Night pain: it’s not just in your head

After a long day, you expect settling down for bed to be the most relaxing part of your evening. But for millions of Americans, it’s the opposite. A 2022 Sleep Foundation survey found that 95.1% of adults lose at least an hour of sleep to pain each week.  

Feeling pain worse at night is an extremely common experience that includes conditions like back pain, nerve pain, joint pain, and chronic inflammation. Night pain can be caused by a number of factors from sleep posture and injury to an underlying chronic disease. Understanding the cause can help determine the best way to treat it and get you back to a more relaxing evening routine. 

Why does my body hurt more at night? 

There are a number of different reasons you can feel more pain at night, and it’s closely tied to where you are feeling the pain.  

“Pain in your joints, back, and spine might signal a poor sleep posture or inflammation from stillness,” said Dr. Lawrence Enweze, an orthopedic and sports medicine surgeon at Frederick Health. “Pain in other areas such as muscles, hips, or knees might point to an injury or underlying condition. Without daytime distractions, the silence of night can also heighten your perception of pain in these areas.” 

Sleep position and stillness 

It’s normal for your joints to feel somewhat stiff in the morning, as you have been lying still for several hours. But prolonged stillness and sleep positioning can affect some people more than others.  

Joints rely on movement to stay lubricated. During rest, lubrication slows, and inflammatory fluid can build up at the joints, causing pain. In addition, lying down for hours can put direct, prolonged pressure on specific joints (hips, shoulders, knees), causing pain in those areas, especially if they’re consistently strained or injured.  

Hormones 

Hormones fluctuate throughout the day based on factors like diet, activity, and sleep quality.  

“Your body naturally releases cortisol, the stress hormone, to provide more energy and reduce inflammation in the morning,” said Dr. Enweze. “Cortisol naturally drops to its lowest levels around midnight, which makes pain and inflammation most likely to flare around that time.” 

If the pain is bad enough that it affects your sleep, consider talking to your primary care physician or a Sports Medicine physician about your symptoms. 

Dehydration 

Something as simple as not drinking enough water can lead to a variety of problems in the body, and joint pain is no exception. Not only can dehydration reduce your body’s natural lubrication of the joints, it can also lead to muscle spasms, muscle cramps, and decreased blood flow, leading to increased aches and pains.  

In addition to your body needing water to carry oxygen and provide lubrication, the cartilage and discs in your spine require water to stay pliable. Dehydration can cause them to become compressed, leading to back pain.  

Medications for other conditions can sometimes indirectly lead to dehydration, so even if you are drinking a normal amount of water, it may not be enough if your medication dehydrates you quickly and often. While drinking more water before bed might help to remedy these symptoms, sometimes there is a deeper, underlying cause. 

Chronic pain 

Chronic pain is when painful symptoms persist for more than three months. It may stem from injuries, ongoing diseases like arthritis, or occur without a known cause. It can feel worse at night because of the causes listed above, but can also be tied to diseases and conditions that need to be addressed by a healthcare professional such as fibromyalgia, arthritis, sciatica, or nerve damage. 

Recovery tips 

Understanding where your pain comes from is the first step towards getting back to a healthier you. As much as we wish the pain would go away overnight, recovery is a process. Exploring options for your care is as much a part of healing as the care itself. 

Enhance your sleep environment 

The quality of your sleep directly correlates with your general health and wellness, and one of the biggest contributors to poor sleep is temperature. If you’re too hot, it could keep you from finding comfort and reduce the quality of your sleep, leading to more painful symptoms. At the same time, too-cold environments can stiffen the joints. Explore a balance until you find one that works best for your comfort and sleep quality. 

Using pillows to support joints and maintain proper posture during sleep may help to reduce the pain you experience throughout the night and when you wake up. You may also want to assess the quality of your pillows and mattress and see if there’s any excessive softness or hardness causing discomfort. A Sports Medicine physician can also help determine if an orthopedic pillow may be necessary. 

Change up your evening and morning routine 

Establish a relaxing, consistent, bedtime routine to reduce anxiety and prepare the body for rest. Using hot or cold compresses before bed can help to calm tissue and improve sleep. For stiffness and muscle tension, use heat to improve blood flow. For sharp and irritated pain, ice can be used to help reduce inflammation.  

Light stretching or mobility work in the evening also helps prevent overnight stiffness. 

“This isn’t an aggressive workout—in fact, it’s wise to avoid those close to bedtime as they can increase inflammation,” said Dr. Enweze. “But gentle, light movement can help to release the tension of the day and signal the body to relax for bed.” 

Sports Medicine: Not just for athletes 

A sports medicine physician can diagnose the root cause of nighttime pain using techniques like physical exams and imaging to develop a targeted treatment plan. They can help create a personalized plan that considers your general activity, health history, and goals.  

Dr. Enweze is skilled in treating ACL injuries, rotator cuff tears, sprains, and other joint conditions. He provides individualized care designed to relieve pain, restore strength, and help patients return to daily activities with confidence. You can schedule an appointment with him by calling Frederick Health’s Orthopedics & Sports Medicine practice at (301) 663-9573.  

Whether you're dealing with joint pain, a sports injury, or limited mobility, an orthopedic and sports medicine specialist can help you take the next step forward.