Waking Up to Crawling Skin? The Truth About Tactile Hallucinations

Have you ever woken up suddenly with the clear sensation that something is crawling on your skin—or worse, that there are bugs in your bed—only to find nothing there?

If you've experienced hallucinations feeling like bugs are crawling in the bed at night, you're not alone. This unsettling sensation is more common than most people realize. While it can feel frightening, there are medical explanations—and in many cases, treatable causes—behind it.

Let's break down what's really happening, why it occurs, and when you should seek medical care.

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What Are Tactile Hallucinations?

A tactile hallucination is when you feel physical sensations on or under your skin that aren't actually happening. These sensations can include:

• Crawling
• Tingling
• Itching
• Prickling
• The feeling of insects moving on the skin (sometimes called formication)

When these sensations happen at night, especially in bed, they can feel especially vivid and distressing.

Importantly, tactile hallucinations are different from normal skin irritation. If there's no rash, no visible insects, and no physical cause you can identify, the sensation may be neurological rather than dermatological.

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Why Does It Feel Like Bugs Crawling in Bed?

The sensation of insects crawling on the skin has a specific medical name: formication. It can be triggered by several underlying causes.

Here are the most common:

1. Sleep-Related Hallucinations

Many nighttime crawling sensations happen during transitions between sleep and wakefulness. These are called:

• Hypnagogic hallucinations (when falling asleep)
• Hypnopompic hallucinations (when waking up)

During these transitions, your brain can partially "dream" while your body is awake. The sensation can feel extremely real.

These episodes are more common in people who:

• Are sleep deprived
• Have irregular sleep schedules
• Experience high stress
• Have narcolepsy

If the feeling only happens occasionally and only around sleep, this may be the explanation.

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2. Anxiety and Stress

High levels of anxiety can increase nerve sensitivity. When your body is in a heightened state of alertness, normal skin sensations may be misinterpreted as something more dramatic.

Chronic stress can also:

• Disrupt sleep
• Increase nighttime awakenings
• Amplify body awareness

This doesn't mean the sensation is "imagined." It means your nervous system is temporarily overreacting.

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3. Medication Side Effects

Certain medications can cause tactile hallucinations or crawling sensations, including:

• Some antidepressants
• Stimulants
• Dopamine-related medications
• Certain sleep medications

If you recently started, stopped, or changed a medication, this is important to discuss with a doctor.

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4. Substance Use or Withdrawal

Formication is well-documented in people who:

• Use stimulant drugs (such as cocaine or methamphetamine)
• Are withdrawing from alcohol
• Are withdrawing from certain prescription sedatives

In these cases, the sensation can be intense and persistent.

If substance use may be involved, medical supervision is important. Withdrawal from alcohol or sedatives can be dangerous and even life-threatening.

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5. Neurological Conditions

Sometimes hallucinations feeling like bugs are crawling in the bed at night are linked to underlying neurological issues such as:

• Peripheral neuropathy
• Parkinson's disease
• Multiple sclerosis
• Migraine disorders
• Dementia-related conditions

These cases usually involve other symptoms as well, such as:

• Numbness or weakness
• Tremors
• Memory changes
• Vision problems
• Balance issues

If additional neurological symptoms are present, a medical evaluation is important.

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6. Hormonal Changes

Hormonal shifts—especially during:

• Menopause
• Perimenopause
• Thyroid disorders

—can increase skin sensitivity or cause unusual sensations. Some women describe crawling or tingling skin during hormonal transitions.

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7. Mental Health Conditions

Tactile hallucinations can sometimes occur in conditions such as:

• Severe depression with psychotic features
• Bipolar disorder (during manic episodes)
• Schizophrenia spectrum disorders
• Delusional parasitosis (a fixed belief of infestation)

If the crawling sensation is accompanied by:

• Strong belief that infestation is present despite evidence
• Hearing or seeing things others don't
• Severe mood swings
• Paranoia

It's important to seek medical evaluation promptly.

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When Is It an Emergency?

Most nighttime crawling sensations are not life-threatening. However, you should seek urgent medical care if they are accompanied by:

• Confusion or sudden mental changes
• High fever
• Severe headache
• Stiff neck
• Seizures
• Chest pain
• Sudden weakness or numbness
• Severe alcohol withdrawal symptoms

These could signal serious neurological or medical issues.

When in doubt, speak to a doctor immediately.

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How Doctors Evaluate Tactile Hallucinations

If you bring up hallucinations feeling like bugs are crawling in the bed at night, your doctor will likely ask:

• When did this start?
• Does it only happen at night?
• Are you taking new medications?
• Do you use alcohol or other substances?
• Are there other symptoms?
• How is your sleep?

They may recommend:

• Blood tests (thyroid, vitamin B12, metabolic panel)
• Medication review
• Sleep assessment
• Neurological exam
• Mental health screening

The goal is not to label—but to identify the root cause.

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What You Can Do Now

If the episodes are mild and occasional, consider these practical steps:

Improve Sleep Hygiene

• Go to bed and wake up at consistent times
• Avoid screens 1 hour before bed
• Limit caffeine late in the day
• Keep your bedroom cool and dark

Reduce Stress

• Gentle exercise
• Deep breathing
• Mindfulness techniques
• Limiting late-night stimulation

Review Medications

• Do not stop medications abruptly
• Discuss changes with your prescribing doctor

Track Patterns

Write down:

• When it happens
• What you were doing before bed
• Stress levels
• Medication timing

Patterns often reveal triggers.

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Should You Be Worried?

Here's the balanced truth:

• A single or occasional episode is often related to sleep or stress.
• Persistent, worsening, or daytime symptoms deserve evaluation.
• If other neurological or psychiatric symptoms are present, seek care sooner.

Avoid jumping to worst-case conclusions. But don't ignore repeated symptoms either.

If you're unsure whether what you're experiencing is actually a medical hallucination or something else entirely, try using a free AI-powered symptom checker for hallucinating to better understand your symptoms and determine if professional medical evaluation is needed.

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The Bottom Line

Experiencing hallucinations feeling like bugs are crawling in the bed at night can be deeply unsettling—but it is a medically recognized phenomenon with many possible explanations.

Common causes include:

• Sleep-related hallucinations
• Stress and anxiety
• Medication side effects
• Substance withdrawal
• Hormonal changes
• Neurological conditions

Most cases are manageable once the underlying cause is identified.

Still, never ignore symptoms that:

• Persist
• Worsen
• Affect your daily functioning
• Include confusion, severe mood changes, or neurological deficits

If you are experiencing recurring or distressing symptoms, speak to a doctor. Some causes can be serious or even life-threatening if left untreated.

You deserve clear answers—and appropriate care.