Why Does My Skin Itch at Night? (2024)

Unexplained itchy skin at night can disrupt even the deepest sleepers. But rest assured, nighttime itching, or nocturnal pruritus, is a common concern and can often be managed with home remedies or over-the-counter medications.

While there’s no singular cause, triggers for nocturnal pruritus can range from the body’s natural circadian rhythm, existing skin conditions, lifestyle, environmental factors, or a more serious underlying disease.

This article will identify common causes of nocturnal pruritus, home remedies, medical treatments, and prevention methods.

Causes

From common dermatological conditions to daily stress, itching can be the result of many causes. Here we explain the most common causes and how to narrow down which one you're experiencing.

Circadian Rhythm

Several aspects of a healthy circadian rhythm, our 24-hour sleep-wake cycle, can cause changes to the skin at night, sometimes resulting in itchy skin with no visible rash.

These changes include body temperature, humidity or skin moisture, and hormones fluctuations.

• Body temperature: At night, our body temperature decreases thanks to the hypothalamus, an essential gland in the brain responsible for regulating body temperature. It cues the body to go through a natural cooling phase at the non-rapid eye movement (NREM) stage of sleep, or right when you begin to doze off. When the skin releases heat to the environment during this phase, it can increase itchy sensations that cause nocturnal pruritus.
• Skin dehydration: Our skin passively loses moisture throughout the night, a process called transepidermal water loss. But when the health of the outermost layer of our skin (stratum corneum) is compromised from existing skin conditions such as dryness or atopic dermatitis, it can lead to increased itchiness.
• Hormone fluctuation: You're less likely to fight off itchy sensations at night. Inflammation-neutralizing hormones, namely cortisol, follow the circadian rhythm. Since its concentration is lowest during the evening and at midnight, we may have less help to reduce inflammatory effects, increasing the potential for nocturnal itching.

Stress

During the day, we are under what's called higher cortical executive control, meaning our brain is working hard to deal with the minute-to-minute decisions of life.

In the evening, when these distractions are reduced and our attention is more singular, you're more likely to notice itching that may have been an annoyance you dismissed during the day.

Age

Like it or not, a few natural factors of getting older can contribute to nocturnal pruritus. Dry skin, a decrease in immune function, and neural degeneration can increase the irritability of itchy skin.

Infestations

Infestations are among the more alarming causes of nocturnal pruritus.

• Bed bugs are nocturnal critters that feed only on blood. Easier to rule out than most conditions, you'll likely see noticeable bite marks on the skin that can cause nighttime itching. If this is the case, it’s unlikely that you will have unexplained itching all over your body.
• Scabies, an itchy skin condition caused by mites, can also cause discomfort at night due to their nocturnal nature.
  

Allergic Reaction to New Medication

Everybody reacts differently to new medications. Sometimes, instead of seeing the drug as helpful, the body sees it as an invader and mounts an immune defense to it, causing blisters, rashes, or hives. Re-read the symptoms of any prescriptions drugs you may be taking to see if itchy skin is listed.

Polycythemia Vera

Pruritus is a common symptom of Polycythemia Vera, a condition caused by the bone marrow producing too many red blood cells, white blood cells, and platelets.

Research is still being done on the mechanics of why the two are linked, but more than 40% of Polycythemia Vera patients experience itching, especially after a shower (or getting the skin wet).

Inflammatory Skin Diseases

Itching could also point to a few common dermatological disorders.Note that excessive scratching, no matter the cause, can result in further irritation or leathery patches of skin called Lichen simplex chronicus.

• Atopic dermatitis (AD), also known as eczema, is a chronic skin condition in 7.2% of US adults. Patients with AD were found to have more difficulty falling asleep and premature sleep awakening due to pruritus leading to fatigue, sleepiness, and insomnia.
• Psoriasis is a chronic inflammatory autoimmune skin disorder that can cause flaky patches of skin, including on the scalp. Another component of this common skin condition is thermo-dysregulation, sometimes making the skin warm when it should be naturally cooling off, namely during the first few hours of sleep. The combination is a perfect storm of itching and discomfort.
• Lichen Planus is an immune-mediated disease that most often impacts the inside of the mouth along with several other body parts, including the nails, scalp. It also affects the skin, presenting as a rash of flat-topped purple itchy areas.

Other Health-Related Causes

• Liver disease
• Chronic kidney disease
• Blood disorders
• Neurological (e.g., brachioradial pruritus)
• Psychological (delusional ideations, depression, schizophrenia, stress)
• Substance abuse
• Restless legs syndrome
• Uremia (a raised level of urea in the blood)
• Cholestasis
• Hodgkin’s lymphoma
• Hyperthyroidism
• Human immunodeficiency virus (HIV) infection
  

Treatment

Thankfully, there are some options to help soothe your skin for a better night's sleep. If you suspect your itching is related to more severe conditions, like liver or kidney disease, see your healthcare provider for treatment.

Medication

There are a few common medications you can find at your local pharmacy.

• Antihistamines: Over-the-counter antihistamines with a sedative effect, such as Benedryl (diphenhydramine), work with the brain to reduce the sensation of itchiness. They also cause drowsiness, which can help you fall asleep. These are more commonly used for treating nighttime itching than non-drowsy antihistamines thanks to their double impact.
• Low doses of antidepressants: Mirtazapine or Doxepin have an anti-itch and sedative effect. They are often used as the first-line therapy for nighttime itching because they cover a wide range of underlying causes.
• Topical steroids: Hydrocortisone, a type of corticosteroid, is effective in reducing dermatological-related itching.
  

Home Remedies

Some of these at-home remedies and treatments will help you doze off naturally or help soothe your skin.

• Melatonin not only aids in falling asleep but it’s also been shown to help regulate your circadian rhythm to improve your overall sleep cycle.
• Valerian is an herb widely used as an alternative to antidepressants that is effective in reducing insomnia.
• GABA (Gamma-aminobutyric acid), a popular supplement used for reducing anxiety and stress, has also been found to calm nighttime itching.
• Apply cool compresses where your skin itches.
• Engage in psychological interventions, such as gentle yoga or breathing meditations to reduce stress and induce sleep.
• Apple cream or petroleum-based moisturizer (fragrance and alcohol-free).
• Take a lukewarm bath before bed to soothe the skin and relax the body.
• Try an oatmeal bath before bed.
  

Prevention

Here are a few simple lifestyle adjustments you can make to decrease itchiness and increase your quality of sleep:

• Drink lots of water to keep your skin hydrated
• Use a hydrating, fragrance-free soap
• Run a humidifier at night to help your skin retain moisture
• Avoid skin-irritating clothing, such as wool, nylon, or polyester
• Set your bedroom to between 60-67 degrees Fahrenheit at night
  

Summary

Nighttime itching is just as common as it is frustrating. There are many underlying causes of nocturnal pruritus: the body’s natural sleep cycles, dermatological skin conditions like eczema, or more severe conditions like Polycythemia Vera.

Thankfully there are several home remedies for nighttime itching like sleep-inducing herbs and topical steroid creams that can help you get the rest you need for a healthy lifestyle.

A word from VeryWell

Without a good night’s sleep, your whole world can feel a little foggy. Emotions rise quicker, productivity decreases, and motivation falls by the wayside. Not to mention how uncomfortable it can feel to have less-than-perfect-looking skin. But by noticing the signs your body is giving you, however frustrating they may be, you're already on your way to restful sleep and a healthier you.