Living with hidradenitis suppurativa (HS) creates daily challenges that extend far beyond your waking hours. This chronic skin condition causes painful bumps and inflammation in areas where skin rubs together, making it difficult to find comfortable sleep positions.

Many people with HS struggle to get quality rest because of throbbing pain, skin irritation, and worry about flare-ups. Poor sleep then creates a harmful cycle where exhaustion weakens your body’s ability to heal and fight inflammation.

The good news is that you can take specific steps to improve your sleep quality, even during active HS flare-ups. Simple changes to your sleep environment, bedtime routine, and pain management strategies can help you rest better and wake up feeling more refreshed.

Better sleep supports your overall health and gives your body the energy it needs to manage HS symptoms more effectively. Read more to learn proven strategies that can transform your nights from painful and restless to comfortable and restorative.

What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa



or
acne inversa



is a chronic
inflammatory



condition that
creates



painful bumps,
cysts



, and
tunnels




under



your skin in areas where skin touches skin, due to blocked hair follicles. These areas include your armpits, groin, buttocks, and under your breasts.

The condition causes throbbing pain that can make simple activities like sitting, walking, or raising your arms difficult. HS
also produces



drainage and odor that can make you feel embarrassed or self-conscious around others.

Many people with HS find that tight clothing irritates their skin and makes symptoms worse throughout the day. The unpredictable nature of flare-ups means you never know when new painful spots will appear.

This constant uncertainty affects your ability to make plans and enjoy activities you used to love. HS impacts not just your physical comfort but also your emotional well-being and confidence.

How HS Impacts Sleep?

HS affects your sleep in multiple ways that go beyond just physical discomfort. Understanding these sleep disruptors helps you identify what to address for better rest.

Recognize physical pain that keeps you awake

The throbbing, burning pain from HS lesions becomes more noticeable when you lie down and try to relax. Your body naturally focuses more on pain signals when you’re not distracted by daily activities.

Inflamed bumps and cysts create constant pressure and tenderness that makes it hard to find any comfortable position. The pain often pulses with your heartbeat, creating a rhythmic discomfort that keeps your mind alert.

Fresh lesions hurt more intensely at night because lying down increases blood flow to affected areas. Even healed areas can ache and feel sore when pressure from your mattress or pillows touches them.

The unpredictable nature of HS pain means you never know which nights will be particularly difficult. This constant battle with pain leaves you exhausted but unable to fall into the deep sleep your body needs to heal.

Understand how stress and worry affect your rest

Anxiety about your HS symptoms creates mental tension that makes falling asleep much harder. You may find yourself lying in bed worrying about when the next flare-up will happen or how bad it might get.

Fear of pain can make you tense up your muscles, which actually increases discomfort and makes relaxation impossible. Embarrassment about drainage, odor, or appearance can cause racing thoughts that keep your mind active when it should be winding down.

Financial stress from medical bills and missed work days adds another layer of worry that disrupts sleep. Social anxiety about how others perceive your condition can create persistent mental chatter at bedtime.

The uncertainty of living with a chronic condition makes it difficult to feel calm and secure enough for quality rest. This emotional burden often proves just as disruptive to sleep as the physical symptoms themselves.

Identify sleep positions that make symptoms worse

Sleeping on your side can put painful pressure on lesions in your armpits or under your arms. Lying on your back may worsen symptoms in your groin area or cause discomfort if you have lesions on your buttocks.

Rolling onto your stomach can irritate chest and underarm areas while making it harder to breathe comfortably. Curling up in a fetal position brings your thighs together, creating friction that can worsen groin symptoms.

Sleeping with your arms down by your sides can cause skin-to-skin contact that increases irritation in armpit areas. Tight sleep positions that compress affected areas reduce air circulation and trap moisture against your skin.

Even seemingly comfortable positions can become painful after a few hours when pressure builds up on sensitive spots. Learning to identify these problematic positions helps you make better choices for pain-free sleep.

Good sleep helps manage HS symptoms

Quality sleep gives your body the time and energy it needs to heal damaged skin and fight inflammation. During deep sleep, your body releases growth hormones that help repair tissues and reduce swelling in affected areas.

Good rest also strengthens your immune system, which helps your body better manage the inflammatory processes that drive HS symptoms. When you sleep well, you handle stress more effectively, and stress reduction can help prevent new flare-ups.

Adequate rest improves your pain tolerance, making existing symptoms feel less intense and easier to manage. Sleep also helps balance hormones that affect inflammation and skin health throughout your body.

Getting enough quality sleep gives you more energy to maintain proper skin care routines and make healthy lifestyle choices. Better sleep creates a positive cycle where improved rest leads to better symptom management and overall health.

Sleeping Better During Flare-Ups?

Active HS flare-ups don’t have to destroy your sleep completely. These practical strategies help you find comfort and rest even when symptoms feel overwhelming.

Use Smart Positioning to Reduce Friction

Smart body positioning protects your sensitive areas from painful contact and pressure while you sleep. The key is creating space between skin surfaces that usually touch and rub together.

• Place body pillows between your thighs – A firm body pillow between your legs stops your inner thighs from touching and reduces friction that can make existing bumps worse or create new irritation.
• Sleep with your arms positioned overhead – Raising your arms above your head opens up your armpit area, lets air flow around inflamed spots, and reduces pressure on painful bumps.
• Find comfortable positions for affected areas – Each person with HS needs different positioning solutions, so use pillows to elevate areas with active bumps and create spaces around painful spots.

These positioning techniques work immediately and can dramatically improve your sleep quality. Try different combinations to find what works best for your specific symptoms and affected areas.

Protect Your Skin While You Sleep

Proper skin protection during sleep stops further damage and creates a barrier against friction and moisture. The right dressings and techniques can make you much more comfortable throughout the night.

• Apply gentle, absorbent wound dressings – Choose soft, breathable dressings that soak up drainage without sticking to your skin, and look for non-stick pads that won’t tear delicate tissue when you remove them.
• Choose soft cloth tapes – Soft cloth
  tapes
  
  
  
  hold dressings in place without irritating your skin, and they stretch with your body movement without pulling on sensitive areas.
• Prevent fluid buildup and skin irritation – Good drainage management keeps your skin dry and reduces infection risk by positioning yourself so gravity helps drain fluid away from affected areas.

These protection methods work together to create a safe barrier between your skin and bedding. Start with clean, dry skin each night and change dressings as needed to maintain effective protection.

How Healthcare Providers Can Help?

Your healthcare team plays a vital role in helping you manage both HS symptoms and sleep problems effectively. Open communication about your sleep challenges can lead to better treatment options and improved quality of life.

When to talk to your doctor about sleep problems

Schedule an appointment with your doctor if you regularly struggle to fall asleep or stay asleep for more than two weeks. Discuss how HS pain affects your sleep quality and whether current treatments are providing adequate nighttime relief.

Bring up sleep issues if you notice your HS symptoms getting worse, as poor sleep can trigger more frequent flare-ups. Your doctor can adjust your treatment plan or refer you to sleep specialists who understand chronic pain conditions.

Discussing pain management options

Talk openly with your healthcare provider about your current
pain levels



and how they affect your ability to sleep. Ask about prescription pain medications that might provide better nighttime relief without causing morning drowsiness.

Explore topical treatments, oral medications, or injection therapies that could reduce inflammation and pain during sleep hours. Work together to find pain management strategies that fit your lifestyle and don’t interfere with other aspects of your health.

Exploring HS treatment plans that improve sleep

Discuss how different HS treatments might specifically impact your sleep quality and nighttime comfort. Ask about newer therapies like biologics that could reduce overall inflammation and lead to fewer painful flare-ups.

Consider timing your current treatments to maximize their effectiveness during your most difficult sleep hours. Work with your doctor to create a comprehensive treatment plan that addresses both daytime symptom management and nighttime sleep quality.

Recognizing signs of sleep disorders

Sleep disorders occur more frequently in people with chronic conditions like HS, making professional evaluation important for your overall health.

Understanding the link between HS and sleep apnea

People with HS
face



higher risks for developing sleep apnea due to chronic inflammation and potential weight gain from reduced activity levels.

Sleep apnea causes frequent breathing interruptions during sleep, leading to poor sleep quality and daytime fatigue that can worsen HS symptoms. The chronic inflammation from HS may contribute to airway inflammation and breathing problems during sleep.

If you snore loudly, wake up gasping, or feel exhausted despite spending adequate time in bed, discuss sleep apnea screening with your doctor.

When to seek professional sleep evaluation

Contact a sleep specialist if you experience persistent insomnia, excessive daytime sleepiness, or loud snoring that concerns your sleep partner.

Seek evaluation if you stop breathing during sleep, have restless legs, or experience vivid nightmares related to your HS condition. Consider professional help if sleep problems continue despite following good sleep hygiene and managing your HS symptoms effectively.

Early intervention for sleep disorders can prevent additional health complications and improve your HS management.

Treatment options for sleep disorders

Sleep disorder treatments range from lifestyle changes and oral appliances to CPAP machines for sleep apnea patients. Many treatments can be adjusted to accommodate HS symptoms, such as using special mask cushions that don’t irritate facial lesions.

Cognitive behavioral therapy for insomnia helps people with chronic pain develop better sleep habits and manage bedtime anxiety. Work with sleep specialists who understand chronic conditions to find treatments that address both your sleep disorder and HS symptoms.

Create Your Sleep-Friendly Environment

Your bedroom environment plays a crucial role in managing HS symptoms and getting quality rest. Creating the ideal sleep space helps your body relax and reduces factors that could worsen your HS symptoms during the night.

Keep your room cool and comfortable

A cool bedroom temperature between 65-68°F helps reduce sweating and keeps affected areas dry throughout the night. Use fans, air conditioning, or open windows to maintain good air circulation around your bed.

Avoid heavy blankets that trap heat and moisture against your skin. Cool, dry air helps painful areas feel less inflamed and reduces the risk of new bacterial infections.

Block out light and reduce noise

Use blackout curtains or eye masks to eliminate light that can disrupt your sleep cycles. Create a quiet environment with earplugs, white noise machines, or soft background sounds to mask disruptive noises.

Position your bed away from high-traffic areas where footsteps or conversations might wake you. A dark, quiet room helps you fall asleep faster and stay in deeper sleep stages longer.

Choose the right mattress and pillows

A medium-firm mattress provides support without creating excessive pressure on sensitive areas. Memory foam or latex mattresses contour to your body while providing consistent support for painful areas.

Use multiple pillows of different firmness levels to create custom support for affected areas. Invest in quality sleep surfaces since proper support directly affects your symptom management.

Pick the best sleepwear and bedding

The right fabrics and clothing choices create a barrier between your skin and potential irritants while allowing your body to breathe and heal.

Wear loose-fitting, breathable clothes

Choose pajamas with plenty of room around areas where you typically experience HS symptoms. Avoid tight elastic bands that can cut into your skin and restrict circulation.

Select sleepwear with flat seams or seamless construction to eliminate rough edges that might irritate those sleeping with sensitive skin. Proper fit allows air to circulate around your skin and gives you freedom of movement without pain.

Select soft fabrics that prevent friction

Natural, breathable fabrics like cotton, bamboo, or modal wick moisture away from your skin and feel gentle against sensitive areas. Avoid synthetic materials that can trap heat and moisture against your body.

Wash new sleepwear several times before wearing to remove manufacturing chemicals and soften the fabric. Soft, natural materials create a protective layer while allowing your body to regulate temperature naturally.

Choose easy-to-wash bedding materials

Select sheets and pillowcases that can withstand frequent washing in hot water to remove bacteria and drainage stains. Cotton or linen sheets are durable, breathable, and get softer with each wash cycle.

Keep multiple sets of sheets so you can change them immediately when they become soiled during the night. Easy-care fabrics reduce the burden of maintaining clean sleep surfaces and help you keep your bed fresh and hygienic.

What About Long-Term Strategies?

Sustainable sleep improvement with HS requires consistent daily habits and strong support systems. These long-term strategies help you maintain progress and adapt to changes in your condition over time.

Developing a consistent bedtime routine

A predictable bedtime routine signals your body that sleep time is approaching and helps you manage HS care tasks efficiently. Following the same steps each night trains your body to expect sleep and makes caring for your skin feel automatic.

• Practice gentle evening skin care – Cleanse affected areas with a mild, non-soap cleanser and lukewarm water to remove bacteria and debris, then pat your skin dry gently with a clean towel.
• Apply dressings as part of your routine – Make dressing changes a regular part of your bedtime routine by applying fresh, clean dressings to all active bumps before getting into bed each night.
• Time your routine for best results – Start your bedtime routine 60-90 minutes before you want to fall asleep so you have enough time for all care tasks and treatments to dry properly.

Managing stress before bedtime

Stress management becomes crucial for people with HS since emotional tension can worsen symptoms and make sleep more difficult. Learning to calm your mind and body before bed helps break the cycle of worry and pain that keeps you awake.

• Practice deep breathing exercises – Use simple breathing techniques like inhaling for four counts, holding for four counts, and exhaling for six counts to quiet racing thoughts about HS symptoms or daily worries.
• Try simple mental relaxation techniques – Start with just 5-10 minutes of quiet focus on peaceful imagery or positive thoughts to help break the cycle of worry and pain that keeps your mind active.
• Do gentle stretching – Choose slow, gentle movements that don’t put pressure on affected areas while releasing tension in your neck, shoulders, and back from daily stress.

Trying natural pain relief before bedtime

Natural pain management techniques can reduce discomfort without interfering with your sleep or causing side effects. These gentle methods work best when you use them consistently as part of your bedtime routine.

• Apply warm compresses to painful areas – Gentle heat increases blood flow to affected areas and helps reduce inflammation and pain by using a clean, damp washcloth warmed with comfortably hot water for 10-15 minutes before bed.
• Time your pain relief for best results – Start your pain management activities 30-60 minutes before you want to fall asleep so the relief lasts through your most difficult sleep hours.
• Use gentle techniques that won’t irritate skin – Choose pain relief methods that soothe without causing additional trauma to sensitive areas, and avoid rubbing or applying pressure to inflamed bumps.

These natural techniques help your body relax and prepare for sleep while reducing pain safely. Combine multiple gentle methods for better overall pain control that lasts throughout the night.

Maintaining daily skin care routines

Consistent skin care prevents new flare-ups and supports better sleep by keeping your skin healthy and less prone to painful inflammation.

• Using non-soap cleansers gently – Cleanse affected areas daily with mild, pH-balanced cleansers that won’t strip your skin’s natural protective barrier.
• Building habits that support skin health – Develop morning and evening skin routines that include gentle cleansing, moisturizing, and applying treatments at consistent times each day.
• Preventing new flare-ups through care – Follow your dermatologist’s recommendations for daily skin care to reduce the frequency and severity of painful outbreaks that disrupt sleep.

Tracking your sleep and symptoms

Monitoring patterns in your sleep and HS symptoms helps you identify triggers and effective treatments for better long-term management.

• Keeping a sleep diary – Record your bedtime, wake time, sleep quality, and pain levels each day. Keeping a sleep diary helps identify patterns and improvements over time.
• Noting what helps and what makes things worse – Track which sleep positions, treatments, stress levels, and environmental factors affect your sleep quality and HS symptoms.
• Sharing information with your healthcare team – Bring your sleep and symptom records to medical appointments to help doctors make informed treatment decisions and adjustments.

Choosing foods and drinks that help sleep

Your evening food and drink choices can either support restful sleep or create additional barriers to getting quality rest. Making smart choices about what you consume before bed helps your body prepare for healing sleep.

• Avoid caffeine – Stop consuming caffeine at least 6 hours before bedtime since it stays in your system and interferes with deep sleep.
• Pick sleep-promoting snacks – Choose light bedtime snacks with natural sleep-supporting nutrients like turkey, bananas, or warm milk if you’re hungry before bed, and avoid heavy or spicy foods that might cause indigestion.
• Stay hydrated without disrupting sleep – Drink enough water throughout the day to stay hydrated for sleep but reduce fluid intake 2-3 hours before bedtime to avoid bathroom trips that interrupt sleep.

These dietary choices support your body’s natural sleep processes and help manage inflammation more effectively. Planning your evening eating and drinking schedule helps ensure better rest without uncomfortable interruptions.

Building a support system

Strong support networks provide emotional encouragement and practical advice for managing both HS and sleep challenges effectively.

• Connecting with others who understand HS – Join local or online support groups where you can share experiences and learn strategies from people facing similar sleep challenges.
• Getting family support for your sleep needs – Educate family members about HS and ask for their help in maintaining quiet, comfortable sleep environments and understanding your bedtime routines.
• Finding online communities and resources – Access reputable HS organizations, forums, and educational websites that provide current information about sleep management and treatment options.

FAQs

Can I sleep on my side if I have HS lesions in my armpits?

Sleeping on your side with armpit lesions can be challenging, but it’s possible with the right positioning techniques.

Try sleeping with your affected arm raised above your head or resting on a pillow to open up the armpit area and reduce skin-to-skin contact.

You can also sleep on the unaffected side and use pillows to support your body so you don’t roll onto painful areas during the night.

If both armpits are affected, consider sleeping on your back with your arms positioned away from your sides to allow air circulation around the inflamed areas.

How often should I change my wound dressings at night?

Change your wound dressings every night before bed as part of your bedtime routine to start with clean, dry protection.

If dressings become saturated with drainage during the night and wake you up, change them immediately to prevent moisture from irritating your skin.

Keep extra supplies on your nightstand so you can quickly change wet dressings without having to get out of bed and fully wake up.

Most people find that high-quality, absorbent dressings last through the night, but heavy drainage may require middle-of-the-night changes.

What type of mattress works best for people with HS?

A medium-firm mattress typically works best because it provides support without creating excessive pressure on sensitive areas affected by HS.

Memory foam mattresses can be particularly helpful as they contour to your body shape and distribute weight evenly, reducing pressure points on painful lesions.

Avoid mattresses that are too soft and cause you to sink in, as this can increase friction between skin surfaces and worsen symptoms.

Consider mattress toppers or overlays if you can’t replace your current mattress but need better pressure relief for affected areas.

Is it normal for HS pain to feel worse at night?

Yes, many people with HS experience increased pain at night because lying down can increase blood flow to affected areas and make inflammation more noticeable.

When you’re not distracted by daily activities, your brain naturally focuses more on pain signals, making discomfort feel more intense.

The pressure from lying on mattresses and pillows can also aggravate tender lesions that felt manageable during the day. Plus, stress and worry about sleep often build up at bedtime, which can increase your perception of pain and make symptoms feel worse.

Can certain foods before bed make my HS symptoms worse overnight?

Spicy, acidic, or heavily processed foods eaten close to bedtime can potentially trigger inflammation and worsen HS symptoms during sleep.

Foods high in sugar or refined carbohydrates may also contribute to inflammation that affects your comfort level throughout the night.

Caffeine can disrupt your sleep cycles and interfere with your body’s natural healing processes during rest.

Stick to light, anti-inflammatory snacks if you’re hungry before bed, and avoid eating large meals within 2-3 hours of your planned sleep time.

Should I wake up my partner when I need to change positions due to pain?

You don’t need to wake your partner every time you change positions, but open communication about your HS sleep challenges can help them understand and support your needs.

Let your partner know about your condition and explain that you may need to move frequently during the night or get up to change dressings.

Consider using separate blankets or a larger bed to minimize disruptions when you need to adjust your position for comfort.

If your movements consistently wake your partner and affect their sleep, discuss whether temporary separate sleeping arrangements might help both of you get better rest.

How long does it usually take to see improvements in sleep quality after starting these strategies?

Most people begin to notice some improvement in sleep comfort within the first week of implementing proper positioning and skin protection techniques.

Significant improvements in overall sleep quality typically develop over 2-4 weeks as your body adjusts to new routines and your HS symptoms begin to stabilize with better care.

Some strategies like environmental changes and stress reduction techniques may show benefits immediately, while others like building consistent bedtime routines take longer to become effective.

HS is unpredictable, so you may experience good and bad sleep periods even with the best strategies in place, but overall trends should improve with consistent effort.

Conclusion

Getting quality sleep with hidradenitis suppurativa requires patience, consistency, and a willingness to try different strategies until you find what works best for your unique situation.

Start by implementing one or two techniques from this article rather than trying to change everything at once, as gradual improvements often lead to more lasting results.

Focus on the strategies that address your most troublesome symptoms first, whether that’s pain management, skin protection, or stress reduction.

Remember that your sleep needs may change as your HS symptoms improve or worsen, so stay flexible and adjust your approach accordingly.

Work closely with your healthcare providers to ensure your sleep strategies complement your overall HS treatment plan and don’t interfere with prescribed medications or therapies.

Building better sleep habits takes time, but the effort you invest in improving your rest will pay dividends in better HS management, reduced pain, and improved quality of life.

With the right combination of environmental changes, bedtime routines, and medical support, restful nights and refreshed mornings are absolutely achievable, even with HS.