Quick answer: Arthritis pain often feels worse at night because joints stiffen with stillness and there are fewer distractions. A gentle evening wind-down, warmth on stiff joints, pillows to support painful ones, pain relief timed as your GP or pharmacist advises and a calm plan for waking can all help. New or worsening night pain should be checked by a GP.
Lying awake with throbbing knees, aching hips or a shoulder that will not let you settle is exhausting. Night pain is one of the most common reasons people with arthritis ask for help, and poor sleep can make the next day's pain and tiredness worse. This guide sets out what usually helps, from the evening before to the small hours, and which kinds of night pain should be checked by a doctor. For a broader look at sleep, see our main guide on how to sleep with arthritis.
Why arthritis pain can feel worse at night
- Stillness. Joints and the muscles around them stiffen when they are not moving. Lying in one position for hours can leave a joint sore and stiff.
- Fewer distractions. In a quiet, dark room, there is little to take your mind off pain, so you notice it more.
- Pressure on joints. Lying on a painful hip or shoulder puts direct pressure on it.
- Daytime activity. A busy day can leave joints aching by the evening, especially in osteoarthritis.
- Inflammation patterns. In inflammatory types such as rheumatoid arthritis and axial spondyloarthritis, pain and stiffness are often worse in the second half of the night and early morning. The NHS notes that ankylosing spondylitis pain often improves with exercise and can wake people at night.
- Medicines wearing off. Pain relief taken in the early evening may have worn off by the early hours.
- The sleep and pain cycle. Poor sleep lowers your ability to cope with pain, and pain disturbs sleep. Our guide to breaking the sleep and pain cycle explains this in more detail.
Step 1: an evening wind-down (from about 2 hours before bed)
- Finish demanding tasks earlier. Try to leave heavy chores, long spells of standing or vigorous exercise for earlier in the day.
- Gentle movement. Five minutes of easy movements, such as ankle circles, knee bends, shoulder rolls and gentle neck turns, stops joints stiffening as soon as you lie down.
- Warmth. A warm bath or shower, or a wheat bag on a stiff joint for 15 to 20 minutes, helps many people feel looser. Use cold instead on a hot, swollen joint. See our heat versus ice guide for safety tips.
- Screens down. The NHS suggests winding down with relaxing activities and avoiding screens for a while before bed.
- Caffeine and alcohol. Avoid caffeine in the afternoon and evening. Alcohol may make you sleepy but tends to disturb sleep later in the night.
- A light snack, not a heavy meal, if you are hungry, and take any medicines that should be taken with food as prescribed.
- A regular bedtime. Going to bed and getting up at similar times each day helps your body clock, which the NHS recommends for better sleep.
Step 2: set up your bed for painful joints
Pillows are your best tool
- Knees and hips: a pillow between your knees when lying on your side, or under your knees when lying on your back
- Shoulder: lie on the other side and hug a pillow to rest the painful arm on
- Lower back: knees slightly bent with a pillow between them on your side, or under them on your back
- Neck: enough pillow height to keep your neck in line with your spine
- Hands and wrists: rest them on a pillow; ask about night splints if hand pain wakes you
Our guide to the best sleep positions for each joint goes into this in detail.
Mattress and bedding
- A medium-firm mattress, or a softer topper on a firm mattress, suits many people with painful hips and shoulders. There is no single "arthritis mattress".
- Lightweight, warm bedding is easier to move under than heavy blankets.
- Satin or smooth sheets, or a slide sheet, can make turning over easier.
- A bed rail or a firm bedside chair can help you get in and out. An occupational therapist can advise; you can ask your GP or local council about a home assessment.
The room
- Cool but not cold. Many people with arthritis feel stiffer in a cold room, so a little warmth in winter can help.
- Dark and quiet, with blackout curtains or an eye mask and earplugs if needed.
- A low night light or motion-sensor light for safe trips to the toilet.
- Within reach: water, any medicines you might need, a spare pillow, and your phone.
Step 3: pain relief and night time
Timing pain relief so it is working when you go to bed can help, but this must be agreed with your GP or pharmacist. They can look at what you take, when, and whether a different timing or type would suit you better.
- For osteoarthritis, NICE guidance (NG226) suggests considering a topical anti-inflammatory gel, especially for knees and hands. Some people apply it in the evening as directed on the pack.
- If you take anti-inflammatory tablets, ask whether an evening dose is appropriate for you, and do not exceed the stated daily dose.
- For inflammatory arthritis, night pain and long morning stiffness can be signs that your condition is not well controlled. Raise it with your rheumatology team rather than relying on extra painkillers.
- Do not take sleeping tablets you have not been prescribed, or someone else's medicines. Sleeping tablets can increase the risk of falls at night, especially in older people. See our guide to sleeping tablets and falls.
Step 4: your plan for waking at 3am
Having a plan makes waking in pain less distressing. Try this sequence:
- Stay calm and change position. Bend your knees and roll as one unit, then rearrange your pillows.
- Move the painful joint gently in bed for a minute: ankle pumps, gentle knee bends, hand opens or shoulder slides.
- Use slow breathing. Breathe in gently for a count of four, out for a count of six, for a few minutes. Relaxing your jaw and shoulders as you breathe out helps.
- Use warmth or cold if you have it ready, but never fall asleep with a heat pad or hot water bottle on your skin.
- Take pain relief only if it is due and within the dose your clinician or the label allows.
- Get up if you are still awake after about 20 minutes. The NHS suggests getting up and doing something relaxing in low light until you feel sleepy, then going back to bed. Lying in bed frustrated tends to make sleep harder.
- Keep it boring. Listen to calm audio, read something light, or sit with a warm, caffeine-free drink. Avoid checking the time repeatedly.
Step 5: daytime habits that help nights
- Regular exercise. NICE recommends exercise for osteoarthritis, and staying active usually helps sleep too. Avoid vigorous exercise late in the evening if it keeps you awake. Our exercise hub has ideas for each joint.
- Pacing. Spreading activity through the day avoids the evening pain that follows a boom-and-bust day.
- Daylight. Getting outside in the morning helps set your body clock.
- Naps. If you need to nap, keep it short and earlier in the afternoon.
- Weight. If you are overweight, losing some weight can reduce load on knees and hips, and NICE supports weight management in osteoarthritis.
- Worry time. If worries keep you awake, write them down in the early evening along with one next step for each, so they are less likely to circle at night.
When poor sleep has become a problem in itself
If you have had trouble sleeping for months, insomnia may have become its own problem, even if pain started it. The NHS recommends cognitive behavioural therapy for insomnia (CBT-I) as a main treatment, and NICE has recommended a digital CBT programme (Sleepio) as an option for people with insomnia (MTG70). Ask your GP what is available locally. You can also self-refer to NHS Talking Therapies in England if pain and sleep problems are affecting your mood.
Night pain during a flare
During a flare, nights can be particularly hard. Keep the evening very gentle, use cold on hot, swollen joints, support the painful joint with pillows or a splint if you have one, and follow your flare plan. Our guide to the first 24 hours of a flare has more detail. If a flare is keeping you awake for several nights, contact your GP or rheumatology team.
When to get medical help
Most night pain in arthritis is part of the condition, but some patterns need checking.
- Call 999 for chest pain, severe breathlessness, signs of a stroke or collapse.
- Call NHS 111 or go to A&E if a joint suddenly becomes hot, red, swollen and very painful, especially with fever or feeling unwell, or if you have back pain with new numbness around the bottom or genitals, problems controlling your bladder or bowel, or weakness in both legs.
- See your GP soon if night pain is new, getting steadily worse, or does not ease at all with changing position; if you have unexplained weight loss, fevers or night sweats; or if you have a history of cancer and develop new bone or back pain.
- See your GP if you are under 45 and have back pain and stiffness that wake you in the second half of the night and improve with movement, as this can be a sign of axial spondyloarthritis.
- See your GP if night pain from known arthritis is regularly stopping you sleeping. This can be a reason to review treatment, refer you to physiotherapy or, for some people with severe hip or knee osteoarthritis, discuss whether surgery is an option.
Why is my arthritis pain worse at night?
Joints stiffen when they are still for long periods, lying on a painful joint adds pressure, and there are fewer distractions at night so pain feels more noticeable. In inflammatory arthritis, pain and stiffness are often worse in the early hours. Medicines taken earlier may also have worn off.
What is the best thing to do when joint pain wakes me up?
Change position, gently move the painful joint, and try slow breathing. Use warmth or cold if you have it ready. If you are still awake after about 20 minutes, get up and do something calm in low light until you feel sleepy, then go back to bed.
Can I take painkillers in the middle of the night?
Only if a dose is due and you stay within the limits on the label or prescription. Ask your GP or pharmacist about the best timing for your pain relief, as a different schedule may help you sleep without extra doses.
Is night pain a sign my arthritis is getting worse?
Not always. Night pain can follow a busy day or a flare. But night pain that is new, steadily worsening or stopping you sleeping most nights is worth discussing with your GP, as your treatment may need reviewing. Night pain with fever, weight loss or night sweats needs checking soon.
Do sleeping tablets help arthritis night pain?
Sleeping tablets do not treat pain and are usually only recommended for short periods. They can increase the risk of falls, especially in older people. The NHS recommends talking therapy for insomnia (CBT-I) as a first approach for long-term sleep problems.
Should I sleep in a chair if lying down hurts?
Some people find a reclining chair more comfortable during a bad spell, which is fine for a short time. Sleeping in a chair regularly can stiffen hips and knees and increase swelling in the legs, so speak to your GP or a physiotherapist if you cannot lie down comfortably.
Sources and further reading
- NHS: How to get to sleep
- NHS: Insomnia
- NHS: Osteoarthritis
- NHS: Ankylosing spondylitis
- NICE MTG70: Sleepio for insomnia
- NICE NG226: Osteoarthritis in over 16s
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- How to sleep with arthritis — our main sleep guide
- Sleep positions by joint — pillows and positions
- Breaking the sleep–pain cycle — why poor sleep raises pain
- Sleeping tablets and falls — safer options
- Pain relief — what to ask about
- Flare-up guide — bad nights during a flare