Here's what's behind that prickly sensation you feel the second you start to doze off.

By Krissy Brady
September 10, 2019
Getty Images/ CRISTINA PEDRAZZINI/SCIENCE PHOTO LIBRARY

From your partner's snoring fits to your pet's bizarre need to sleep directly on your face, it can feel like the entire universe is against you getting a good night's rest—especially when your own skin decides to get in on the action, suddenly becoming super-itchy as you start to nod off.

No, you're not imagining it. This is a real thing. Nocturnal pruritus is the term that doctors use to describe itchy skin at night. "It's common for people with dermatological conditions, such as psoriasis and eczema; however, many people experience it without any co-existing skin disorders," says Zain Husain, M.D., a dermatologist practicing at the New Jersey Dermatology & Aesthetics Center.

Itchy skin at night can strike during any stage of your body's natural sleep/wake cycle but is most likely to happen right before you fall asleep. So, why is your skin being so mean?

Why Your Skin Feels Extra-Itchy At Night

It's not entirely clear why nocturnal pruritus does its thing at the most inconvenient time ever, but doctors do have a few theories. "There are many physiological changes that occur in your body at night, including changes in thermoregulation, skin barrier function, and fluid balance," says Donna Hart, M.D., a dermatologist at Westlake Dermatology in Austin, Texas.

For starters, your body regulates its core temperature to be lowest at night. It does this by increasing blood flow to the skin, which is what allows the heat in your body to dissipate, says Dr. Hart. This temporary uptick in body temperature may correspond to increased sensations of itchiness. (Related: What's Causing Your Itchy Skin?)

Your skin's ability to retain moisture is also lowest at night. Not only can the subsequent dryness cause itchy skin, but an impaired skin barrier makes it easier for itch-inducing substances (known as pruritogens) to cause drama, says Dr. Hart.

These substances are produced by your cells for a variety of reasons, such as managing inflammation (the most famous one being histamine, which your immune system pumps out during an allergic reaction), and can be triggered by your environment as well (the weather, bug bites). Once the substances are released, they bind to specific receptors that activate nerve endings in the skin, triggering itch.

To top it off, the body's anti-inflammatory corticosteroid levels are lowered at night, while certain itch-inducing hormones and cytokines (proteins that act as tiny signaling messengers) are released in higher quantities—a one-two punch that can make the sensation of itchiness that much more noticeable.

Then there's the psychological component: "We have fewer distractions when we lie down at the end of the day, making us more aware of any itchiness we may feel," says Joel Schlessinger, M.D., an Omaha-based cosmetic surgeon.

Stress, Anxiety, and Depression Can Make Nighttime Itchiness Worse

There's a strong association between psychological issues (stress, anxiety, and depression) and nocturnal pruritus, though it's not clear how one leads to the other, says Dr. Hart. (Related: 10 Weird Ways Your Body Reacts to Stress)

One theory is that psychological drama can hyper-activate the body's fight-or-flight response, flooding the body with hormones (like cortisol and adrenaline) and activating the immune system (cue histamines) as protection.

When stress happens in small doses, the body's release of cortisol has an anti-inflammatory effect that may cancel out the stress-induced itchiness caused by the excess histamines. But chronic stress and anxiety can interfere with your body's ability to produce enough cortisol to pick up the slack (your body gets desensitized to cortisol after a while), says Dr. Hart, and this may be what makes the nighttime itchies that much more intense when you're always stressed out.

Another possibility: Because our skin is a direct pathway to our nerves, and our nerve endings go into overdrive during psychological stress, this can also result in intense itching, says Michele Green, M.D., a New York-based dermatologist. (Related: How Your Emotions Affect Your Skin)

A (cruel) cycle of sleep deprivation and itchiness may follow, since an out-of-whack sleep cycle can dysregulate the hormones necessary to keep nocturnal pruritus in check, resulting in a cascade effect that ultimately triggers—you guessed it—more itchiness.

It Can Also Be a Sign of an Underlying Health Issue

Obviously, an underlying skin condition, such as eczema, psoriasis, or hives, can cause excessive nighttime itching. Ditto for infestations, like bed bugs and scabies, which can be worse at night when the mites are more active, says Dr. Hart. (Shudders.)

There are also non-dermatological conditions that can cause nighttime itchiness, such as restless leg syndrome, diabetes, and thyroid problems, as well as kidney disease and cancer on the more serious (albeit rare) side of the spectrum.

"These conditions can trigger a hormonal imbalance, autoimmune response, or sensory response that results in itchy skin at night," says Dr. Green. In addition to nighttime itchiness, you might experience other pesky symptoms like night sweats, constipation, tingly feet, weight gain, dry skin, dizziness, and fatigue.

Fortunately, There Are Lots of Ways to Cope With Nocturnal Pruritus

"If you aren't suffering from an underlying condition that's contributing to nighttime itching, there are a few things you can do to relieve the sensation without actually scratching," says Dr. Schlessinger. (After all, the more you scratch, the more your nerve endings will act up.)

Using a (fragrance-free) lotion throughout the day and right before bed, like Vanicream Moisturizing Skin Cream (Buy It, $12, amazon.com), can keep your skin from drying out. Meanwhile, a melatonin supplement, like HUM Nutrition Beauty zzZz (Buy It, $10, sephora.com), can help with keeping your sleep cycle on the rails (and you snoozing through the itchy sensations), he adds.

And avoid taking hot showers, as the heat can actually trigger histamine release and exacerbate nighttime itchiness. Keeping your skin as cool as possible at night (say, with cold showers or a humidifier) can also suppress the desire to itch, says Dr. Green.

Lastly, topical steroids, like over-the-counter hydrocortisone cream, can be useful in breaking the scratch-itch cycle—so can popping an antihistamine, like Benadryl. "Antihistamines block the release of histamine, your body's natural response to inflammation, thus calming down the itchiness," says Dr. Husain. (Related: Products and Tips to Deal with Itchy, Dry Skin On Your Face)

Should You Check In With Your Doctor?

If your nighttime itchies are causing you to lose sleep or last longer than a few weeks, experts recommend checking in with your doctor—especially if you notice other unusual symptoms too. "Your physician can rule out any conditions that are contributing to your nocturnal pruritus or refer you to a specialist, such as a dermatologist, to seek treatment," says Dr. Husain.

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