PRP Survival Guide


Issues related to sleep and sleep deprivation

The PRP Survival Guide is a repository of experiences and insights shared by PRP patients and their caregivers. Collectively, the PRP community possesses a wealth of practical knowledge about pityriasis rubra pilaris. We need to harvest that knowledge for those in need of enlightenment.
Share what you have learned about PRP as a patient or caregiver. Share what you have been told by your dermatologist? Share articles  you feel might be worth reading or websites worth visiting. Whenever you have information to share, please use “Leave a Reply” at the end of this webpage.


Bill M — Plano, Texas
PRP is such a fickled disease. There are PRP patients who would love to sleep 8 to 10 hours at night but can only manage 4. Here is what worked for me. Please use “Leave a Reply” at the bottom of this webpage to share what worked for you.


During the first two months after onset — when my first dermatologist was convinced I had seborrheic dermatitis — I was told to sleep in DAMP long johns after having slathered my entire body with triamcinolone OINTMENT. There were nights that I never fell asleep.
The only benefit of that experience with OINTMENT was to tell my third dermatologist I wanted triamcinolone cream. He told me that the ointment was more effective than the cream. I told him, “I don’t give a rat’s a##. Prescribe cream.
That was the first time and only time I ever needed to “pull rank” on my dermatologist. I learned that a patient does not have to be a lemming. Articulate a reason and defend your position. Ask “Why?”


It took me MONTHS to find the right nighttime regime to virtually guarantee a good night’s sleep from 11 PM to 7 AM.
(1) drugs (hydroxyzine, Ambien® and Extra Tylenol®,
(2) an EXHAUSTING evening shower and total body slathering of topicals, and
(3) the use of appropriate covering on feet (plastic bags over which I wore non-skid socks) and hands (nitrile gloves).
IMPORTANT — But there was a fourth rule that could not be broken: NO liquids after 9 PM. If you quench your thirst at 11 PM, your bladder will set the alarm in your brain for 3 AM.

On the Subject of Naps
Murray Rose, British Columbia. Canada
Posted: April 17, 2022
Tired all the time? Need to take a nap? I did.Here is some interesting information about sleep and naps.
Are naps helpful?
Your eyes get heavy and gradually… close… But wait! It’s only lunchtime and you still have so much to do. Would taking a nap help? Or would it derail your day?
Our sleep, both at night and in naps, is made up of approximately 90 minute sleep cycles with four stages each. A nap can last anywhere from five minutes to three hours, so it can include full sleep cycles or just a few stages.
As you fall asleep, you enter
  • Stage 1: the first two to five minutes of sleep.
  • Stage 2 comes next, for about 30 minutes. In Stage 2, body temperature drops, muscles relax, and breathing and heart rate become more regular. Your neurons start to fire in unison, creating waves of activity that sweep across the cortex, punctuated by rapid bursts of neural activity called sleep spindles.
  • As you enter Stage 3, or slow wave sleep, the rolling waves increase as your neurons fire in coordination. This phase lasts about 20 to 30 minutes and is where your deepest sleep occurs. Then, you enter REM sleep, which lasts about 10 to 20 minutes in a nap. In REM, the brain becomes more active, more like your brain activity while awake. The end of REM signals the completion of a sleep cycle.
OK, but will a nap make you feel better? Well, that depends on a few things— especially what stages of sleep the nap includes.
Take a 30 minute nap, which consists mainly of Stage 2 sleep. Stage 2 sleep is associated with long-term potentiation, a process that’s thought to strengthen the synapses between neurons, which is essential for learning. A 20 to 30 minute nap stops short of Stage 3′s deep sleep, making it relatively easy to wake up from.
A 30 to 60 minute nap, meanwhile, has the benefits of Stage 2 sleep and also takes you into the deeper sleep of Stage 3. During Stage 3, multiple brain areas work together to transfer information from short-term memory storage to long-term storage, stabilizing and strengthening long-term memory by coupling sleep spindles with slow waves.
Stage 3 is the most difficult stage to wake up from. So while a 30 to 60 minute nap can have cognitive benefits, those benefits often don’t kick in until about 15 minutes after waking up.
60 to 90 minute naps enter the REM stage. While in REM, the prefrontal cortex, which is largely responsible for inhibition and cognitive control, becomes much less active. Meanwhile, the amygdala and cingulate cortex, regions associated with emotion and motivation, are highly active. Researchers have posited that the combination of these things leads to bizarre dreams during REM sleep: the decrease in inhibition and cognitive control might lead to wild associations— and, thanks to the amygdala and cingulate cortex activity, those associations can be between emotionally charged topics. Some researchers think this stage might help us make innovative connections between ideas upon waking. Because the brain activity during REM is closer to waking, it may be easier to wake up from REM than Stage 3, even though the nap is longer.
The time of day also matters. Our need for deep Stage 3 sleep progressively increases throughout the day. So if you nap later, you may rob yourself of the sleep pressure needed to go to sleep at night. This doesn’t happen for REM sleep. Longer periods of REM occur during morning hours, so morning naps are dominated by REM, midday naps have about equal parts of REM and deep sleep, and evening naps contain more deep sleep.
On top of all this, it seems that we’re just about evenly split between nappers and non-nappers. Nappers consistently show cognitive benefits from napping, but non-nappers may not. Researchers think this could be because nappers are able to stay in a lighter sleep and move through sleep stages more easily. Meanwhile, non-nappers may experience more deep sleep while napping, making them groggy afterward. So will a nap help? Well, there’s only one way to find out…

Gary R – Port Perry, Ontario, Canada, initiated a discussion about sleep on March 14, 2017 that is available to members of the PRP Facebook Support Group. Members of the PRP Facebook Support Group may ACCESS POST HERE.

Am I the only one who can sleep 10-12 hours? I’ve never slept like this before. I take a Hydroxyzine tablet before bed for the itching, but I can’t see it helping me sleep that long. I used to sleep 6-7 hours, and once my eyes were open, I was up! Now, once my eyes are open, I roll over and go back to sleep! LOL

Third-Party Websites

The New Yorker: The Secrets of Sleep; Author: Jerome Groopman, October 16, 2017

BBC News: How much can an extra hour’s sleep change you?

October 9, 2013: The average Briton gets six-and-a-half hours’ sleep a night, according to the Sleep Council. Read about an unusual experiment to see if this is enough.