If unusual sensations continue despite improved sleep, a healthcare professional can help determine whether another cause is involved.
4. Peripheral Neuropathy: When Nerves Send Abnormal Signals
One important medical cause of crawling sensations is peripheral neuropathy.
Peripheral nerves carry information between the brain, spinal cord, and the rest of the body. When these nerves become damaged or irritated, they may send abnormal signals.
People with peripheral neuropathy can experience:
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Tingling in the hands or feet
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Burning sensations
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Numbness
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Sharp or shooting pain
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Unusual sensitivity to touch
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A crawling or buzzing sensation beneath the skin
Symptoms often begin in the feet and may gradually move upward, depending on the underlying condition.
Several health problems can contribute to peripheral neuropathy.
Diabetes
Diabetes is one of the most common causes of peripheral neuropathy. Persistently elevated blood glucose can damage nerves over time.
People with diabetic neuropathy may initially notice tingling, burning, or reduced sensation in their toes and feet. Some experience discomfort that becomes more noticeable at night.
Early recognition matters because appropriate diabetes management and foot care can help reduce the risk of complications.
Vitamin B12 deficiency
Vitamin B12 is essential for normal nerve function and the maintenance of healthy nerve tissue.
A deficiency may cause tingling, numbness, balance difficulties, weakness, and other neurological symptoms.
People at increased risk may include those with certain digestive disorders, people who have undergone some types of stomach or intestinal surgery, and individuals whose diets provide insufficient vitamin B12.
A blood test can help identify a deficiency. Supplementation should be based on the person's actual needs and medical advice.
Other possible causes
Peripheral neuropathy may also be associated with:
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Certain autoimmune diseases
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Kidney disease
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Excessive alcohol consumption
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Some chemotherapy medications
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Certain infections
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Other nutritional deficiencies
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Nerve compression or injury
If crawling sensations occur together with persistent numbness, burning, weakness, or balance problems, medical evaluation is appropriate.
5. Medication Side Effects Should Not Be Overlooked
Some medications can cause itching, tingling, restlessness, or other unusual sensory symptoms.
The relationship may not always be obvious. A person might have taken a medication for months before noticing a new symptom, or the sensation may appear after a dose change or when several medicines are combined.
Medication groups that may sometimes be associated with unusual sensory effects include:
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Certain antidepressants
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Stimulant medications
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Some medicines used to treat neurological conditions
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Certain blood pressure medications
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Some pain medications
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Certain chemotherapy drugs
This does not mean that everyone taking these medicines will develop formication. The risk depends on the particular medication, dosage, individual health, and other substances being used.
If a new crawling sensation begins after starting or changing a medication, tell the prescribing clinician.
Do not stop a prescribed medicine abruptly without medical advice. Some medications need to be reduced gradually, and sudden discontinuation can cause withdrawal symptoms or other complications.
A clinician or pharmacist can review the medication list and determine whether an adjustment is appropriate.
6. Hormonal Changes May Affect Skin and Nerve Sensitivity
Hormonal changes can influence skin moisture, temperature regulation, sleep, and sensory perception.
Some people experience new or unusual skin sensations during perimenopause and menopause. These may include itching, tingling, prickling, burning, or a feeling similar to insects crawling.
Changes in estrogen levels may contribute to skin dryness and altered sensory experiences. Hot flashes and night sweats can also interrupt sleep, making discomfort more noticeable.
Pregnancy may bring additional changes, including:
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Increased skin sensitivity
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Changes in circulation
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Swelling
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Nerve compression
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Hormonal fluctuations
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Changes in sleep patterns
For example, fluid retention during pregnancy can contribute to pressure on certain nerves, sometimes producing tingling or numbness in the hands.
Hormonal changes are only one possible explanation. Persistent, severe, or unexplained symptoms should still be discussed with a healthcare professional, particularly during pregnancy.
7. Restless Legs Syndrome Is Different From Formication
Restless legs syndrome (RLS) can sometimes be confused with formication because both may involve uncomfortable sensations.
However, they are not the same condition.
RLS is a neurological disorder characterized by an urge to move the legs, usually accompanied by unpleasant sensations. People may describe these sensations as:
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Crawling
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Pulling
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Tingling
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Aching
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Itching deep inside the legs
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A feeling of restlessness
There are four important features of RLS:
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An urge to move the legs, usually with uncomfortable sensations.
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Symptoms begin or become worse during periods of rest.
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Movement, such as walking or stretching, provides at least temporary relief.
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Symptoms are worse in the evening or at night.
Unlike a crawling sensation that may occur on the back, arms, or other parts of the body, RLS primarily affects the legs.
Iron deficiency can be associated with RLS, even when a person does not have obvious anemia. A clinician may recommend checking iron status and other relevant factors.
Treatment depends on symptom severity and individual circumstances. It may involve addressing iron deficiency, reviewing medications, improving sleep habits, and considering specific treatments when necessary.
8. Skin Conditions Can Create a Crawling or Itching Feeling
Not every crawling sensation begins in the nervous system. Sometimes, the skin itself is irritated.
Dry skin is a common example. When the skin loses moisture, its protective barrier becomes less effective. This can produce itching, tightness, flaking, and irritation.
Other skin conditions may include:
Eczema
Eczema can cause dry, inflamed, itchy patches. Scratching may make the skin more irritated and create a cycle of discomfort.
Contact dermatitis
Certain soaps, detergents, cosmetics, fragrances, fabrics, and cleaning products can irritate the skin or trigger an allergic reaction.
Symptoms may include redness, itching, swelling, and small bumps.
Allergic reactions
Some allergic reactions cause widespread itching or hives. If swelling of the lips or tongue, breathing difficulty, or throat tightness occurs, seek emergency medical assistance.
Shingles
Shingles is caused by reactivation of the varicella-zoster virus, the virus responsible for chickenpox.
Before the characteristic rash appears, some people experience burning, tingling, itching, or pain in a localized area.
The sensation often affects one side of the body and follows a particular nerve distribution. A painful blistering rash may appear afterward.
Anyone who suspects shingles should contact a healthcare professional promptly, because antiviral treatment is most effective when started early.