Quick answer: Pain and poor sleep feed each other: aching joints can stop you settling or wake you, and a broken night can make pain feel worse and harder to cope with the next day. You can break the cycle from three sides: settle pain before bed, keep regular get-up times and NHS sleep habits, and keep gentle movement in the day. Keep a two-week sleep and pain diary to share with your GP, and if poor sleep lasts for months, ask about CBT for insomnia.
Many people with arthritis notice the same loop: pain wakes them, the broken night leaves them tired and sore, and the next day's pain makes it harder to settle that evening. This guide explains how that cycle works and gives you a simple two-week diary to find which end to break it from. For what to try tonight, such as warmth, pillows and settling pain before bed, see our main how to sleep with arthritis guide.
How pain and poor sleep feed each other
- Pain disturbs sleep: aching joints, stiffness when you turn over, and lying on a sore hip or shoulder can stop you settling or wake you
- Poor sleep makes pain harder to cope with: after a bad night, many people find pain feels louder, energy is lower and patience runs thin
- Tiredness changes the day: you may move less, nap longer or rely on caffeine, which can make the next night worse
- Worry joins in: lying awake dreading another bad night can keep your mind busy, so bed starts to feel like a place for being awake
Inflammatory arthritis, such as rheumatoid arthritis, can be more painful and stiff overnight and in the early morning. If that is new for you, tell your rheumatology team, as it can be a sign your arthritis is more active.
Break the cycle from three sides
1. The pain side
- Ask your GP or pharmacist whether your pain relief plan suits your nights. Our pain relief guide explains the options. Do not change prescribed medicines or doses yourself
- Support sore joints with pillows; our sleep positions guide goes joint by joint
- If night pain spikes with a flare, use the flare-up guide and your flare action plan
2. The sleep side
The NHS self-help advice for insomnia includes:
- going to bed only when you feel sleepy
- getting up at the same time every day, even after a bad night
- relaxing for at least an hour before bed, for example with a bath or a book
- keeping the bedroom dark and quiet, with a comfortable mattress, pillows and covers
- avoiding tea, coffee, alcohol and smoking for at least 6 hours before bed, and big meals late at night
- putting phones and screens away before bed
3. The daytime side
- Keep gentle movement in most days. The NHS recommends regular exercise for better sleep, but not in the 4 hours before bed. Our exercise hub has routines for stiff joints
- Pace your activity so you are not exhausted one day and stuck the next; see our pacing guide
- If naps leave you awake at night, keep them short and early in the afternoon, or try going without for a fortnight
- Get outside in daylight when you can
A two-week sleep and pain diary
Keeping notes for two weeks shows patterns that are easy to miss when you are tired. Each day, jot down:
- the time you went to bed and the time you got up
- roughly how long you were awake in the night, and what woke you (pain, toilet, worry, noise)
- your pain at bedtime and on waking, from 0 to 10, and how long morning stiffness lasted
- naps, caffeine and alcohol
- what you did that day, and what you tried at bedtime
- when you took your usual medicines (record the times only; do not change them without advice)
Take the diary to your GP, physiotherapist or rheumatology team. It turns "I sleep badly" into something they can act on. If you are not sure what is waking you, our guide to what keeps you awake with arthritis runs through the common causes.
Help from the NHS
- CBT for insomnia: a GP may offer cognitive behavioural therapy (CBT) for insomnia, face to face or through an online self-help programme. NICE has recommended Sleepio, a digital CBT programme, as an option for insomnia. What is offered depends on where you live
- Sleeping pills are rarely prescribed for insomnia now and, when they are, only for a few days or weeks. They can cause drowsiness the next day; see our sleeping tablets and falls guide
- Worry and low mood: in England you can refer yourself to NHS Talking Therapies. Our arthritis and mental health guide and depression guide explain other routes
- Tiredness that better sleep does not fix may need its own plan; see our arthritis fatigue guide
When to see your GP
- You have had trouble sleeping for months, or changing your habits has not helped
- Poor sleep is making it hard to cope with daily life
- You snore loudly, make gasping or choking noises at night, or feel very tired in the day, which can be signs of sleep apnoea
- Night pain is new or getting worse, or comes with fever, night sweats or weight loss
- You think a medicine is affecting your sleep
When to get urgent help
- Get urgent advice from NHS 111 or your rheumatology team if a joint becomes hot, red and very swollen, especially with fever
- If you feel you cannot keep yourself safe, call 999 or go to A&E. You can also call Samaritans free on 116 123, day or night
Frequently asked questions
Which comes first, the pain or the poor sleep?
Often both, and they keep each other going. That is why working on pain, sleep habits and daytime activity together tends to help more than any one change.
Will better sleep reduce my pain?
Many people find pain easier to cope with after better nights, but it varies. Keep following your treatment plan while you work on sleep.
How long should I keep going before I judge a change?
Give a new routine a couple of weeks and use your diary to compare, unless pain or swelling clearly gets worse. In that case, get advice sooner.
Sources and further reading
- NHS: Insomnia
- NHS: How to get to sleep
- NICE MTG70: Sleepio to treat insomnia and insomnia symptoms
- NHS Talking Therapies
- NHS: Why am I tired all the time?
- NHS: Sleep apnoea
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. 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 — what to try tonight
- What keeps you awake — common causes and who can help
- Sleep positions — joint by joint
- Arthritis fatigue — when tiredness lasts
- Pacing — avoid boom and bust
- Arthritis and mental health — worry and low mood
- Pain relief — what helps
- Newly diagnosed — first steps