What can cause joint pain at night?

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Joint pain during sleep can be due to many factors, including:

Body position

How a person sleeps can affect whether their joints hurt more at night.

For example, side sleeping can put pressure on hips and shoulders, and stomach sleeping can cause neck discomfort if a person’s head is turned in one direction for prolonged periods.

Bedding materials

A mattress or pillow not providing enough support may cause or worsen joint pain at night.

Reasons include:

• spine misalignment
• bodyweight pressure on joints
• bedding weight on joints

Existing conditions

Some medical conditions can cause joint pain during the night. For example, some people with arthritis may find that the pain worsens at night.

One theory involves the level of cortisol in the body. Cortisol is an anti-inflammatory hormone. Nighttime cortisol levels typically begin low and rise during sleep.

However, cortisol does not increase overnight for people with chronic inflammatory conditions, such as rheumatoid arthritis (RA). This results in reduced anti-inflammatory action, leading to more joint pain.

Ankylosing spondylitis (AS) is another type of arthritis that can cause worsening pain at night. AS mainly affects the back but can also cause other joints in the body to become stiff and painful, including the following:

• neck
• shoulder
• hip
• thigh
• knees
• ankles

Sleep deficiency and inflammation

Although pain can adversely affect how well a person sleeps, unsettled and insufficient sleep can also impact the development of pain.

According to the Arthritis Foundation, one theory suggests that sleep problems can lead to increased inflammation throughout the body.

For example, cytokines are immune system signaling proteins that may contribute to joint pain at night. Certain cytokines, such as interleukin 6 (IL-6), can promote nervous system hyperalgesia, an increased response to pain. IL-6 can also increase inflammation, which may also worsen joint pain.

According to older research from 2016, studies have found that IL-6 levels increase at night.

A person may be able to reduce their joint pain at night in the following ways:

Hot or cold therapy

Warmth may help relieve joints that are sore but not inflamed.

A warm bath or shower before bed may reduce nighttime pain. A microwaveable hot pack wrapped in a towel can also soothe individual joints.

If inflammation accompanies joint pain, a cold compress, such as a freezable gel pack, may help. Cold reduces blood flow, which decreases swelling and can also numb pain.

Learn more about hot and cold therapy.

Topical pain relief

Applying topical pain relief can help reduce joint pain.

One example is topical nonsteroidal anti-inflammatory drugs (NSAIDs) gel. Topical NSAIDs may not be appropriate for those who also take oral NSAIDs, have sensitive skin, and need treatment for several joints.

A pharmacist might recommend applying salicylates, which are over-the-counter (OTC) pain relief medications available in oral and ointment forms. People who use blood thinner medication or have an aspirin allergy should check with their doctor before using salicylate ointment.

Sleep hygiene

Sleep hygiene is the practice of establishing routines, habits, and an environment that promotes restorative sleep.

Sleep hygiene habits include:

• maintaining a consistent bedtime
• turning off electronic devices 30 minutes before trying to sleep
• removing electronic devices from the bedroom
• avoiding caffeine consumption in the afternoon and evening
• keeping the bedroom dark, quiet, and cool at night
• avoiding alcohol and large meals before sleeping
• getting regular exercise

Modifying uncomfortable bedding

If unsupportive bedding is contributing to joint pain at night, some modifications may help. For example:

• People who sleep on their backs can use a thin pillow to support their lower back and position another pillow under their knees.
• Side sleepers can use pillow support under their neck and waist to align their head and spine.
• Supporting arms with pillows may alleviate shoulder and elbow pain.
• Sleeping with a pillow between the legs may ease hip and knee pain.
• Using a splint or brace to straighten a sore wrist can prevent carpal tunnel pain from worsening at night.
• Devices called blanket lifters can hold up the top sheet and blankets to relieve pressure on sore lower legs and feet.

Learn about some other ways to improve sleep.

Mild or infrequent joint pain may not require medical intervention. However, joint pain can be a symptom of arthritis.

There are many types of arthritis and related conditions, some of which can cause permanent joint damage without treatment.

The Arthritis Foundation recommends that people contact a doctor for joint pain if they experience symptoms that persist for 3 days or more or several occurrences of joint pain within 1 month.

Joint symptoms of concern include:

• pain
• swelling
• stiffness
• warmth
• tenderness
• reduced mobility
• interference with daily activities

A person can start with their primary care doctor, who can refer them to a specialist if necessary.

When should a person worry about joint pain?

A person should seek a medical assessment if their joint pain persists for over 3 consecutive days or recurs several times within 1 month.

However, a person should also speak with a healthcare professional if they are worried about the pain they are experiencing, regardless of its duration.

At what age do joints start hurting?

There is no particular age at which a person’s joints begin hurting. However, osteoarthritis (OA), the most common type of arthritis, usually begins to occur in people over age 50 years. OA develops as a result of wear and tear over time.

What does rheumatoid arthritis (RA) joint pain feel like?

RA is a systemic autoimmune disease. The main symptoms include pain, stiffness, swelling, warmth, and joint inflammation. The pain can feel like a burning sensation, a sharp pain, or sustained pressure.

Can joint pain at night be a sign of cancer?

Bone cancer, such as osteosarcoma, can cause joint pain that worsens at night. Initially, a person may feel pain only at night or while they are active, but as the cancer progresses, the pain can occur more consistently throughout the day.

Can joint pain at night be a sign of menopause?

During the menopausal transition, a person may experience stiff and aching joints. Joint pain may be due to getting older and changing hormone levels.

Joint pain can worsen at night for several reasons, including sleeping position, unsuitable bedding, and existing medical conditions.

At-home treatments such as sleep hygiene, topical pain relief, and supportive bedding materials are a few ways to reduce joint pain at night.

A person with persistent joint pain that does not respond to home treatment should speak with a healthcare professional.