Everything You Need to Know About Itchy Skin at Night

Itchy skin at night is also called nocturnal pruritus. Itchy nighttime skin is a common problem and can often be managed with home remedies or over-the-counter (OTC) medications.

While there’s no one cause, triggers for itchy skin at night can range from your body’s natural circadian rhythm and chronic skin conditions to lifestyle and environmental factors. Sometimes, itchy skin at night is a sign of a more serious health problem.

This article will go over the most common causes of itchy skin at night, home remedies and medical treatments, and how to prevent it. 

What Causes Itchy Skin at Night?

From skin conditions to daily stress, itching at any time of day or night can be caused by a range of factors. Here are the most common reasons for nighttime itching.

Circadian Rhythm

Several key parts of your 24-hour sleep-wake cycle (circadian rhythm) can cause changes to your skin at night. Sometimes, it causes itchy skin with no rash.

Changes in body temperature, humidity or skin moisture, and hormone fluctuations can all contribute to nighttime itching. 

• Body temperature: At night, your body temperature goes down thanks to a gland in your brain that regulate it, called the hypothalamus. The gland cues your body to go through a natural cooling phase during the non-rapid eye movement (NREM) stage of sleep, right when you start dozing off. When your skin releases heat in this phase, it can increase itchy sensations.
• Skin dehydration: Your skin passively loses moisture during the night. If an existing skin condition like atopic dermatitis affects the health of the outermost layer of your skin (stratum corneum), it can lead to itchiness. 
• Hormone fluctuations. Inflammation-neutralizing hormones like cortisol follow your body’s circadian rhythm. When the concentration of cortisol is lowest during the evening and at midnight, your body has less help reducing inflammation. With this, you're less likely to fight off itchy sensations.

Stress

Your brain responds to both stress and itching. When one rises, it's likely the other will, too. 

This cycle can affect people with mild cases of stress to those with diagnosed anxiety. Both stress and itching can start the cycle and keep it going. 

During the day, you’re under what’s called higher cortical executive control, meaning your brain is working hard to deal with the minute-to-minute decisions of life.

When you have fewer distractions in the evening, you're more likely to notice itching that may have been an annoyance that didn't even register with you during the day.

Age

There are some natural parts of getting older that contribute to nighttime itching. Age-related factors that can make itching at night more likely include:

• Dry skin
• Decrease in immune function
• Neural degeneration
  

Infestations

Bug infestations are among the more concerning causes of nighttime itching, but an important one to rule out. 

• Bed bugs: These critters feed on blood at night. Bed bugs are one of the easier causes of nighttime itching to identify because you'll likely see noticeable bite marks on your skin.
• Scabies: The mites that cause this itchy skin condition are active at night (nocturnal), so their bites can cause itching while you're trying to sleep.
  

Allergic Reaction to New Medication

Everybody reacts differently to medications. Sometimes, instead of seeing a new drug as helpful, the body sees it as an invader and mounts an immune defense to it. An allergic reaction to a medication can lead to skin symptoms like blisters, rashes, or hives.

If you’ve recently started taking a new medication and notice nighttime itchiness, look at the label to see if it’s listed as a side effect—especially if you take the drug around bedtime.

You should also let your healthcare provider know if you think a medication is causing itching, especially if it’s affecting your sleep.

Polycythemia Vera

Itching is a common symptom of a condition called polycythemia vera. This happens when the bone marrow makes too many red blood cells, white blood cells, and platelets.

Research is still being done to figure out why itching is common in people with the condition, but more than 40% of polycythemia vera patients have itching. This symptom is particularly likely after a shower or getting the skin wet.

If you have the polycythemia vera and routinely shower before bed, it could make you more likely to feel itchy at night.

Inflammatory Skin Diseases

Itching can be a symptom of several common dermatological disorders.

• Atopic dermatitis, also known as eczema, is a chronic skin condition that about 7.2% of adults in the United States have. In one study, patients with eczema had more trouble falling asleep and premature sleep awakening caused by itching 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. Thermo-dysregulation is another aspect of psoriasis. This problem can make the skin warm when it should be naturally cooling off, especially during the first few hours of sleep. The combination is a perfect storm for nighttime itching and discomfort.
• Lichen planus is an immune-mediated disease that most often affects the inside of the mouth but can also affect the nails and scalp. When the skin is involved, you can get a rash of flat-topped purple itchy areas.

Other Health-Related Causes

• Hormonal changes (e.g., pregnancy and menopause)
• Liver disease
• Chronic kidney disease
• Blood disorders
• Neurological (e.g., brachioradial pruritus)
• Psychological (e.g., delusional ideations, depression, schizophrenia)
• Substance use
• Restless legs syndrome
• Raised level of urea in the blood (uremia)
• Cholestasis
• Hodgkin’s lymphoma
• Overactive thyroid (hyperthyroidism)
• Human immunodeficiency virus (HIV)

Treatment

The treatment you’ll need for itching at night depends on what’s causing it.

For example, if you have a health condition like liver or kidney disease, your provider will recommend specific treatment for those conditions that will probably help with the symptom of nighttime itching.

Keep in mind that you might need to try more than one treatment before you start feeling better. You also may need to use more than one treatment to get itching skin at night under control.

Home Remedies

Some at-home remedies and treatments for nighttime itching can ease discomfort and help you sleep:

• Supplements: There are a few supplements that alternative medicine practitioners might recommend to help with sleep and nighttime itching. Melatonin helps you fall asleep and may help regulate your circadian rhythm and improve your overall sleep cycle. Valerian is an herb that’s widely used as an alternative to antidepressants. It might be effective at helping with insomnia. GABA (gamma-amino-butyric acid) is a popular supplement that’s used for reducing anxiety and stress. It may also help calm nighttime itching.
• Hydrating your skin: Using a cream or petroleum-based moisturizer (that’s fragrance and alcohol-free) to keep your skin hydrated. 
• Using heat and cold: Applying cool compresses where your skin itches can help relieve the discomfort. Taking a lukewarm bath before bed to relax your body and mind. Adding oatmeal to your bathwater can also make it more soothing.
• Managing stress: Gentle yoga or breathing meditations can help reduce stress and make you feel sleepy. Doing things that calm you down can also help you cope with frustrating itching.
  

Medication

• Antihistamines: Over-the-counter antihistamines with a sedative effect, such as Benadryl (diphenhydramine), reduce itching by blocking a substance in the body that causes it and can help you fall asleep. These medications are more commonly used for treating nighttime itching than non-drowsy antihistamines, which are favored for daytime use. 
• Low doses of antidepressants: Mirtazapine and doxepin both have an anti-itch and sedative effect. These medications are often used as the first-line treatment for nighttime itching because they cover a wide range of underlying causes.
• Topical steroids: Hydrocortisone is a type of corticosteroid. It’s effective at reducing nighttime itching that’s caused by skin problems.
  

Prevention

Excessive scratching—no matter the cause—can lead to worse skin irritation or even leathery patches of skin called lichen simplex chronicus. 

You’ll want to try to avoid scratching as much as you can and take steps to reduce nighttime itching. 

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

• Learn what your triggers are and try to avoid them.
• Drink lots of water to keep your skin hydrated.
• Use a fragrance-free soap that won’t dry out your skin.
• Run a humidifier at night to help your skin retain moisture.
• Avoid skin-irritating clothing, such as wool, nylon, or polyester.
• Try to keep your bedroom temperature between 60 to 67 degrees F at night to help promote sleep.
  

Summary

Nighttime itching is a common, frustrating problem. There are many causes of nocturnal pruritus: the body’s natural sleep cycles, dermatological skin conditions like eczema, or more serious health conditions like polycythemia vera. 

Thankfully, there are several things you can do to try to cope with nighttime itching at home, like taking sleep-supporting herbs and using topical steroid creams.

However, if you try these treatments and they’re not helping after a couple of weeks, or if you have other concerning symptoms besides itching at night, talk to your provider. They can figure out why you’re having nighttime itching and makes sure you get the right treatment.