Not being able to fall asleep at night can be exhausting. If itching is keeping you awake, it’s normal to feel worried about what’s happening in your body. That’s why chronic urticaria, very itchy hives that last longer than six weeks, can be stressful and affect your quality of life.

There are two main types of chronic hives. “Chronic” means the hives keep coming back or last a long time. Chronic spontaneous urticaria, also called chronic idiopathic urticaria, happens when hives show up without a clear cause. Chronic inducible happens when something specific sets your hives off, like heat or cold. To manage chronic hives at night, the first step is to figure out what might be triggering them.

In this article, we discuss the different kinds of chronic hives, common triggers, and steps you can take to manage the discomfort of itchy skin for better sleep.

Understanding the Cause of Chronic Hives

The itchy welts we commonly refer to as hives — also called wheals — are caused by a reaction from your immune system. Acute hives are short-term hives that come on suddenly and usually go away within a day or two. Like acute hives, chronic hives happen when your immune system becomes active, causing intense itching, discolored skin, and swelling under the skin.

Unlike acute hives, which come and go quickly, chronic hives may flare every few days for weeks or months. Mast cells are immune cells in your skin. When they turn on, they release histamine. These chemicals lead to itching, swelling, and skin color changes often seen with hives.

Doctors don’t always know why chronic hives flare. Between 7 percent and 30 percent of people with chronic hives have both triggered hives and hives with no clear cause. More common causes of flare-ups include bacterial or viral infections, stress, autoimmune disease like lupus, medications, and cold temperatures.

What Can Trigger Hives at Night?

If your chronic hives flare at night, the itchiness may keep you from falling asleep or wake you up. This can make you feel worn out because you aren’t getting good sleep. There are a few reasons why your hives may be bothering you more at night.

Physical Triggers of Your Sleep Environment

If your chronic hives are acting up at night, your sleep environment may be to blame. This is because hives are sometimes triggered by external factors like heat, pressure, or friction (rubbing). For example, pajamas, bedsheets, or blankets might be putting pressure on certain parts of your body. Friction against your skin from bedding or tight clothing may also be triggering your hives.

Hot or cold temperatures can also trigger your hives. While you sleep, your skin doesn’t control its temperature as well. If your bedroom is too warm or if you use heavy bedding, it can raise your skin temperature. This extra warmth may make hives and itching worse.

Your Internal Clock

Your body works a little differently during the day than it does at night. Your body follows a daily rhythm that affects hormones and the immune system.

At night, your cortisol levels drop. Cortisol is a hormone that helps calm inflammation, so when levels are lower, hives may flare more easily. Your internal clock can also affect immune cells and chemicals like histamine. Because of that, mast cells may be more active or less controlled at night. And if hives keep interrupting your sleep, that can throw your immune system off even more.

Stress

Chronic hives can be challenging, especially during a flare. Stress doesn’t cause hives on its own, but it can sometimes make flare-ups more likely, so finding ways to stay calm may help you feel more comfortable.

Your sympathetic nervous system kicks in when you’re stressed. It can speed up your heart rate and send more blood and oxygen to your muscles to help you respond. It can also affect your immune system.

When you’re stressed, your sympathetic nervous system is more active. When turned on, it releases certain chemicals that can activate mast cells and trigger hives. This may turn into an endless cycle as stress can make hives worse, hives can make it harder to sleep, and lack of sleep can lead to added stress. One research study found that people with sleep disorders had a higher risk of developing chronic spontaneous urticaria compared to people without sleep issues.

Fewer Distractions

Lack of distractions is another reason hives may be more noticeable at night. During the day, our minds are often busy with many different concerns, like work, family responsibilities, health issues, money, or tasks we need to get done. A busy schedule can help distract you from the discomfort of chronic hives. At night, when it’s quiet and your daily tasks are done, you may start noticing the itch of your hives again.

Medications

Certain medications you take may also be the reason behind flaring hives. For some people, nonsteroidal anti-inflammatory drugs and some stronger pain relievers like opioids can lead to an outbreak of hives. On the other hand, some chronic hives treatments like antihistamines, corticosteroids, and glucocorticoids can disrupt sleep, which may make hives feel worse at night.

How To Manage Chronic Hives at Night

There are some strategies that may help you manage your chronic hives at night. If you find that your hives continue to be bothersome despite at-home efforts, talk to your primary care or dermatology provider. Your doctor can help you decide what treatment options may be right for you.

Stay Cool

Heat can make chronic hives worse. To avoid overheating, try setting your thermostat lower or sleeping with fewer or lighter blankets. Loose-fitting, breathable pajamas can help you stay cool while reducing pressure and friction against your skin.

Follow a Bedtime Routine

Better sleep hygiene (bedtime habits) can lead to better sleep. If you’re getting more restful sleep, you’ll likely feel less stressed and anxious. Strategies like keeping lights dimmed, limiting screen time, avoiding caffeine, and sticking to a routine may make it easier to sleep and, as a result, calm bothersome hives. As a general rule, try to start your bedtime routine about an hour before you plan to go to bed.

Avoid Known Triggers

Although some flares of chronic hives have no obvious trigger, others have specific triggers. If you’re aware that pressure, friction, or heat tend to be triggers for you, do your best to avoid them. Steering clear of known hives triggers, especially late in the day, may offer you some relief at night.

If you’re not sure what your triggers might be, consider starting a hives journal. Keeping track of what you’re doing each day, when you get hives, and how long they last may help you notice patterns and find your triggers.

Relax Before Bed

To de-stress before bed, try some mindfulness or relaxation practices. Breathing exercises or guided meditations, for example, may help you reduce stress that might be contributing to your chronic hives. Practicing a low-intensity exercise like yin yoga in the evenings may help you physically and mentally relax before bed.

Try Medication

If lifestyle changes aren’t helpful, you may find relief from antihistamines. These medications block the chemical histamine and its itchy side effects. Many of these anti-itch medications are available over the counter without a prescription. If itching keeps you up, ask your doctor if a bedtime antihistamine that makes you sleepy could help. Anti-itch lotion or cream may help to relieve itchiness while moisturizing your skin.

Talk to your healthcare provider to learn what they suggest for treatment. Some antihistamines may be better than others, depending on your symptoms. Your doctor might also suggest a stronger medication to ease your symptoms.

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On MyChronicHivesTeam, people share their experiences with chronic hives, get advice, and find support from others who understand.

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