Just thinking about bed bugs is enough to keep you awake at night. Emerging insidiously from sheets, blankets, pillowcases, mattresses, box springs, carpets, and upholstery, these nearly ubiquitous household pests bite human skin, inject natural anesthetics into the wound, feed on human blood for 10 to 20 minutes at a time, and they crawl back to their hiding places to breed.

The bugs that can inhabit your bed aren’t just creepy to think about. After the pain-relieving chemicals in your saliva wear off, the sting site may tingle and itch. This is due to the amazing variety of toxic chemicals that the bed bug spits out to help it get its food.

Bed bugs secrete a chemical nitrorine, which causes blood vessels in the skin to dilate and fill with blood. They release an enzyme called apyrase, which acts as a kind of “meat tenderizer” to prevent blood vessels from repairing the sting site. These parasitic bugs even produce their own antimicrobial agents that prevent them from catching infections from you, though they can inject more than 40 different types of disease-causing microorganisms into their hosts.

Itching and scratching often follow bed bug bites. A significant percentage of people bitten by these bugs develop allergic reactions that cause purple spots on the skin or hives, and even, in the worst cases, hemolytic anemia, which breaks down red blood cells. Many people have spent weeks or months of expensive and invasive medical testing to track down the causes of allergies and autoimmune diseases only to discover by accident or inspection that bed bug bites were the real culprit. Worse yet, these insects can transmit Salmonella, Lyme disease, hepatitis B, hepatitis C, hepatitis E, Q fever, aspergillosis, and a variety of parasitic infections.

know your bed bug

Bedbugs belong to the same family of insects as aphids and cicadas. As adults, they are reddish-brown ovals that grow up to 1/8 inch (about 3 mm) across. Its two wings are vestigial; they cant fly. Like all other insects, they have six legs and, as hematophagous and blood-sucking insects, their heads end in sharp pincers.

From egg to adult, this bloodsucking insect goes through 5 instars, or stages of development. After the egg hatches, the larva grows a tough exoskeleton that it “stuffs.” In order to shed its exoskeleton, it has to feed on human blood. (This is true of both species that feed on humans; there are other species of closely related creatures that feed on the blood of birds, bats, and pets.) Every time a bed bug molts, she leaves behind her “shell” as a telltale sign of infestation. After each moult, the hymen or abdomen lightens and the thorax or trunk darkens.

However, a much more noticeable sign of infestation is the accumulation of bed bug feces. Like other animals, begging bugs poop. They prefer cracks along the edges of mattresses and box springs for their latrine. Any accumulation of brown crusts under the sheets at the edge of the bed may indicate the problem.

Bedbugs also have a skunk-like function when alarmed. Anything that threatens the insect can trigger the release of a sickly sweet smell, but humans cannot detect the scent of one or two insects. Many pest companies have trained dogs to track the scent of bed bugs; these dogs are typically 80-100% accurate, and false positives (pointing out bed bugs that aren’t there) are rare.

Know your bed bug bite

If you’re only bitten by one or two bugs, chances are you won’t even notice. However, if you get bitten by a family of insects, you almost certainly will.

Bed bugs feed in a “breakfast, lunch, and dinner” pattern. Bites usually occur in a line up or across an arm or leg, concentrated in groups of three.

Since these pests don’t just live in beds, bites can show up in unexpected places. A doctor reported seeing several patients who had bed bug marks on the backs of their knees. It turned out that all the patients were traveling on the same commuter train and were bitten by insects that also traveled on the train to work on their seat cushions.

The real reason to control bed bugs, aside from the bites, is the variety of side effects of the bites. Not only bites but the presence of the child’s mother can cause:

• Allergic reactions, including asthma.
• Anemia, especially in infants and the elderly who are confined to bed.
• Food poisoning, by Salmonella in their feces.
• Hepatitis B, when the insect bites someone who has the virus and then bites another person who doesn’t.
• A number of diseases that ticks and fleas also transmit, including Lyme disease, leishmaniasis, Q fever, and trypsomaniasis.

Get rid of bed bugs forever

Professional bed bug extermination is not cheap. A 2010 New York City survey found the average cost to exterminate an infestation in a single room was $1,310. Exterminating bugs in a house that has more than three bedrooms can cost more than $5,000, not including the cost of hotel stays that are necessary while the house is heated. Most families simply can’t afford to hire professionals to take care of their bed bug problems, but they do have to get bed bugs under control for their health’s sake.

The first thing to know about do-it-yourself bed bug control is that insecticides generally don’t work. These pests have developed resistance to pyrethrin insecticides that you can purchase for home treatment. The poisons that actually kill them are too dangerous for home use, especially for families with children, the elderly, or pets.

So what can you do to keep bed bugs away? Here are my 10 suggestions.

1. Put a cover on the mattress. The mattress cover will prevent an insect from retreating into its hiding places during the day and since the cover is white it makes it easy to identify the insects.
2. Wash sheets, blankets, and pillowcases before bringing them into the bedroom, especially if they’re second-hand, but even if you’ve bought them new.
3. Minimize clutter in the bedroom. Any kind of clutter provides a hiding place for all kinds of pests, including mice.
4. Wash clothes in warm water (115-120 degrees F/45-50 degrees C) whenever possible. If the fabric cannot be washed in warm water, be sure to expose it for 10 to 20 minutes to the heat of a dryer or to sunlight on a clothesline.
5. When you change the bedding, vacuum the mattress, but don’t forget to dispose of the vacuum bag. Vacuum cleaning is a good way to remove insect eggs.
6. Keep suitcases closed when you’re not using them, especially when staying in motels or hotels of questionable cleanliness. If the suitcase is kept closed, any bed bugs in the room cannot travel. Take special care when staying at hotels in New York, Cincinnati, Philadelphia, Los Angeles, and Columbus and Dayton, Ohio, where infestations are unusually common.
7. If you’re inclined to use an insecticide, use diatomaceous earth. The sharp edges of the diatomaceous earth crystals cut into the exoskeleton of the insect so that it bleeds to death, over a period of 3 to 5 days. During that time, spread the crystals to other bugs. There are no harmful effects of diatomaceous earth for people or pets.
8. Never, ever use any insecticide labeled “pyrethrin” or “pyrethroid.” It won’t kill the bed bugs, but it will make them more excited and itchy.
9. If you live in a place that has cold winters, store mattresses and bedding in unheated rooms when not in use. Exposure to 5 degrees F/-15 degrees C overnight will kill both adults and eggs.
10. Consider the use of a bed bug trap. These insects are attracted to the carbon dioxide in human breath. Bed bug traps use carbon dioxide to lure insects into a trap where they can be captured and killed.