Why Am I Itching All Over at Night?

Itching all over the body at night could be caused by many medical or lifestyle factors. 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.

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

This article will address 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, unexplained itching all over the body at 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 and Blood Flow 

At night, your body temperature goes down thanks to a gland in your brain that regulates 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.

Hormone Levels

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.

Cytokines

Cytokines are proteins that play a role in your immune system. Certain cytokines may stimulate the sensory neurons that initiate the itching sensation in your body. Research has found that people with the itchy skin condition atopic dermatitis may have an increase in the expression of these cytokines in their skin.

Hydration

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. 

Stress

Your brain responds to both stress and itching. When one increases, 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.

Allergies

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.

Bugs

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.
• Lice: Body lice are parasites that live in bedding and clothing. They are uncommon in the United States and are usually only found on people who don't have access to bathing facilities and clean clothing.
• Pinworms: Pinworms are small nematodes that can infect the colon and rectum of a person. Although they do not cause all-over itching, they can cause intense itching around the anus, usually at night.

Inflammatory Skin Diseases

If you feel itchy all over at night, it could be a symptom of several common dermatological disorders.

Atopic Dermatits

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

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

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.

Hormonal Changes

Hormonal changes can cause dry, itchy skin. During menopause, your sebaceous glands produce less oil, which can increase skin dehydration and cause your skin to become dry and itchy. Changes to the skin's microbiome that happen during menopause can also lead to itchy skin.

Excessive itching may also occur during pregnancy. This is also thought to be caused by hormones, but as your pregnancy progresses, the skin around your abdomen becomes tighter. This can lead to itchy skin as well.

Medical Conditions

Certain medical conditions are associated with all-over body itching. Some of these conditions can be serious and require treatment by a healthcare provider, including:

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

Other Risk Factors

A few other circumstances can put you at risk for having itchy skin.

Age

There are some natural parts of getting older that contribute to itchy skin at night, especially in people over the age of 65. Age-related factors that can make itching at night more likely include:

• Dry skin
• Decrease in immune function
• Neural degeneration

Lifestyle

Sometimes itchy skin has to do with certain lifestyle factors, like where you live and your hygiene habits. For example:

• High heat
• Frequent bathing
• Substance use
  
  

Home Remedies

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

Hydrate Your Skin

Using a cream or petroleum-based moisturizer (that’s fragrance and alcohol-free) to keep your skin hydrated. 

Use Heat and Cold

Applying cool compresses where your skin itches can help relieve the discomfort. Take a lukewarm bath before bed to relax your body and mind. Adding oatmeal to your bathwater can also make it more soothing.

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.

Manage 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.

When to See a Healthcare Provider

Many causes of itching can be managed at home. Sometimes, however, they are a sign of a more serious condition. If you have itching accompanied by other symptoms such as fever, feeling unwell, frequent urination, or a rash that crusts or bleeds, see a healthcare provider for help determining the cause of your symptoms.

You should also see a healthcare provider if the itching feels unbearable or is persistent enough to keep you awake at night, or if your symptoms resolve but then come back.

Medical Treatment

Treatment for itching will depend on what is causing it. Since this symptom can have widely varying causes, not all of these remedies will work for every case of itching.

Some of the treatments that your healthcare provider might recommend include:

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. 

It's important 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. 

Luckily, 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 make sure you get the right treatment.