What is night time itching?
An itch is an irresistible urge to scratch the skin (also known as the scratch reflex). It can occur in any part of the body. Although itching can occur at any time of day or night, some conditions preferentially aggravate the itch during night time. The exact reason for this is not always clear. Night time itching can be intense enough to disrupt normal sleep. In fact, it has been found that individuals suffering from night time itching wake up more and spend less time in deep sleep (non-REM sleep) than those who do not suffer from this problem. Therefore, it is a serious enough condition to disrupt normal day-to-day functioning and decrease the quality of life.
Other Symptoms with Night Itching
The primary symptom is an intense urge to scratch the skin. In some cases, the affected skin region might show visible features such as dryness, redness, patches, and bumps. This is usually the case when the cause of the itch is some external factor that came into contact with the skin. In other cases, especially when the cause of the itch is internal, no visible signs of change can be seen on the surface of the skin.
Causes of Nighttime Itching
The causes of itching can either be external or internal. External conditions that aggravate night time itch can usually be counteracted by simple measures. However, some of the internal causes can be serious and life threatening if not diagnosed and treated promptly. The conditions that precipitate night time itch could either be restricted to a region of the skin, or be spread throughout the body (systemic disorders). In some cases, the exact reasons for increased night time itch are not known and their treatment is only symptomatic.
Increased itching at night (also referred to as nocturnal pruritus) can be caused by certain skin diseases such as atopic dermatitis, psoriasis, and hives. It can also result from dry skin (xeroderma) in the absence of any skin disease.
Various systemic diseases such as chronic kidney failure, liver diseases and blood disorders are associated with increased night time itching. Chicken pox is associated with intense itching all over the body.
One theory associates night time itching with changes that occur in the circadian rhythm. Circadian rhythm refers to the body’s internal clock mechanism through which it changes secretion of various hormones. Many biological processes occur in accordance with the body’s circadian rhythm.
Circadian changes associated with increased night time itching include increased body temperature, increased water loss from the skin, decreased levels of anti-inflammatory molecules, and increased parasympathetic activity. Changes in the levels of cytokines (e.g., IL-2, IL-8 and IL-31), associated with disrupted circadian rhythm, have also been implicated in causing increased night time itching.
It has been suggested that a person becomes more aware of itching sensations at night as other environmental stimuli decrease during sleep. This could lead to a perception of increased itching, even though there is no change from the day time levels.
Certain individuals might have allergic skin reactions to the bedding and clothing that they use at night. In fact, woolen clothes and blankets can irritate the skin and cause increased itching sensations at night.
A common cause of increased night time itching could be related to the presence of insects such as mosquitoes, bed bugs, mites and lice. Some of these insects are night-feeders and their increased activity at night might be the cause of aggravated itch.
Disease conditions that affect the nervous system (e.g., multiple sclerosis, diabetes, shingles) are also associated with itching.
Increased activity of the thyroid gland is associated with abnormal thickening of the skin. The skin develops red patches and is associated with increased night time itching.
Fungal skin infections
Fungal infections of the skin are a common cause of increased itching at night. These infections include athlete’s foot, jock itch, and pinworms.
Certain malignancies such as skin cancers, lymphomas and leukemias are associated with an itching skin. The itch is initially confined to the lower extremities but then spreads all over the body.
Hormonal changes during menopause also contribute to increased itching in women. This has been attributed to a decline in the levels of the hormone, estrogen.
Certain medications can also increase itching as a side-effect. Some examples include opioid analgesics, statins and allopurinol.
Infection with the human immunodeficiency virus (HIV) that causes AIDS is also associated with increased itching.
Remedies for Nighttime Itching
The following measures can be taken to relieve night time itching:
- Bathing before bedtime may remove the causative irritants from the skin. However, soaps that can dry out the skin should not be used.
- Applying moisturizer to the skin before sleeping at night can help in alleviating the itch. A thick layer of moisturizer prevents the skin from drying out and becoming susceptible to irritants.
- Keeping the nails short helps in reducing the damage during itching.
- Having proper ventilation in the room keeps it cool and helps in suppressing conditions that cause itching.
- Change bedding regularly to a fresh set.
- Wear loose-fitting cotton clothes while sleeping.
- Take measures to control pests/insects that can bite and cause itching.
- Do not allow pets to sleep in the same bed as you. The fleas from their bodies can infest your bedding and cause intense night time itching.
Treatment of Nighttime Itching
In cases where night time itching is due to an underlying skin disease or other systemic conditions, a doctor can prescribe treatment options based on the specific cause.
- Anti-histamines can relieve itching due to allergies.
- Corticosteroids can reduce itching that arise due to skin inflammation.
- Calcinuerin inhibitors are alternatives to steroids in controlling local itching.
- In psycogenic cases, anti-depressant medications can help in relieving the itch.
- Phototherapy with certain wavelengths of UV light is also used to control itching.
- Relaxation techniques before bedtime may also help in some cases.
In cases where the cause of an intense itch is not immediately obvious, it is recommended to get it checked by a dermatologist. Some of the causes of itch can be serious underlying diseases that would benefit from prompt diagnosis and treatment.