Why Does My Pain Get Worse at Night?

You finally lie down after a long day. And suddenly, the pain feels louder.

If you’re symptoms worsen at night, you’re not imagining it. There’s a reason it happens.

“Many patients tell us they’re more uncomfortable in the evening,” says Hans Knopp, DO, a pain management specialist with Hartford HealthCare. “They’re often surprised to learn how many factors contribute.”

Here’s why pain tends to spike after sundown – and what you can do to sleep more comfortably.

1. Your hormones shift at night

One of the biggest factors? Your body’s natural rhythm.

“Our pain sensitivity is closely tied to the circadian rhythm – the internal clock that regulates everything from sleep to hormone levels,” says Dr. Knopp.

“Cortisol, a hormone that helps reduce inflammation, is highest in the morning,” he adds. “At night, it drops – which can let inflammation increase and make pain feel worse.”

> Related: Can’t Sleep Because of Knee Pain? Try These 7 Expert Tips

2. You’re more tuned into your body

During the day, distractions keep pain in the background. At night, everything slows down.

“When we aren’t distracted, we’re focused more on what we’re feeling,” says Dr. Knopp. “Even if your pain level hasn’t changed, your awareness has – which can bump up that intensity.”

> Related: 5 Ways to Sleep With Hip Pain

3. Your sleep position may be making it worse

Lying down changes how your body distributes pressure – and for some, that’s a problem.

“People with arthritis or back pain often find that certain positions put more pressure on joints or nerves,” says Dr. Knopp. “Swelling in the legs can also worsen when you lie flat, because gravity isn’t helping move fluid out.”

Try this: Use pillows to support painful joints. Tuck them behind your back, between your knees or under your arms to reduce pressure.

> Related: 5 Reasons Your Shoulder Hurts at Night

4. The healing process can trigger inflammation

Here’s something most people don’t expect: Sometimes, healing hurts.

“Our bodies do a lot of repair work at night,” says Dr. Knopp. “Part of that involves inflammation, which is necessary, but can increase pain.”

If you have a chronic inflammatory condition like arthritis, you may feel it more acutely overnight.

5. Stress and emotions can amp up the pain

Pain and emotions are deeply connected – especially at bedtime.

“Anxiety, stress and even sadness often feel stronger at night,” says Dr. Knopp. “That emotional discomfort can increase your perception of physical pain. It becomes a cycle – poor sleep increases pain, and pain interferes with sleep.”

> Related: How to Choose the Right Pillow for Neck Pain

How to sleep better

A few small shifts can help you sleep more comfortably.

Try these tips from Dr. Knopp:

• Avoid late-night stimulants: Cut out caffeine, nicotine and alcohol at least six hours before bed.
• Block noise and light: Use a sleep mask, earplugs or white noise to reduce disruptions.
• Keep your space cool: A dark, quiet, comfortable room makes a big difference.
• Reserve your bed for sleep: Skip the TV, snacks and scrolling.
• Wind down gently: Try deep breathing, light stretches or reading.

Still struggling? “If pain keeps affecting your sleep or daily life, talk to your doctor,” says Dr. Knopp. “We can help you put the right pieces in place.”