Waking Up With Scratches: Causes And Treatment

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Causes

a woman waking up with scratches on her back — Several different skin conditions may cause a person to wake up with scratches.

When a person is awake, they have a greater sense of control over their scratching and can find other ways to soothe itchy skin. While sleeping, the same level of control is not always present. The following are some of the possible causes of waking up with scratches:

Skin conditions

The body has a circadian rhythm by which it uses natural changes during the day to signal when a person should feel either awake and alert or sleepy.

The skin has its own circadian rhythm, as well. Specifically, the skin barrier may experience a higher incidence of water loss at night, when the body may also secrete less of a hormone called cortisol. These factors can cause a person’s skin to itch more at night.

Examples of skin conditions that may cause scratching while sleeping include:

atopic dermatitis
dry skin
eczema
psoriasis
scabies

According to an article in the Journal of Clinical Sleep Medicine, doctors have not ruled out the possibility that there is a distinct skin condition that causes sleep-related scratching. However, they have not yet named this condition.

Allergic reactions

A person may scratch while they sleep due to allergic reactions to medications that they take in the evening. Itching can also occur if the detergent that the person used to launder the sheets or blankets irritates their skin.

Observing the skin or considering additional allergic reaction symptoms can help identify the cause. These symptoms may include:

rash
skin redness
swelling, including that of the skin or lips
welts

If a person wakes up with problems breathing, this could signal a severe allergic reaction, and they should seek immediate medical attention.

Another person or pet

Sometimes, the cause of waking with scratches is not self-inflicted. If a person sleeps with a partner, they should ask if their partner recollects scratching them at night. Occasionally, a vivid dream can lead to scratching.

Pets may also scratch a person while sleeping. If a person has a dog, a cat, or another animal that sleeps with them, this is especially possible. A person can compare the animal’s nails or claws to their scratches to see whether this is the case.

If a person suspects that their cat scratched them, they should remember that the scratches can cause cat scratch disease. Cats can have bacteria on their claws, which can lead to a usually mild infection that typically causes a low grade fever, enlarged lymph nodes, and stomach pain.

At-home treatments, including over-the-counter fever reducers, can usually lessen these symptoms. However, antibiotics are often necessary if the fever is over 100.4°F, and the area around the scratch is red, swollen, or tender.

Dermatographia

Dermatographia is a condition that doctors also call “skin writing.” This skin condition can cause a person to experience large, raised, red scratch or welt-like areas on the skin. These may occur even after mild scratching or light touching of the skin.

The condition may cause scratches that appear very concerning when a person wakes up but go away shortly after waking.

Learn more about dermatographia here.

Insect bites

If an insect bites a person while they are sleeping, they might start to scratch the area at night. Bed bugs are a type of insect that can bite at night. A person can examine their mattress and bedcovers for these insects should they wake up with bites.

Mosquitoes and spiders can also cause itchy bites that may worsen at night. Applying topical anti-itch creams before bed may help.

Pregnancy

A growing stomach during pregnancy can lead to the development of stretch marks, which can be very itchy. Applying anti-itch moisturizers can help control the itching during the day, but women cannot do this while asleep.

As a result, a pregnant woman may wake up with scratches on or around the stretch mark areas when she wakes up.

Sleepwalking

Sleepwalking is a type of parasomnia that causes a person to walk and move around as though they are awake, but they remain in a state of sleep.

A person can experience injuries of unknown origin, including scratches, due to their sleepwalking.

Treatment and remedies

Treatments for scratching while sleeping depend upon the underlying cause. For example, if a skin condition is leading the person to scratch, treating this condition can usually resolve the issue. Applying topical products, such as moisturizers, can often help.

Keeping the nails short can help a person reduce the risk of deeper, more painful scratches. Some people may even choose to wear soft gloves while they sleep.

Those who cannot identify an underlying cause can take steps to improve their sleep that may reduce scratching symptoms. These steps include:

Improving sleep hygiene: Examples include refraining from using stimulants — such as coffee or cigarettes — before bed, sleeping in a cool and dark room, and refraining from using electronic devices 1 hour before bed.
Taking steps to reduce stress: Increased stress can enhance a person’s perception of skin itching. Often, a person will have a few moments to themselves before sleep. Stressful thoughts can be present at this time, and the sensation of stress can continue in a person’s sleep. Meditating, deep breathing, or even repeating a positive phrase before going to sleep may help.
Avoiding alcohol or recreational drugs: Alcohol and recreational drugs can affect a person’s sleep quality, which may increase the risk of parasomnias, including scratching.
Preventing sleep deprivation: The incidence of parasomnias may increase when a person is sleep deprived. Going to sleep at regular time intervals and getting a sufficient amount of sleep can help reduce this risk.

If a person still does not respond to these measures, doctors may prescribe medications that can improve sleep. Examples include benzodiazepines and selective serotonin reuptake inhibitors (SSRIs).

Learn more about how to improve sleep quality here.

When to see a doctor

A person should see a doctor if they try to treat their symptoms at home but still wake up with scratches. Deep scratches that look infected or the appearance of any other severe symptoms alongside the scratches are also reasons to visit a doctor.

A doctor may recommend a sleep study to observe a person while they sleep. Researchers are also studying the effectiveness of apps using smartwatches to detect nighttime scratching, as these may aid diagnosis.

Summary

Sleep-related scratching can cause discomfort in the day and fear of sleeping at night.

Taking steps to treat underlying conditions and improving sleep quality may help reduce the incidence of waking up with scratches.

If a person takes steps at home to reduce scratching, yet it persists, they should speak to their doctor.

Allergy
Dermatology
Infectious Diseases / Bacteria / Viruses
Sleep / Sleep Disorders / Insomnia

How we reviewed this article:

SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Baranowski, K., & Huang, B. (2018). Cat scratch disease. https://europepmc.org/article/NBK/NBK482139
Chang, Y.-S., & Chiang, B.-L. (2018). Sleep disorders and atopic dermatitis: A 2-way street? https://www.sciencedirect.com/science/article/pii/S009167491831176X
Fine, L. M., & Bernstein, J. A. (2016). Guideline of chronic urticaria beyond. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4921693/
Fleetham, J. A., & Fleming, J. A. E. (2014). Parasomnias. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016090/
Lee, J., et al. (2017). Itchtector: A wearable-based mobile system for managing itching conditions. https://dl.acm.org/doi/abs/10.1145/3025453.3025569
Nigam, G., et al. (2016). Sleep related scratching: A distinct parasomnia? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702205/
Patel, T., et al. (2007). Nocturnal itch: Why do we itch at night?https://www.ingentaconnect.com/content/mjl/adv/2007/00000087/00000004/art00002

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Medically reviewed by Cynthia Taylor Chavoustie, MPAS, PA-C — Written by Rachel Nall, MSN, CRNA on April 20, 2020

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Treatment and remedies

When to see a doctor

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