The medical term for it is pruritis—also known as that terrible gotta-scratch-it-now feeling. Itchy skin can come on especially strong at night, thanks to skin conditions like eczema and psoriasis as well as other bodily issues like liver disease, substance abuse, and simple old age, robbing us of valuable rest time and leading to daytime sleepiness, irritability, and general lower functioning.
As you probably already know, scratching relieves the problem for a hot second, but it’s not a long-term solution, or even a short-term solution. In fact, scratching only further disturbs agitated skin, increasing inflammation and making the skin even itchier, making you want to scratch again—a terrible catch-22 known as the itch-scratch cycle.
So how do you stop that cycle in its tracks and bring an end to that infernal itching? Let us count the ways.
1. Moisturize, moisturize, moisturize.
If you have eczema, you need to keep your skin barrier intact so the allergens that cause your skin to freak out cannot enter. And because your skin loses more moisture at night than in the morning, your skin’s barrier function is not as efficient at night.
You can strengthen it by the conscientious use of moisturizers and emollients, which produce a film that limits transepidermal water loss — that’s a complicated way of saying they keep moisture in your skin so it doesn’t dry out, let in itch-mongers, and make you want to scratch it off. There is no such thing as too much moisturizing — so definitely don’t skip it at night!
Look for lotions and creams with ceramides, and steer clear of anything with artificial fragrance. Products with a low pH may be especially helpful in keeping the skin, research has shown. Dr. Wang likes products from CeraVe, Vanicream, and Aquaphor, and of course Dr. Wang Herbal Skincare Herbal Rescue Balm, which contains eight herbs as well as natural oils.
2. Break out the Benadryl.
Antihistamines not only relieve acute itching caused by an allergic reaction, but they also make you drowsy and go to sleep so you won’t lie awake scratching. Certain antihistamines, such as hydroxyzine, may also relieve the anxiety that accompanies a sleepless night: double win! Although one type of nondrowsy antihistamine, called olopatadine, was shown in a study to be effective at reducing night scratching, it’s generally a good bet to go for the sedative variety.
3. Go for the tried-and-true.
The conventional treatment for itch brought on by atopic dermatitis (aka eczema) is steroid creams or ointments. They don’t work for everyone, side effects do exist, and many people are looking for steroid-free treatments, so make sure to ask your dermatologist lots of questions before you choose this option. That said, topical steroids do control flare-ups quite effectively.
4. Consider an antidepressant.
There is a whole host of different medications that have been shown to help reduce nighttime itchiness. An antidepressant called mirtazapine has been found to reduce nocturnal itching by relaxing the receptors that trigger itching. The best part? Mirtazapine has a good safety profile, with no serious side effects to speak of. Talk to your doctor to see if it would be a good option for you.
5. Work on your sleep.
Although there is some evidence that people do continue scratching in their sleep, it stands to reason that if you’re actually unconscious, you’ll scratch less than you would if you were mindlessly scrolling through your Instagram feed because you can’t seem to drop off.
So practice good sleep hygiene by turning off screens at least an hour before bedtime (easier said than done, we know!) and climbing in bed around the same time every night so your body gets used to the same routine—disturbed circadian rhythms have been shown to be a factor in increased itching.
Another hot tip is to keep your bedroom cool, and not just when it’s warm outside: Studies have shown that it’s easier to fall asleep in a cooler room (experts recommend between 60 and 67 degrees Fahrenheit), and ambient heat has been found to be a factor in exacerbating itch.
Another worthwhile tool to consider adding to your arsenal of good sleep strategies is the use of melatonin, a natural hormone made by your body that you can buy as a supplement. Bonus: Side effects are uncommon, and experts agree it’s safe enough to give to your kids, but you should still talk to your doctor if you’re considering it.
6. Light up your life.
Remember how we said nighttime itching may be related to messed-up circadian rhythms? Well, there are treatments you can undergo to help regulate your biological clock; one of those is bright-light therapy — and it’s also been proven to help nighttime itching in certain cases. Worth a shot, right? Contact a local sleep clinic and ask an expert if this might be an appropriate treatment for you.
7. See a therapist.
Nighttime itching can actually have a strong psychological component. Of course, we’re not saying it’s all in your head, but did you ever notice how if someone starts talking about being itchy, you all of a sudden feel itchy, too?
If you think your itching may be exacerbated by stress and it’s really affecting your life, you may want to pursue some behavior-modification techniques. Seek out a psychotherapist who specializes in rational emotive behavior therapy or cognitive behavioral therapy (search psychologytoday.com to find practitioners).
A good therapist should be able to give you mindfulness-based tips to help you reduce your stress and hopefully prevent that agonizing itch.
8. Whatever you do, don’t scratch!
Take some practical, common-sense measures: Try to wear comfortable clothes that won’t aggravate itchy skin, and keep your fingernails short—or better yet, wear gloves!