe the heat makes your veins leak (venous insufficiency). Maybe you have a histamine reaction when laying or touching something with your face. Maybe more SCTE or cathelicidin is produced at night. We don't know. I can tell what's helped me at night: Allegra 180, Boswellia Serrata, white willow bark, omega 3, and QuerCelain. I take those in the morning and at night and they help a lot! Fatty acids (arachidonic acid and LA) sometimes cause inflammation due to the omega 3/6 imbalance (too much omega 6 in or diets due to animal/plant treatment). You can take the Omega 3 pills and apply something like 30% Rosehip/30% Borage/20% Hemp/20% Meadowfoam to your skin topically for that. For leukotreines, prostaglandins, and cytokines you can take something like Boswellia Serrata, White Willow Bark, and Turmeric orally. You can also make serums with White Willow, Ginger, and Licorice root (glabra) for topical use. For histamine you can take Allegra or QuerCelain or Quercetone. For redness relief you can use topically: 5% licorice, 10% azelaic acid (or derivative at 7-8%), 1% hydrocortisone, and "CalmPlex". Maybe you already know all that. Anyways, good luck and keep posting.

Someone asked: W
hen i have a flushing attack, which always occurs when moving from a cool environment to a warm one, the flushing will be intensely burning and bright red for hours. often five to eight hours. However, i have noticed that if i were to take a nap, maybe for only 20 minutes, the flushing would be reduced significantly. Does this make sense?

David Pascoe: "I think this sort of experience is common. Your nervous system and flushing calms down when you are asleep. Unfortunately this is not a viable treatment for whenever you have a flushing episode ....

Judworth wrote: "Sadly, I hurt my back on Monday & have had to sleep laying on my back (I am usually very much a right-hand side sleeper) and since then have noticed that my right cheek is very much paler! I am having considerable sucess with the RLT unit, however from a cosmetic point of view sleeping on my back certainly helps the look of the rosacea on my cheeks! After years of sleeping on my side, maybe lying on my back to sleep needs to be an option. Just a thought!

Mutantfrog wrote: Interesting! Is your right cheek usually redder than your left? I too am a mostly right side sleeper, with some on my back. However my left cheek is almost always worse than my right cheek. Weird. I'm happy for you that it's a positive change, rather than a negative one! smile:

Phlika29: I normally sleep on one side and too have found that this side tends to be redder in general and usually flushed when I wake up. Over the years I have taken to sleeping right on the edge of the pillow with one hand cupped around my ear so that my cheek is not actually touching the pillow.

Mutantfrog: wow ok maybe I'm just a freak! laugh: I wonder why the opposite cheek for me is always worse? I'm right handed--i hold the phone to that side, i rest my head on that side usually when reading...so bizarre...

Mistica: I can't sleep on the sides of my face either due to the same reasons. I have trained myself to sleep on my back, propped up. This can be uncomfortable on a continual basis, but on the bright side ( no pun intended), we should have far less wrinkles than our peers in years to come!

GJ: Do you spend a lot of time driving: your left cheek is perhaps more exposed to heat/light from the driver's side window? Are you prone to many left-sided headaches?
http://jnnp.bmj.com/cgi/content/abstract/53/2/121 Unless you are David Beckham or Monica Belluci the chances are that there is some asymmetry about your face. Are you perhaps inclined to lovingly linger on your fundamentally more comely left side when looking in the mirror? Or, does that increased redness on the left prompt you to attend to it obsessively? A vicious circle!
Certainly, over time, repeated episodes of increased blood flows limited to one cheek might just prompt an appreciable asymmetry in symptoms...Perhaps a tendency to use one side of the brain rather more than the other might have an effect...It might be that blood flowing to the brain does not use facial pathways to get there, but I imagine that once there, it likely spills over from its point of operation. I gather that some think this outdated, fanciful talk but there would be no little worth in the lob-sided rosacean asking whether he's an artist or a sociopath? laugh.

Nat007: I have the same experience as mutantfrog. The side of my face that I sleep on is always less red then the side I don´t sleep on. It also works like this when I turn sides (then the usually redder side get´s paler the next morning). I was thinking that maybe it has to do with the blood in the upright cheek going downwards and staying in the cheek area next to the nose because of this, giving that cheek a more flushed look ??

Solutionquest: Without a doubt sleeping on the back and getting good sleep help with rosacea. It is very hard for me to fall asleep on my back, I am trying to break the habit of curling up. A lot of life is sleeping and dreaming and if you are in positions that do not promote good blood flow than this is not good. I was struggling with getting into good dream cycles and have been taking Melatonin and this helps. It also helps for anyway coming off anxiety drugs. (Benzos) I am convinced more and more that so much of my rosacea is about not getting good relaxed relieving sleep.

Twoface wrote about flushing after taking a nap:, Hej, I am experiencing a strange problem since a while. When i take a nap in the evening because i am tired of work i get a strong flush when i wakeup. It is only when i sleep short 15,30minutes to 3 or 4 hours. when i sleep for 6 hours or more i wake up with only slightly hot face and pale. what is this, i thought of suddenly high histamine distribution because i have also strong heart beat but why isn't it that bad when i sleep until the morning ? or maybe my dust mites allergy but again it should also be a problem in the morning Anyone experiencing the same ? regards

Ohheckyes replied: I do. When I wake up in the morning I find my skin is looking its best, however if I nap in the afternoon I get flushed. The flushing subsides within half an hour. (..) I'm no expert but apparently body temperature rises as the day goes on, and drops when you sleep, but only if that sleep is at the 'correct' time i.e. night. Something to do with the superchiasmatic nucleus (SCN). I guess if you nap during the day then the proper cycle is disrupted and sensitive bodies will protest.

Freeme3 wrote again about this topic here"Does anyone go to bed pretty pale with cool cheeks but wake up hours later (to go to the bathroom) completely flushed and hot cheeks? My face isn't burning but it's all red. It's very cold out, like 17 degrees so my room is cooler. i am snuggled up under my sheets. Could that be a cause or can food affect me hours later? I ate some sugar about 18-24 hrs ago..? For the past few mornings on this no carb, sugar, dairy, wheat diet I am wake up calm looking. Can taking too many ativans cause flushing? I took more yesterday because I felt more stressed (dr. Said I could do so). Can meds make a person flush? Sometimes I find benadryl causes me to be a little more flushy.  Anyone wake up red but get better throughout the day? Wow, this one's RED! I want to add that I never look this flushy in the day.

Dora wrote: maybe you should try a hypoallergenic laundry detergent for your bed linen.

Helpforrosacea wrote: you may be experiencing overheating. When i snuggle under thick blankets i wake up red too. Do the cold treatment. Set the temperature to a suitable one, and don't sleep with thick woolly blankets. Wear socks to warm your feet.  Hope you feel better J

Dryfairskin wrote: I wake up red faced in morning, if my face has been touching pillow, also have eczema on arms which appear redder if i had put pressure on them. Face doesn’t feel hot now but used to feel hot also . Not sure if this is seb derm or rosacea. However after about 15-30 mins redness fades. i think its down to pressure of head or arms against pillows or bed. The book skin fitness by Hugh Molloy is from Australia. he blames modern environments for a lot of skin problems. Don’t think this causes rosacea in my view . However he does complain about duvets causing lots of skin probs as body during night overheats and face to sweat and oil to build up in hair. his solution which may take months is to sleep with a window open and use bed sheets and not a duvet. Initially use
only one sheet and why u may feel cold body will adjust to temp. remember this book is written for Australia were depending what parts you’re in temps in winter could easily be 18 degrees Celsius. I haven’t tried this solution. In part of his book he makes only minimal ref to rosacea in which he says the body overheats and people who rub face in sleep can contribute to this condition.  By the way i sleep on my side, can sleep on my back. i do know if i put less pressure on the pillow face is less red in morning. Also on a side note but slightly related my derm did mention that if you have heat on in the house u should try to have a window up for ventilation. Central heating she says dries the air and reduces moisture in the air and suck moisture from you skin.

Freeme3 wrote: Thanks helpforrosacea! I am noticing with my diet change that i am not waking up as much red. I do sleep with a fan though an my window cracked to get some ventilation and I use a humidifier because the air is so dry. I am also just sleeping with a sheet and thin comforter with socks on my feet. Thanks!

Hula wrote: This might help - just posted on a separate thread about this. Might help you? These cool sheets should help night flushers I would think - they have no naughty fibers to irritate skin too! Let me know if anyone does purchase (they are expensive eek!) and let me know how you go. I'm going to get a pillowcase by them as I htink it would be better for me than the one i have now which I can't let me face touch really. http://www.allergend.com.au/pages.php?pageid=8
Usually i don't wake up red. I sleep with a fan and doona but try not to get too snuggly and hot under the doona e.g. will pull it off me if I am getting too hot!  Hope that helps!

Tarky wrote about his severe flushing during sleep in this thread 

"Hey everyone . Just wondering if anyone has any advice on severe flushing? Every nightaround 12am-2am my face breaks out into a severe heat rash. It usually always starts with the outer right cheek and then spreads throughout my whole cheeks, nose, forehead and ears. It's been doing this for months now and lasts between 5-10 hours every single day. I've tried cutting things out of my diet, not laying down to sleep, spending a few days in different locations (away from home), clonidine, remeron, everything. But every night my face, eyes, and ears burn up and stay that way for hours on end. As a result it's become impossible to sleep due to the heat and i'm really struggling to cope with the pain it's causing me. Would love some advice. thanks for reading."

GJ replied: Aside from all the standard advice that might help with flushing and redness - you know, anti-inflammatory diet, lasers, RLT etc etc - more specifically you might try some melatonin a little while before you intend to sleep. It might help you sleep through it/ diminish the burning a little - it cools the body. As these things go it's pretty good for you - certainly can do no harm - so worth a shot. Trying to fatigue the nervous system with sustained, vigorous exercise in the early evening - not too close to bedtime - might help. It will likely bring on a heavy flush too, but it is likely the lesser of two evils (if it works). Good luck

Alba: The only way i can sleep at night if with a small fan 5" right by my bedside aming directly at my face. unfortunately if i move during the night then the side that is not being hit by the fan will wake me up from the severe flushing/heat on that area. i keep by my pillow a small bottle with water and when woken up by this i start to spray that area with the water until it cools down. yes it wakes me up more but its the only way besides getting up and getting an ice pak which will wake me up more. there are a rare wonderful nights that i dont move and the fan aims great and i sleep straight through the night. but most of the time i am waking up around 4 am but at least i get some sleep not much but better than nothing. Have you tried taking an allergy medicine like zyrtex at times i take the generic brand from the store and it helps me sleep more soundly. on other nights i take a muscle relaxer i alternate they make me sleepy and at times i can sleep through the flushing or im so sound asleep that i don't move and this helps the fan to continuously cool off my face and i sleep good. i can not under any circumstance sleep w/o the fan next to me i have tried with the ceiling fan but no luck the only way is with the fan next to me on top of a chair so it aims correctly at my face. unfortunately i can only sleep facing up or to my left where the fan is at i cant sleep on my right side and my left arm will start to hurt. but i just have to deal with this at least i get some sleep. we do the best we can sleep is just so important. i know we are not suppose to have a fan on our face but its the only way for me to sleep. Good luck i pray you get some rest.

Melissa W.: Tarky, Have you tried the chillow? It might help keeping your face cool and allow you to sleep. I'm sorry you are dealing with this!

Tarky: ok thanks, i haven't tried melatonin, i never knew it cooled the body. Thanks Alba. i try and sleep with a fan on my face too, but it doesn't seem to help prevent the burning episodes from occurring or give any relief during an attack, Hi melissa, i haven't, but i've been laying on cold wet flannels to help combat the heat. It isn't the most comfortable solution though. I haven't really cut anything out, but i eat pretty well. Every night i usually have veges / pasta with either chicken fish / meat and drink water. I never have desert and i don't usually eat a thing up until i go to bed.

JesseC: Well eating healthy is great - especially if it's trying to avoid inflammation (like omega-3s and avoiding sugar), but I wonder if you might want to try eliminating some foods for a couple of weeks. It sounds like a long shot I know but I really achieved a great deal of relief myself from eliminating some pretty common but specific foods. You can read my thread here. It's a pretty easy diet to follow and 2 weeks should tell you if it's working at all. I'd be interested if you have any success should you try it.

Trish: I recommend you get checked for food allergies. I have a corn allergy but it is a delayed response. This makes it very hard to determine exactly what it is you are reacting to. My allergist did a patch test on me and I had a pretty severe reaction to corn. My flushing went away once I stopped eating corn and corn derivatives. I would have never suspected corn! I would not necessarily flush on days I would eat corn, because of the delayed reaction. I could never figure it out on my own. It took seeing an allergy Dr. to do testing.

Ghost: A chillow is a good thing to try. But you can also try having an ice pack handy; the soft kind. It's really good it you place it on top of your head. Wrap it up in something as per instruction, like a bandana. Some come with a sleeve.

Sparrow-legs wrote about waking up flushed here:

"Does anyone else get this? I have been waking up with a pink warm face for the past week or so now. I hate it so much. I don't sleep in a very cold or very warm room, just moderate temperature. I sleep on my back too so it isn't that my cheeks are squashed into the pillow or anything. I can't feel heat or burning sensations, so I'm really confused. I always thought body temp would be fairly low in the morning due to lack of metabolic activity overnight not to mention the cooler temps in the A.M. I'm scared that this will help rosacea progress! Does it happen to you?"

TheMediumdog replied: I get this too. I wouldn't say "flushed", but I would say "warm". If it’s flushed, its really hot, and quite a strong red, and also really uncomfortable, whereas this is more like a deep warmth. I would say that it is just because of the temperature you keep your body when you're in bed. You're not moving around, so, you know, you have to keep the temperature under the duvet/blanket/whatever quite high to not feel cold. There might also be an element to do with lying down (blood to the head), as well as more complicated circadian rhythm stuff. I do find that, unlike other times of the day, it cools down fairly quickly after I get up (15- 30 mins). Whereas if I was that hot later on in the day, it would take a lot longer. Yeah, its probably not great for the rosacea to be like that through the night (although maybe there's a diff. between a true flush and just a constant warmth), but what are you going to do?

Melissa W. replied: Helena, Do you sleep at all elevated - for instance on 2 pillows? I find it helps if I sleep with my head slightly elevated.
Sparrow-legs replied: Hi Melissa, yes i do sleep with 2 pillows at home (which is where i am now).
At uni I sleep with more!

Melissa W: I used to sleep with 3 pillows in college and I remember I went to stay at a friends house and it was like I was committing a horrible crime sleeping with so many pillows LOL. I like sleeping that way Sorry it doesn't help you Helena

Wicked Dish rag replied: I noticed a correlation between my dog sleeping on my bed during the day and waking up flushed. I now try to wash all the bedding if the dog has snuck onto my bed while I was out. Also get a red face in morning if someone used scented detergent on the sheets. I'm personally linking this to my allergies. Yours could of course be a different reason.

I replied: I would also advise you to sleep a bit elevated with your head, so with several pillows. Also, after my rosacea progressed over the years I found that I would in time get more problems with sleeping and my rosacea. At my worst years I spend all day in front of the fan, now I am doing much better and can go through my days without a fan, but I still need it at night: sleeping is the worst trigger for me. So I use a fan, on the lowest speed and proper distance from my face, when I sleep and have some extra pillows. This helps me to stay cool and unflushed during the night and thereby it helps a lot to keep me unflushed during the day. If I wake up flushed at night or in the morning, my blood vessels seem to have a memory for it and stay dilated for most of the day, and this cycle get's worse over time. So I found that staying cool during the night is the best remedy for me. Have a window open, no pets in the bedroom (allergies or other irritating things in the air!!), some extra pillows, don't dress too warmly or have a very thick and warm cover and perhaps even use a small fan for some air circulation. This will probably improve your rosacea and flushing on the long term as well.

And sparrow-legs wrote more about flushing during sleep here

"Hi everyone, I am looking for some advice about sleeping conditions. I've just come to the end of six weeks of absolute hell (university finals). It's been boiling hot here in south west England, I live in an attic room in the student accommodation and the temperature in there is often getting up to 30 degrees C, which is way too hot for me. I wake up very flushed and with bumps and burning skin. Coupled with the awful stress of revision and exams etc. my face looks crap... all this after about 6 months of calm lovely skin! (Calm happy mood, temperate weather, IPLs in Oct 09 and Jan '10). I have a month left here before results come back and the stress starts again (don't think I did as well as I hoped) and I need to restore my skin to a nice state!
My question is, is it OK to sleep with the fan going full blast? When I do this my face looks much better in the morning, but I have read 'the warm room flush' article and know that it isn't good to cool the face for a long period of time because it encourages flushing in warm environments. But to me it seems that this causes far less damage than sleeping in a boiling hot room! If I can keep my skin calm at home it seems I can tolerate hot summer weather outside much better. Any ideas? Thanks"

Melissa W. replied: That's a tough question about the fans and sleeping. I love that warm room flush article and have found it to really help but I do sleep with the house cool as that is how I sleep best. I have altered the conditions though and we do not sleep with it as cold as we used to but it is still pretty cool. So my advice to you is to keep it cool enough where you can sleep comfortably and not wake up with a bumpy burning face but not so cool that it is extreme. Try not to have the fan blow on your face either but instead direct it away from your face and just allow the ambient temp to be cool. Good luck and enjoy your break!

Driven wrote: I'll second that. I always have the AC or a fan going, usually not right at my face, and never have a problem. I just try not to go lower than about 69-70 F (about 20 C?) I think the warm room flush thing is more detrimental if it's very cold, and in your case it probably won't be.

Coldwave wrote about night flushing as well, here; 

"Do many of you find that you flush at night while you're asleep? I really don't understand why this happens. I wake up with my cheeks hot, slightly swollen, and red (especially the left side - my ride side seems to have responded better to my IPL treatments). it wakes me up during the night, and i groggily go to the bathroom and splash cool water on my face, which improves things, but as soon as i lie back down and get comfortable, i feel the uncomfortable sensation of heat beginning in my cheeks it's really prevented me from having a good nights sleep lately! i also just had an IPL so i'm more flushy than usual, so maybe it will get better, but it's still driving me nuts! Any ideas of how i can prevent this, or make it a little better? Currently i sleep with a gentle fan on, and my head propped up. i don't generally eat right before bed."

Alba replied: I live in Miami so you can imagine the heat here. I have to keep my central a/c at night on 74, then i have a floor a/c which keeps my bedroom at 69 temperature and a small fan by my bedside. as long as the fan hits my entire face I´m fine no flushing but as soon as i move during the night i get flushed & feel heat where the fan is not hitting my face. its horrible! I don’t know what it is to get a good night sleep, & this is costing me a lot in my electric bill. I really don’t think it has anything to do with what you eat, of course if you eat spicy things you will get flushed but otherwise its the stupid rosacea. my rosacea flushes when i feel warm go to the movies i have to get a cup with ice so i ice my ears & face during the movie. i cover with concealer on my face but the ears are I can’t cover up. but i guess God forbid there is such other more horrific diseases out there that we are actually blessed just to have rosacea. but i know it is still awful and takes total control of my life at time where I can and cannot go.

And: for me as long as I have the fan blowing towards my face but i have to make sure that it hits my entire face towards the central part of my face where i flush i wake up without flushing/redness on my cheeks. but as i start doing my makeup i start to get red, so in between i stop to have the ac vent on my face and at times when its bad i also have ice pack gels (i have about 6) i put it inside a pillow case and apply on my cheeks so it cools my face and ears and the redness goes away. but I can not sleep without the fan and my room being cool around 70 degrees. My redness is mostly brought on by heat and stress. at work i have a fan but thankfully the a/c in our building is really cold. I have had the opportunity to have a real big office w/a window and instead i stay in my small office w/o a window because it’s the coldest, how sad right? but like i keep telling myself there are so much worse things. at home during the day i keep my a/c around 74 degrees and a cold ice gel pack near me to cool me off when i feel the redness/heat coming on. this past weekend i went to my sister's in Orlando & I took my small fan i bought it at sharper image black/round small i propped it on a chair w/a box point it so it hits my face i sleep mostly on my side so the fan hits my entire face and i slept fine thankfully woke up not red. but i have to make sure my face/cheeks are away from the pillow or i will get red on that spot. if i sleep on my back i have to make sure to position the fan so it hits my face correctly, this is what i do every night but at least it helps me get the best sleep possible.

Froggirl: I have this too, it's winter here and very cold at night and often my face still flushes worst at night than any other time. Laser has helped me more than anything else with this, exactly four weeks after my first v-beam i woke up unflushed for the first time in 6 months and stayed that way. It started getting it again but another laser treatment has cut it right down again for the moment. Other things that have helped me are, sleeping with the least bedding possible (so i don't overheat), using a chillow when the weathers at all warm and sleeping on my back. And i'm always at the movies with a giant cup of ice too!

Flemmo wrote: I have this problem too. Still looking for a solution. I've stopped using fans and forced cooling and the night flushes are a little better. I think I get bad rebound flushing after using fans etc

Vesna replied: I also have night-time flushing a lot, especially during flare ups. Things which help me most of the time (nothing helps for 5-6 days during a flare up): Keeping the bedroom very cool - w/central AC, pop-in window unit and a small fan blowing at my face. Sleeping on two pillows. Walks outside (when it's cool) immediately prior to bed-time. Not eating supper after 6 p.m.  Icing my face prior to laying down and keeping an ice-cold gel pack next to me. Taking Bendaryl two hours before going to sleep. Hope this helps!

Kate812 wrote here"Recently I've found that I've been flushing badly when I sleep - I'll often wake up with a really red pulsating cheek (the side I have been lying on). When i put my cover-up on in the morning I always find the cheek that has flushed the most is also really flaky which looks awful - I feel like I have facial dandruff (I have seb derm as well but this flakiness seems more connected with the flushing). I'm having difficulties sleeping, as I can no longer sleep on my side (my natural position) and I find lying on my back uncomfortable. The fear of flushing also keeps waking me up and whenever I wake up I always want to feel my face to see how bad it's getting. Does anyone else have this problem? This is really affecting me as it means I'm constantly tired throughout the day, and I'm sure tiredness makes my flushing worse. Even if I have a short nap during the day it sets my rosacea off. Just wanted to vent really, but if anyone has any advice it would be much appreciated!

Melissa W: I sometimes have that problem when my skin is extra sensitive. I would suggest you make sure your skin is well moisturized and be very gentle with any products you use. Also, try to keep the temp cooler in the bedroom and try to find a very soft pillow case. I sleep on my side also and usually I sleep with my hands between me and my face so my face isn't rubbing anything. I hope you find something that works for you. This looks like a great idea!

Lookout wrote: Just some thoughts I have on this....when I was dx hypothyroid I read lots about how this all worked...lead to reading about adrenal glands also and so on. How is this related to your experience you are thinking....well when we sleep our cortisol production is at it's lowest....when we are nearing wake up...the adrenals begin to secrete a higher level of cortisol thus the awful morning flush. Now if your system is working normally your cortisol is highest in the am and begins to tapper down thru out the day until bed where it should be about nil. I think there is a link between the flushing we experience and our cortisol levels. I took progesterone cream under my docs advice about 1 yr ago....progesterone converts to cortisol...within 6wks my face was flushing almost constantly...swelled up and blood red...p &p's came roaring back. So I had everything rechecked... Progesterone was in the thousands (as it stores in the body's fat cells for 6mo's.) and my cortisol was double the norm almost borderline Cushings syndrome levels! 
Now factor in the anxiety we experience having rosacea and flushing...this cycle promote the increase of the stress hormone cortisol...hence the vicisous cycle escalates....over and over and over. Use the suggestions others are recommending...but stopping the anxiety that produces the surges in cortisol is key to stopping flushing IMO. I won't go into the depth of this...I have spent the last yr reading so much material it makes my head spin on adrenals, pituitary gland, adrenal gland and sex hormones! I am not saying that in everyone’s case to much cortisol is the reason one has rosacea but believe me it will cause a sub type 1 to turn into a sub 3 in no time...I never understood this 10yrs ago. I would wake up like you all night....face just boiling on one side....and I was in an almost constant state of anxiety....now I understand what was happening and how it was worsening my rosacea by leaps and bounds. HTH...I am not trying to confuse anyone just shed some light with info I have learned from my experience."

About flushing being worse on one side and the connection with sleeping people posted as well:

Betty wrote: Rosacea worse on one side. How many people here suffer from a cheek that is significantly worse with Rosacea than the other cheek? My right cheek seems to be progressing quite a bit and I can only put this down to getting this side sunburnt (not too badly) 6 years ago. I am getting really cheesed off with a fat, red, shiny, blotchy cheek that is so painful, sensitive, flushes independently and is so different to the left side.

Twickle Purple wrote: I have one side redder than the other, some days it is really pronounced. Someone here commented that perhaps it may correspond to which side we sleep on. I know I sleep on my right side most and it is my right side that is more affected. Maybe it is that simple?

Windsor90 wrote: I thought I'd mention this again because it unexpectedly helped me:
I use one of those contoured, memory foam pillows because of neck problems. It keeps me from sleeping on my stomach, which is what I prefer. What I didn't expect is that being forced to sleep on my back has improved the side of my face that is usually more red. When I sleep on my stomach, I always sleep on the same side. That's the side that used to be "redder" than the other. It certainly can't hurt to try out one of these contoured pillows. It takes a few days to get used to it, but once you do it's hard to use a regular pillow again.

Moomy wrote: Hi there, I am much worse on one side that the other. I wondered if it was because of sun damage whilst driving.

PA Dancer wrote: My left cheek is worse than my right for sure. I sleep on my right side, and I once had a hair stylist tell me my hair was thicker on the right. Interesting idea with the left being the drivers side. That makes sense.

Firefly wrote: My left cheek is not that worse but the blush is bigger up to my forehead where the redness on the right cheek is just on the cheek. I am convinced that squeezing pimples - which I used to do all the time - has something to do with it. I have a 'lazy' right eye with almost no sight so no squeezing on my upper right cheek...

Betty wrote: I've trained myself to sleep on my left 'good' side as sleeping on the right only makes the problem worse. At first I put a huge hair clip on the right side of my head, so that if I rolled over accidentally whilst asleep it would dig into my head and wake me up. Now I don't need the clip as I never roll onto the right. I can't actually get to sleep on my back. As the right cheek is the side that drivers in the UK have exposed to the sun and the left elsewhere, it would be interesting to see how peoples 'worse side' corresponds to which side they drive. I feel comforted that other people have some asymmetry with their Rosacea.

Moka wrote: I also have some difference between my cheeks. the left is more prone to dryness, itching and redness, and the right one is more prone to breakouts. I used to sleep on my left side for many years but when it started to get flushed and red i switched to sleeping on my right cheek which caused more breakouts on it. Now (for over a year) i sleep on my back. it took me a long time to train myself to stay on my back for the entire night, but it really improved the irritation and breakouts. I find that fabrics really irritate my skin and when my face has nothing but air around it during the night it stays very calm. who would have thought sleeping would involve so many considerations? I miss the days when sleeping just meat putting my head on the pillow (which ever way i want) and pulling the blanket over my head... :?

Barbara: The flushing on my right cheek is more intense and takes more space (down to the jaw) than on my left. When my rosacea started I only flushed on my right cheek for a some time until my left cheek thought it had to give the other cheek some company. Directly after IPL treatments my right cheek is also much more red than the left one.

Liam: My left cheek is worse than my right: it is/was redder, had a few pimple-like break outs, and was more prone to being dry. My derm told me that it can be common for one's left cheek to be worse due to continued sun exposure to that cheek's being closer to the window (and therefore, the sun's rays) while driving (at least, here in the US).

Nzboy: My right cheek is much worse than my left. Probably about 30% worse. It is redder, and covers about a 25% greater area. This is the side I have slept on since I was a kid, and i'm convinced that is why it is the worse side. I try and fall asleep on my back or left side, but always wake up on my right side with my right cheek burried against the pillow When I wake on my right side, if i touch my right cheek it is always burning, whereas my left one is usually cold and not very red. On the odd occasion I wake up on my left side this is not the case. It makes logical sense that the cheek pressed against the pillow will generate much more heat, and therefore cause more damage to blood vessels than the other cheek.

Nat007: I too have one cheek (right) that is worse than the other. BUT, I have exact the opposite to many who wrote here, and it startles me still: the cheek that I sleep on is always more pale then the one I don't sleep on! I found out on holiday. I always sleep on my left cheek normally, but on that holiday I had to sleep on the right one, to get close to the open window and the fan there. All of that week, my flushing had turned around! So my left cheek was flushing much more all of the sudden. It changed to the old situation again at home. I was thinking, that perhaps the cheek I don't sleep on, that is pointed upwards, 'collects' the extra blood in the blood vessels near the nose area, whereas the cheek I sleep on has the blood drawn away to the ear and further down. I'm not sure that it makes sense, but it is always the inner cheek area of the unslept cheek that is worse for me. Also, I have chronic inflammation of the cartilage of my right ear since some years and it definitely drives up the flushing on the right cheek for me...Annoying! It happens often that I get up an about in town in the morning and have one pale cheek and one bright red one. Looks so odd!

Conclusion (as far as we can make any):

A good night's sleep is important, especially when you are dealing with rosacea. I used to have a lot of bad nights, where I flushed a lot and got up often to cool down, grab a cold pack from the fridge or just lie awake, but nowadays it is rare for me to wake up flushed at night. What has helped me most is to firstly sleep a bit elevated with my head, so with several pillows. It also helps me to not overheat at night, so no heavy warm PJ's, no thick heavy duvets, but layers of bed linen. Your face is the main skin surface that sticks out of the bed, so when your body gets very warm, the release of heat happens mostly through the face (and in our case through dilated blood vessels in the face area). I also use a fan, on the lowest speed and at a decent distance to avoid rebound flaring, but enough to have a gentle breeze. Also try to keep the bedroom cool, windows open or use of airconditioning in summer. But don't make it too cold in winter, because that can trigger a rosacea flare too. Also helpful for some people; no pets in the bed room (due to allergies or irritants circulating in the air) and washing your bed linen at least once a week, ideally with perfume free and hypo-allergenic washing detergent can also help. I change my pillow cases twice a week. Some people also saw improvement from buying special dust mite allergy covers for their pillows and bed linen. Others have relief from a chillow pillow.

What helped me most is starting to take anti flushing medication (for me, clonidine, propranolol and mirtazapine + an antihistamine (Xyzal, 20 mg a day) - that has helped me most to reduce night time flushing. I used to wake up so flushed at night or in the morning, that my blood vessels seemed to have developed a memory for it and stay dilated for most of the day, and this cycle got worse over time. Changing my sleeping modus and taking anti flushing medication has reduced this, I now am unflushed and non burning about 90% of the time at night. You can read more about anti flushing and anti redness medication in this blog post.

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