For many people with chronic hives, itchy hives interfere with sleep. More than 1 in 3 people with chronic hives have a sleep disorder. In fact, itchiness often gets worse at night. This happens because of a combination of biological and environmental factors.1,2
It can be hard to resist the urge to scratch your hives during sleep. But scratching can make hives more inflamed and increase your risk of an infection. That is why it is important to take steps to prevent scratching during sleep.
Why does itchiness get worse at night?
Many skin conditions get worse at night, including chronic hives. Itchy skin that occurs at night is called nocturnal pruritus. It is usually caused by natural processes of the body.1
The main cause of nighttime itching is your natural daily cycle of hormones and other body chemicals. Your body regulates hormones in a 24-hour cycle. This is called your circadian rhythm.1
During this cycle, hormones increase or decrease at night while you are sleeping and lead to:1
- More blood flow to the skin
- Higher skin temperature
- Higher levels of pro-inflammatory chemicals
- Lower levels of anti-inflammatory chemicals
- More water lost from the skin through sweat
Other health conditions and some drugs may also add to nighttime itchiness.1
In some cases, mental distress can make skin feel itchier at night. For example, you have fewer distractions in the quiet of the night. Daytime activities can help distract you from the itchiness. Without distraction, it may be harder to ignore the itch.1
Preventing scratching during sleep
Scratching often feels like the only way to relieve itchiness. However, it can actually make hives worse. Scratching can also cause you to break skin, which can increase your risk of infection.
The best way to prevent scratching during sleep is to treat chronic hives. Taking antihistamines or other treatments may relieve nighttime itchiness. However, these treatments do not always work for everyone.3
There are many over-the-counter (OTC) and prescription treatments that can reduce itching. However, there are not many specific for nighttime itchiness. Many people find using general anti-itch treatments before bed works best.1
Some of these remedies include:1,3,4
- Applying a cool, damp cloth to the skin
- Using natural ointments and creams with vitamin E or aloe vera
- Using creams that have steroids or antidepressants
- Using alcohol-free moisturizers, such as CeraVe and Cetaphil
- Trimming fingernails
- Taking a bath in cool or lukewarm water with colloidal oatmeal
- Using meditation apps to distract you while falling asleep
- Practicing other relaxation techniques before bed
Treatments that alter your biological clock (circadian rhythm) are often used for sleeping disorders. These treatments may also work to reduce nighttime itchiness. For example, bright light therapy exposes your eyes to light for a set time in an attempt to reset your biological clock. Taking supplements of a sleep hormone called melatonin can also help orient your biological clock. Ask your doctor if these treatments are right for you.1
Changing your sleeping environment
Your sleeping environment can also affect your symptoms. This includes the clothes you wear and your bedroom’s environment. Changes that may reduce nighttime itchiness include:3,4
- Keeping your room cool
- Using a humidifier to keep the bedroom air moist
- Wearing loose-fitting clothing made from natural fibers
- Wearing light gloves or mittens to avoid scratching
- Using a fan to create airflow and background noise
- Reducing exposure to any triggers during sleep
Things to avoid
Your activities during the day can also affect your itchiness at night. Changing some aspects of your lifestyle may help to prevent scratching. For example, some things to avoid before bedtime include:3,4
- Warm baths or showers
- Scented or dyed beauty treatments
- Activities that increased body temperature
- Drinking caffeine and alcohol