Key takeaway
- Changes in hormone and cytokine levels, which affect inflammation, may be a reason why arthritis symptoms worsen during the night.
- Arthritis-related pain can disrupt sleep, leading to difficulty falling asleep, shorter sleep periods, and poor sleep quality.
- Improving sleep hygiene, developing a pain management strategy, and considering psychotherapy are potential ways to improve sleep and manage arthritis symptoms.
It is common for pain to worsen at night. A 2020 study found that online searches for information about pain management peaked between 11:00 p.m. and 4:00 a.m.
Doctors do not fully understand why arthritis pain often worsens at night but possible causes involve changes in the levels of hormones and cytokines, which are cell-signaling proteins, in the body.
Daytime arthritis medication, which some people take during the morning, may also wear off by the evening.
Researchers have several theories to explain why many people with arthritis experience worse pain at night.
One theory is that the body’s circadian rhythm may play a role. In people with rheumatoid arthritis (RA), the body releases less of the anti-inflammatory chemical cortisol at night, increasing inflammation-related pain.
Other processes may also intensify RA pain, including the nighttime release of pro-inflammatory cytokines, an increased number of cells traveling to inflamed tissue, and changes in the body’s immune response.
Additionally, the body releases higher levels of melatonin and prolactin at night, both of which can cause an increase in inflammatory cytokines.
A person’s arthritis inflammation and pain may worsen if:
Many studies show a link between arthritis and sleep deprivation. People with arthritis may have trouble falling asleep and staying asleep. They may also report lower quality sleep due to pain.
A 2021 study involving 133 people with arthritis and 76 matched controls found that 54.1% of people with arthritis reported poor sleep quality. The issues included:
- greater difficulty falling asleep
- shorter periods of sleep
- poor sleep quality
- more daytime problems related to poor quality sleep
A 2023 study found similar results, with 41.75% of 102 people with RA experiencing poor sleep quality. The study also associated the risk of poor sleep quality with anxiety, depression, and RA affecting the hips.
A 2025 study suggests that insomnia may also occur in people with osteoarthritis (OA) of the knee and hip, and may be more common in people with hip OA. The prevalence of insomnia was higher among people with more intense pain.
A 2025 review also highlights the bidirectional link between sleep and arthritis pain. The researchers highlight that sleep issues may worsen pain in people with various types of arthritis, including RA, OA, psoriatic arthritis, and inflammatory arthritis.
Another 2025 study of 502 people with RA supports this, finding an association between greater pain levels with worse sleep in the previous 6 months.
As insomnia can make pain worse, it is important that people with arthritis take steps to improve their sleep, as well as treating their pain.
Practice better sleep hygiene
Tossing and turning at night when unable to sleep may cause a person to notice and fixate on their pain. Good sleep hygiene may help a person fall asleep faster and remain asleep longer.
The
- Set a sleep routine in which you go to sleep and wake up at the same times each day.
- Keep the bedroom cool, dark, and quiet. This could involve using blackout blinds and air conditioning.
- Turn off electronics at least 30 minutes before you sleep.
- Avoid drinking alcohol or eating large meals close to bedtime.
- Avoid caffeine in the afternoon and evening.
- Get plenty of exercise during the day.
- Eat a balanced diet.
Sleep conditions can affect a person’s sleep quality regardless of their sleep hygiene. Speaking with a healthcare professional for diagnosis and treatment may help people with sleep conditions.
Develop an arthritis pain management strategy
People can work with a doctor to develop a plan for managing arthritis pain.
People may benefit from avoiding going to bed when they are already in pain. A doctor may be able to recommend an appropriate pain relief medication to prevent pain before bedtime. They might suggest:
- nighttime release arthritis drugs
- drugs that work for 24 hours
- an evening dose of pain medication
Identifying and managing arthritis triggers can also be helpful. People can try keeping a pain and sleep log to determine and address any patterns that seem to worsen sleep or pain.
Consider psychotherapy
A 2023 review suggests that cognitive behavioral therapy (CBT) may improve insomnia and pain intensity in people with OA. The review did not find any improvements in sleep efficiency.
Therapy may help a person better cope with their pain and manage daytime stressors that undermine sleep. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based intervention that assists a person with learning new skills for sleeping better.
People can speak with a healthcare professional for more information about CBT-I and how to get started.
What you can do today
- Improve sleep hygiene by establishing a routine and keeping the bedroom cool, dark, and quiet.
- Schedule an appointment with your doctor to discuss potential adjustments to your treatment plan.
- Start a sleep diary to identify links between triggers and sleep disruptions.
- Practice relaxation techniques before bed.
Nighttime arthritis pain is common. However, having arthritis does not mean someone has to live with chronic sleep deprivation. The right treatment plan may help a person sleep better and for longer.
While pain can make sleep worse, low quality sleep can also intensify pain and increase stress. This can create a vicious cycle that arthritis medication alone may not be sufficient to break.
The best path to complete relief is to treat both insomnia and arthritis. A person can work with their doctor to create a treatment plan that addresses the two conditions.