Bed Sheets | A complete guide to choosing bed sheets with your skin in mind

Choosing bed sheets for skincare

April 17, 2022

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Have you ever given much thought to the role bedsheets play in your skincare routine?


Consider this:  Your skin is in direct contact with these sheets for hours on end. Perhaps even as much as a third of your life, or even more! Understanding your options from the perspective of skincare as well as implications for skin care products you may apply and clothing you may wear to bed is important. Many of the medical studies on textiles for bedding are focused on the impact on the skin of bedridden patients.






What kinds of bedsheets are available?



From a textile perspective,  bed sheets are broken down into these most common textile categories:


  • Cotton and Cotton blends
    • Percale
    • Sateen
    • Jersey
    • Flannel
    • Organic Cotton
    • Supima Cotton
  • Silk
  • Linen
  • Bamboo
  • Microfiber
  • Hemp

Even though there are a number of different types of cotton and cotton blend sheets, the main way that they differ is in the patterns of textile weave or how they are knit together. This can impact how the textile feels as well as how they retain or release heat.






Are cotton sheets all the same?


Not all cotton sheets are the same.  There are variations based on the construction, weave, and thread count of the textiles. The variations result in a different “feel” against the skin in terms of softness and a different experience in how they retain or release heat and moisture. Also, the type of cotton fibers used -  tencel, Egyptian cotton, organic cotton, Pima cotton, American Upland - have varying qualities that influence how they “feel” against your skin.







The way the textile is constructed –  woven versus knit – can impact how warm the cotton keeps you by trapping or releasing heat.  Think of flannel,
sateen, and jersey knit as examples of how when the fibers are brought together or constructed in different ways this impacts the feel and warmth. 



The thread count, as it suggests, is somewhat like the concentration of threads in the fabric which relates more to durability.  Blends with polyester and other materials make these sheets a little more wrinkle-resistant and softer to touch. Cotton blends tend to contain formaldehyde resins which are important to note for those with skin sensitivities or allergies.






bed sheets for skin care

 Related: Dr. Erum Ilyas discusses bed sheets with NBC News

 

What should I think about when it comes to choosing bed sheets?

 

When it comes to bedding choices with your skin in mind, consider asking yourself the following questions.

 

  • What are your personal preferences when it comes to warmth overnight?
  • Do you have any skin sensitivities or allergies to keep in mind? 
  • Do you tend to favor a softer textile at night or one with more texture?  

 

For example, many of my patients that struggle with hot flashes in the middle of the night may find cotton sheets more likely to trap in moisture and heat and not love this material.

 

bed sheets for skincare
Related: Dr. Erum Ilyas discusses bed sheets with Syracuse.com

 

 

 

However, many people in cooler and colder climates may prefer to stay warmer at night.





 

 

What are percale sheets?

 

Percale is another type of cotton textile weave that affects the way the fabric feels.  Most Percale tends to still be cotton with most as 100% cotton although there are some that are cotton blends.  This type of weave reminds me of an Oxford shirt- a crisscross weave that gives the textile a crisp look and feel.  Percale usually has a matte-like finish since it does not take on the shine of sateen or other cotton weaves.  Due to the construction, the fabric is lightweight and very breathable.  Warmer climates and months and/or humid environments may be ideal for these. These sheets are also durable through multiple washes.

Incidentally, I have many patients that sleep with a humidifier on for eczema and other skin conditions.  I tend to find that percale is a good option here too because some patients will feel like their sheets feel damp if they choose a different weave or blend.



Overall benefits to Percale:

  • Lightweight
  • Breathability
  • Durability
  • Less likely to retain heat and moisture
  • Ideal for hot flashes, skin sensitivities (avoid cotton blends, stick with 100% cotton percale)

 

bed sheets for skincareRelated: Dr. Erum Ilyas discusses skincare with Domino
 



What are sateen sheets?  


Sateen sheets have that classic luxurious look and feel while still being made of primarily cotton.  The difference with sateen is in how the cotton fibers are prepared as well as the weave of the fibers. The cotton tends to be mercerized which is a finishing treatment that improves the strength of the cotton fibers. The weave is still a criss-cross weave pattern, however, instead of taking on the checkerboard look of Percale, sateen can have multiple- often three or four- yarns cross over for each one that crosses under.  The weave is tight. This leaves more yarns exposed which provides a softer and smoother feel.  With more yarns exposed, the textile has a sheen and silky look. Sateen is tightly woven giving it warmth for cooler climates. 

 




Overall benefits to sateen:

  • Luxurious look with a sheen
  • Soft, silky feel against the skin
  • Retains warmth with tight weave
  • Ideal for cooler months or climates 

 






What about Jersey sheets- are there some benefits to these?


Jersey sheets are primarily made of 100% cotton or cotton blends.  These sheets are constructed like a T shirt. The construction of the jersey is knit, not woven.  Just like a T shirt, jersey sheets are soft and breathable.  These are meant for warmer climates as it keeps your skin a little cooler.  Jersey sheets are not as durable as Sateen or Percale given the knit construction.  






Overall benefits to jersey sheets:

  • Soft to touch
  • Comfortable against the skin
  • Less likely to retain warmth with knit construction





Flannel sheets sound like they would keep you pretty warm, right? 

 

Flannel sheets can be made of cotton, cotton blends, wool, or made of other synthetics. Flannel is woven as a simple weave pattern or as a twill weave.  Flannel is known for its warmth and soft feel. Although considered a breathable textile because of its weave construction, it is not the textile of choice for those that struggle with hot flashes or excess warmth at night.  Flannel tends to be loosely woven while still offering warmth.  The final textile is brushed to lift the fibers of the textile to add a fuzziness or softness when felt.  The loose weave offers the benefits of breathability and even moisture-wicking while still offering warmth.




Overall benefits to flannel sheets:

  • Soft to touch
  • Comfortable against the skin
  • Warmth with breathability





Is organic cotton a better choice when it comes to bed sheets?

 

Organic cotton has gained in popularity owing to the fact that it is grown without the use of toxic synthetic pesticides and fertilizers. However, to be labeled as organic, the only criteria to meet is to utilize USDA-certified organic crops in production.  The word organic can still be ascribed to cotton that utilizes certified organic crops even if it has been chemically modified with finishes or dyes. (USDA, 2019). This is an example of speaking to intent- if your goal is to buy organic cotton sheets to avoid added chemicals in the production process, then it is important to look for undyed organic cotton to meet your goals.

 



Remember that organic cotton is the fiber, however it can be woven or knit to form jersey, percale, flannel, or sateen sheets. 

 




 

What is Supima cotton? 


Supima cotton is durable soft cotton with a soft luxurious feel. Just like Egyptian cotton, it is thought to get softer over time.  It is also considered highly breathable.








Are silk sheets good for your skin?



Silk is a textile with some interesting properties.  It is considered hydrophobic compared to other textiles in that it repels and prevents the absorption of droplets.  It has good breathability and can be cleaned easily.  Silk has been studied if, when treated with antimicrobials, can reduce inflammation in the skin including acne. Studies looking at how much bacteria colonizes silk compared to cotton for coliform bacteria (from the colon) have  been unclear in that although some show bacteria are less likely to colonize silk compared to cotton, it is not certain if this is a property of the silk itself or other aspects to its production.


bed sheets as skincare
Related: Dr. Erum Ilyas discusses bed sheets with Domino



What does this mean when it comes to your skin? Seeking silk sheets may be of benefit to acne-prone or eczema-prone skin.  The other category of patients that can consider this material would be those with a tendency toward sweat acne or folliculitis.





What about linen sheets?



Linen is made from flax plant fibers.  It has a high tendency to crease or wrinkle, however, it may be treated with added finishes to improve its appearance. Linen is considered an eco-friendly product given its recyclable and biodegradable quality.  In the medical literature, linen has been shown to have antimicrobial and wound healing properties. Its lightweight quality makes it a favorable option for those that tend to get “overheated” at night.  It is also highly durable given the high tensile strength of the flax plant fibers.   


 

 


Are bamboo sheets good for your skin?

 

Bamboo in textiles is an important topic for discussion as it is often misrepresented by the industry.  Bamboo itself is a very fast growing and renewable resource and does not require pesticides or fertilizers to grow.  This is why it is often considered eco-friendly. 

 

 





 

Bamboo, when used in textiles, is often in one of four forms. 

  1. Bamboo rayon
  2. Bamboo lyocell
  3. Bamboo blended with cotton
  4. Bamboo linen

 

It is very common for companies to boast bamboo in their products however each of these forms is very different. 

 

bed sheets as skincare
Related: Dr. Erum Ilyas discusses bed sheets with LiveStrong


Most Bamboo in bedding is likely bamboo rayon.  Although bamboo may be used initially, it is processed in a manner similar to rayon.  Rayon, although made from cellulose harvested from wood pulp (in this case the pulp would be from bamboo), it is chemically converted into the final product. Although bamboo itself may be considered eco-friendly, the production process for bamboo rayon is not. Although made from regenerated cellulose using bamboo pulp, the FTC fined four major retailers in 2013 for false advertising stating their products were made from bamboo when in fact they were made from “rayon made from bamboo.” (Commission, Bamboo Textiles, 2019)

 




Lyocell has become very popular in recent years given its soft feel and comfort.  It is derived from regenerated cellulose using bamboo pulp.  99% of the solvent used in production, N-methyl-morphine-N-oxide (NMMO), is recycled earning this textile a more favorable environmental rating.  

There are studies that show that people with eczema or atopic dermatitis favor lyocell.  It tends to cause less itching, it is softer and it can regulate temperature and moisture more effectively than cotton. 



Bamboo linen is produced in a manner similar to linen from flax.  However, it is a durable and coarse textile and not as soft as Lyocell or Rayon from Bamboo.

 

The softness of rayon from bamboo and lyocell tends to give textiles a feel similar to silk making it very favorable for linens. I think its important to not assume that if a company states it uses bamboo is using it in the most eco-friendly manner.  If your goal is to choose bamboo products for the environmental benefit, it would be worthwhile to review what type of bamboo product you are investing in to avoid a false sense of security in a buzzword.







Microfiber sheets are also advertised. Any advantages to these?

 

Microfiber textiles are often made of synthetics materials or blends.  The fibers used to make the textile are very fine - on the order of microns, not millimeters! The fibers are tightly woven or knit together making the fabric durable, soft and moisture wicking.  Bed sheets made of microfiber can offer warmth because of the tightness of the weave.  Sometimes microfiber is added to the lining of a sleeping bag to add warmth as well. Commonly polyester and other synthetics are used to create these.  When it comes to polyester and polyester blends that can potentially release micro plastics into the environment from washing, I recommend the use of a Guppeyfriend washing bag when laundering. 

 


 

 

Is hemp a better choice when it comes to skincare? 

Hemp is increasingly used in the textile industry with the lack of widespread use likely linked to other uses for hemp outside of clothing, namely recreational drug use.  The texture of hemp varies based on the environment in which it is grown and can range from coarse to soft. One of the advantages to using Hemp fabric is that it is naturally antimicrobial.  

Hemp is considered eco-friendly given the small amounts of water needed, natural tendency to resist pests requiring little pesticide use, and little fertilizer use.






In terms of texture and feel, cotton most often has a much better feel.  In terms of cost, hemp is more expensive to work with.  

From a manufacturing point of view, hemp is a coarser and stronger fiber and more expensive to work with.  To attain a truly softer feel is difficult.  I have tried to do so for sun protective textiles and it is difficult to work with.


Related: Dr Ilyas discusses Hemp

 




Aside from overall comfort and body temperature, are there any other reasons to consider the type of textile chosen from a skincare perspective?



From a skin care product perspective, it is very common for Dermatologists to recommend certain overnight treatments when it comes to acne, rashes, or eczema.  



Some acne products run a risk of bleaching or discoloring bed sheets.  I tend to preemptively remind my patients to choose white sheets or sheets they are not worried about ruining so there are no surprises when this occurs!  






For patients with a tendency towards dry, itchy skin, we often recommend nightly moisturizers or other medicated products.  One of the most common worries expressed by patients is whether these products will ruin their bedsheets.



If they have silk sheets, this can pose a challenge.  If you have ever spilled oil on silk, then you know what I mean!   Although there are methods to remove oil from silk, it's not a simple process.  Cleaning a drop of oil off a silk tie is a more straightforward process compared to oil the entire length of a bedsheet! For these cases, cotton, cotton blends, and linen may be better options for ease of product removal from the fibers during the wash. 




What are antimicrobial bed sheets?


A special mention to another type of product in the bedsheet world is antimicrobial sheets.  These are often treated, infused, or woven with metals such as silver and copper to make them antibacterial.  It is a challenging question to answer in terms of long-term effectiveness and benefits simply due to the lack of studies available.  Our skin’s bio flora is a delicate balance of bacteria and yeast.  The use of antimicrobial sheets “sounds good” but it has yet to be determined if the routine use for the average person can serve as an actual benefit.  



Textile finishes are not necessarily regulated by the FDA and studies are lacking on the impact on human health and the environment. We have plenty of textile choices that, if cleaned and maintained, should serve the role they were meant to! From a research perspective, I wonder if these products may end up playing a role in specific medical or surgical circumstances as opposed to routine use.

 



 

 

What does "OEKO-TEX Certified" mean?

 

The goal of this certification process is to try to add another level of consumer confidence to growing concern about textiles, human health and our environment.  This certification refers to checking materials for harmful substances, considering the facility it was produced in as being environmentally friendly, and also the workplace for production as safe and socially responsible.   I consider this one more bonus to look for.

 

What does 'wrinkle resistant' mean? 

 

Wrinkle resistance can be achieved with certain blends of fibers.  In other words, synthetic textiles, wools, and cotton blends may be naturally more wrinkle-resistant than 100% cotton or linen based on the qualities of the fibers themselves. The other way that fabrics can be made wrinkle resistant is to treat them with a chemical finishing process. This process may use formaldehyde.



 

As a Dermatologist, I do patch testing for contact allergens routinely and do often find formaldehyde comes up as a trigger for some skin rashes and sensitivities.  Although other chemical finishes such as titanium can be used to achieve wrinkle resistance, the chemical finishing process is not disclosed on the packaging.  The product claim “wrinkle resistant” is not necessarily regulated.  For my patients with concerns about formaldehyde exposure, since we cannot necessarily determine directly if formaldehyde was used, I think it is safest to choose sheets that make no claims to wrinkle resistance.  The thought is that if they make the claim, they more than likely treat the fabric unless they say otherwise!




What does “thread count” mean?

 

For years, before I studied textiles, I remember thinking the thread count was an important indicator of quality.  Thread count references the concentration of fibers per square inch; i.e., the number of yarns or threads per square inch.  If there are more yarns per square inch, then it stands to reason that the textile is softer and perhaps more durable. Given the different types of weave and fiber processing, the thread count is not necessarily as important as it once was to find a soft durable sheet.  Often higher thread counts come at a much higher cost without necessarily achieving the look and feel you may be looking for.  Once I discovered sateen sheets, I stopped looking at thread counts as the weave gave me a better sense of what I was seeking.





What is the difference between fibers and weaves?

 

Fiber refers to the actual composition of the textile.  Cotton, linen, bamboo, silk, polyester, microfiber are examples of the fiber.  

Weave refers to how these fibers are brought together to construct the final textile. Woven, knit, tightness of the weave are examples of how the weave impacts the final textile.





Why are sheets important and how can they impact sleep?

 

Until you have tried out different sheets, you may never realize just how impactful they are to a good night’s sleep.  Of course mattresses and mattress quality matter, however, your skin serves as a thermoregulator for your body.  If your bed sheets are not supporting your skin’s ability to do its job, you will find your sleep may not be as restful.  

 

The feel of the sheet against your skin in terms of softness or comfort can contribute to how “aware” you are of your skin.  My patients that struggle with itching will almost always say, no matter the cause, that their itching is worse at night.  When your mind is finally at rest from the stresses of the day, it has the ability to focus more on your skin.  To avoid aggravating this tendency, softer sheets can make a world of difference.



 

If you tend to flush or get warm overnight, choosing sheets that are cooling such as Percale or linen can be ideal.  The tendency to get a little hot somewhere around 2am is a common phenomenon for a variety of reasons- hormonal, medication related, etc.  If you choose sheets that keep your skin cooler, you are less likely to wake up to physical throw the sheets off.  If you can avoid waking up, then you are more likely to sleep through the night and feel more rested the next day!  

 

For couples that disagree on temperatures at night, a nice workaround is to consider the role the bed sheets can play.  Many of the annual skin cancer screenings I perform have couples that come in together for their skin checks.  Since I often discuss the impact of moisturizers, sunblocks and thinning of our skin over the years during these visits, I also often open a can of worms when couples disagree on temperatures to keep the thermostat on!   If she wants it cooler and he wants it warmer, perhaps choose percale bed sheets with an added blanket for him.  There are lots of ways to work together here!



 

 

 

When people think of luxurious hotel sheets, what type are they usually thinking of?

 

Sateen is the most common variety of sheets to be found in hotels, especially high-end hotels.  The luxurious feel, silky look, durability, and breathability all factor in here.  Oftentimes, Egyptian cotton is used as it is high-quality long-staple cotton fiber. This means the fibers can be as long as 2 inches making them more durable and less likely to pile.  Piling is what makes textiles look worn or older.  Fuzzballs form when loose fibers clump together.

 

 

 

Do you have any specific recommendations for sheets? 


I can break this down by category.

 


Best affordable

 


100 % Organic Cotton Percale Weave Sheets by Purity Home

This sheet set is made with Organic cotton which is highly breathable and great for couples that disagree on temperatures and children that feel warm overnight. They carry the OEKO TEX Certification and are 100% organic cotton. 

 

Best overall

Nordstrom  400 Thread Count Organic Cotton Sateen Sheet Set

These sheets have a luxurious look and feel, and cover multiple categories. 100% organic cotton (GOTS Certified), high thread count at 400, and sateen for the weave.  Breathable, durable, comfortable and look luxurious!

  

Best high-end/splurge

Pottery Barn  Belgian Flax Linen Sheet Set

These sheets are splurge but it is very hard to find linen bed sheets that are soft and durable.  Linen is a great textile for bed sheets for those that tend to be too warm or hot overnight. The textile is highly breathable and permits air flow.  The challenge with linen is that it tends to wrinkle or crease so easily!   

 

Best for hot sleepers (best cooling)

 

Brooklinen Classic Percale Sheets

These are supersoft made with 100% cotton and carry the OEKO TEX certification.  Percale carries the cool crisp feel that is great for hot sleepers.

 

 

Best for cold sleepers

Garnet Hill Hemstitched Supima® Flannel Bedding

 

When it comes to choosing flannel bedding, warmth and softness are key.  These bedsheets are 100% Supima Cotton (American grown!) and brushed on both sides. Flannel sheets or textiles are brushed on both sides (this is what distinguishes it from brushed cotton which is only brushed on one side).  

 

Best Percale

Brooklinen Classic Percale Sheets

These are supersoft made with 100% cotton and carry the OEKO TEX certification.  Percale carries the cool crisp feel that is great for hot sleepers. 

 

Best Sateen

Nordstrom  400 Thread Count Organic Cotton Sateen Sheet Set

 

These sheets have a luxurious look and feel, and cover multiple categories. 100% organic cotton (GOTS Certified), high thread count at 400, and sateen for the weave.  Breathable, durable, comfortable and look luxurious!

 

Best Jersey

Target’s Solid Jersey Sheet Set - Room Essentials

 

These affordable and soft sheets are Jersey knit and carry the OEKO TEX.  If you are seeking 100% cotton be sure to check the label as the composition can vary across the brand. 

 

Best Linen

Pottery Barn  Belgian Flax Linen Sheet Set

These sheets are splurge but it is very hard to find linen bed sheets that are soft and durable.  Linen is a great textile for bed sheets for those that tend to be too warm or hot overnight. The textile is highly breathable and permits air flow.  The challenge with linen is that it tends to wrinkle or crease so easily! 

 

Best Flannel 

Garnet Hill Hemstitched Supima® Flannel Bedding

When it comes to choosing flannel bedding, warmth and softness are key.  These bedsheets are 100% Supima Cotton (American grown!) and brushed on both sides. Flannel sheets or textiles are brushed on both sides (this is what distinguishes it from brushed cotton which is only brushed on one side). 

 

Best Bamboo

100% Organic Bamboo Sheets Set 4 PC - Natural Softest Cooling Christmas Bedding (Queen, Charcoal Grey)

Truthfully, I find it very difficult to evaluate Bamboo products as it almost requires a law degree to decipher the convoluted ways that companies twist and hide the messaging in terms of production.  With my meager medical degree and bachelors in philosophy I believe that this brand is likely complying with FTC guidelines and not misrepresenting the use of bamboo in their product.  That being said, bamboo is highly durable and has antimicrobial qualities that can be of benefit for those that sweat when they sleep.

 

 

 

 

 

About Dr. Erum Ilyas

 

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