Itchy in Bed but No Bugs? Causes of Itching at Night

If you lie down at night and start itching, but you can't find a single bug, you're not imagining it, and you're far from alone. In a large German survey, about 1 in 7 adults (13.5%) had long-lasting itch at the time,¹⁰ and in one clinic three out of four people with chronic itch said they itched at night.¹ The good news is that most causes are easy to identify and treat once you know where to look.

Why Does Itching Get Worse at Night?

Several things happen in your body as you wind down for sleep:¹

• Your skin warms up. The body sheds heat through the skin at night, raising skin temperature and blood flow, which can intensify itch.^1,11
• Your skin loses more water. Moisture loss through the skin rises at night, weakening the skin barrier.¹
• Anti-inflammatory hormones dip. Cortisol, the body's natural anti-inflammatory hormone, is at its lowest in the evening and overnight.¹
• There's nothing to distract you. Without daytime activity, the brain pays more attention to itch signals.¹

First, Rule Out Bed Bugs

Bed bugs are worth checking for, but some people don't react to bed bug bites at all.¹² Look along mattress seams, the box spring, headboard and nearby furniture for live bugs, tiny dark droppings, rusty stains and shed skins.¹³ Our bed bug bite pictures and guide and signs of bed bugs walk you through it. If you find nothing, work through the causes below.

Common Causes of Itching in Bed (No Bugs Involved)

1. Dry skin ("winter itch")

Dry skin is the most common cause of itching.² It's worse in cold, dry winter air, in heated homes and in people over 40, and long hot showers and harsh soaps make it worse.^14,4,15 Clues: itch without a rash, rough or flaky skin, and itching that's usually worst on the arms and legs.¹⁵ Fixes: shorter showers (10 minutes or less) in warm or lukewarm water, a fragrance-free cleanser, moisturizer applied to damp skin right after bathing, and a bedroom humidifier in winter.^14,16,17,4

2. Detergent, soap or fabric reactions (contact dermatitis)

Soaps, detergents and fragrances are among the most common skin irritants and allergens.¹⁸ A new laundry detergent, scented products or wool blankets can make you itch only in bed. Switch to fragrance-free soap and detergent, cotton clothing and 100% cotton sheets.^17,16,11 Once the trigger is gone, the rash usually clears in 2–4 weeks.¹⁸

3. Eczema and hives

Nighttime itching is a hallmark of eczema (atopic dermatitis).¹ Heat, sweat, soaps and some fabrics can trigger flares.^19,20 Hives are raised, itchy welts that come and go; heat and pressure from a tight waistband can set them off, and they can interrupt sleep.²¹ For many people, antihistamines relieve hives.²¹

4. Fibers and fiberglass

Fiberglass from insulation can lodge in the skin and cause itching and tiny red bumps. Family members can even pick it up from a worker's clothes, so wash work clothes separately.²²

5. Medicines

Many common drugs can cause itching without a rash, including opioid pain medicines, some blood pressure medicines (ACE inhibitors), statins, certain antibiotics and some antidepressants.^4,3 If itching started after a new prescription, ask your doctor or pharmacist; don't stop a medicine on your own.²³

Bites but No Bed Bugs? Other Biters to Check

Fleas

Fleas prefer pets and rodents and bite people mainly when those hosts aren't available.⁵ Adult fleas are tiny (under 1/10 inch), wingless and can jump up to 8–10 inches.²⁴ Bites are itchy red bumps with a small center puncture, usually on the ankles and lower legs, and last a day or two.²⁴ Treat pets with a product from your vet, vacuum thoroughly and throw out the vacuum bag.²⁴

Scabies

Scabies mites burrow into the skin and cause intense itching that is worst at night.⁶ The rash shows up in skin folds: between the fingers, on the wrists, elbows, armpits, waist, buttocks and genitals.^6,25 The first time, symptoms can take 4–8 weeks to appear;⁶ in people who've had scabies before, they can return within a few days.²⁶ Most people have fewer than 10–15 mites, so they're rarely seen.⁶ Scabies spreads mainly through prolonged skin-to-skin contact.⁶

Treatment needs a prescription, usually permethrin cream or ivermectin pills; no over-the-counter product has been tested and approved.^9,27 Your doctor will choose a treatment that's safe for babies, young children and pregnant women.²⁷ Everyone in the household, plus close contacts, should be treated at the same time, and bedding, towels and clothing used in the 3 days before treatment should be washed hot and dried on high heat (or sealed in a bag for at least 3 days).^6,9 Itching can last several weeks after successful treatment; see your doctor again if it hasn't eased after 2–4 weeks.⁹

Chiggers

Chiggers are larval mites, not insects, and are almost too small to see.^28,29 They don't burrow into skin; they crawl under clothing and attach where it fits snugly, such as the sock line, waistband and behind the knees.^28,30 Itching starts a few hours after the bite, peaks at 1–2 days, and bumps can last up to 2 weeks.^28,29 If you were in tall grass or woods a day or two earlier, chiggers are a likely suspect.

Bird and rodent mites

When birds leave a nest in your eaves or attic, or rodents die or are exterminated, their mites go looking for a new host and may bite people, sometimes for weeks afterward.^7,31,32 They aren't true human parasites (bird mites can't reproduce on human blood), so the fix is removing nests and controlling rodents, not treating yourself.^7,31,33

Carpet beetle larvae

Carpet beetle larvae don't bite,³⁴ but contact with their tiny hairs can cause an itchy rash that people often describe as "being bitten by something."⁸ Find and remove the source: wool items, lint buildup in vents, dead insects or old pet food.⁸

Lice

Head lice live on the scalp and don't spread disease; they die within 2 days off the head.³⁵ Wash bedding and clothes used in the 2 days before treatment in hot water and a hot dryer, or bag them for 2 weeks; extensive house cleaning and fumigation aren't needed.³⁵ Body lice are different: they live in clothing seams, so regular bathing and changing into clean, hot-washed clothes and bedding is usually all the treatment needed.³⁶

Mosquitoes

A mosquito in the bedroom can leave a few puffy, reddish, itchy bumps on exposed skin within minutes of the bite.³⁷ Repellents the CDC lists include DEET, picaridin, IR3535 and oil of lemon eucalyptus; oil of lemon eucalyptus and PMD shouldn't be used on children under 3.³⁸ The American Academy of Pediatrics notes that 30% DEET protects for about 5 hours.³⁹

Poison ivy, oak and sumac

A rash from these plants usually appears 12–48 hours after contact and lasts 2–3 weeks.⁴⁰ The oil (urushiol) can linger on clothing, tools and pet fur, so wash skin with soap and water soon after exposure and launder clothes separately.^40,41 These plants grow in every state except Alaska and Hawaii.⁴¹

Quick Guide: What's Making You Itch?

Itching All Over With No Rash

When you itch everywhere but your skin looks normal, the cause may be inside the body. Doctors look for:⁴

• Iron deficiency anemia, the most common cause of all-over itching among people with an underlying illness.⁴
• Kidney or liver disease, including blocked bile flow (cholestasis).⁴
• Thyroid disease or diabetes.⁴
• Blood disorders and some cancers, especially lymphoma. Hodgkin lymphoma can cause itching along with drenching night sweats, fever and weight loss, and a blood disorder called polycythemia vera commonly causes itching after a warm bath or shower.^4,42,43,44
• HIV and medicine side effects.⁴

A doctor will usually start with blood tests for blood counts, iron, kidney, liver, thyroid and blood sugar.⁴ The most common cause of itching is simply dry skin,² but persistent unexplained itching is worth checking.³

Pregnant? Itching on the palms and soles, especially late in pregnancy and worse at night, can be a sign of a liver condition called intrahepatic cholestasis of pregnancy. Contact your maternity care provider right away.^45,46

Feeling Bugs Crawling, but None Are There

A crawling or biting feeling on the skin with no bugs present has a name: formication. It's a real sensation with real causes, including some medications, stimulant use, alcohol withdrawal, vitamin B12 deficiency, thyroid or liver disease and nerve conditions.^47,48 A doctor can check for these with a few routine tests.⁴⁸

Sometimes the feeling becomes a firm belief that bugs are infesting the skin even when repeated checks find none. This is called delusional infestation.^47,48 In a Mayo Clinic study of 108 such patients, none of 80 skin biopsies showed an infestation.⁴⁹ A CDC study of the condition sometimes called "Morgellons" found no infection or parasite, and the fibers people found in their skin were mostly cellulose, likely from cotton.⁵⁰ The distress is real, and it's treatable: the best first step is a doctor or dermatologist who takes your symptoms seriously and rules out other causes.^47,51

How to Stop Itching at Night

• Keep the bedroom cool and use breathable cotton sheets.^11,4
• Moisturize with a fragrance-free cream right after a short, lukewarm shower.^14,17
• Use a humidifier in winter.¹⁷
• Cool the itch: a cool, damp cloth for 5–10 minutes, a colloidal oatmeal bath, or calamine or menthol lotion.¹⁷
• Switch to fragrance-free soap and laundry detergent.¹⁷
• Antihistamines: they help hives, but non-drowsy types do little for most other itch, and drowsy ones mainly help by making you sleep.^1,21 Adults 65 and older should generally avoid drowsy antihistamines such as diphenhydramine (Benadryl), which can cause confusion; ask a doctor or pharmacist about alternatives.^52,53
• Topical steroid creams help itchy, inflamed skin such as eczema; ask a doctor before long-term use.⁴

When to See a Doctor

• Itching that lasts more than 2 weeks despite home care.³
• Itching that is severe, keeps you from sleeping, or affects your whole body.³
• Itching with weight loss, fever or night sweats.³
• A rash you think is scabies (it needs a prescription).⁹
• Itching during pregnancy, especially on the hands and feet.⁴⁵

Itching at Night: Frequently Asked Questions