Why does it hurt more at night?

looking at the clock

I think many of us have asked this question:

Why does it seem to hurt so much more at night?

Now I’m also certain that a few will respond that it hurts more during the day, or after strenuous activity or when the weather changes, etc.  I’m not disagreeing with any of that but only trying to address the issue of some of the things that I think contribute to us hurting more at night than during the day.

Personally, this is true for me.  My pain tends to escalate in the evening and become so much worse after going to bed.  Why might this be true?

First and foremost, there are fewer distractions at night.

Seems so obvious, but it is so obviously true.  During the day, we can distract ourselves by concentrating on so many other things than our pain.  I’ve written about this before and there are many ways to do this.  Some coping tips may be found in my blog:


Phone calls, working on the computer, running errands or just listening to your favorite music may actually serve as powerful non-drug pain killers.  When we can pre-occupy our minds with other things, it can not process pain in the same way as when it is left to focus solely on our pain and other discomforts.

At night, the stimulations and diversions around us drop off which leaves us plenty of time to focus on our pain.  In addition, we tend to feel more isolated at night.  The darkness and quiet can increase feelings of loneliness and add to anxiety and depression.

Did you know that carbon dioxide might be a culprit?

We all know that we breathe in oxygen and exhale carbon dioxide.  But most of us probably don’t realize that our blood vessels expand when our body has a higher level of carbon dioxide concentration.  At night, when we are relaxing (or trying to relax), our breathing becomes slower and more shallow.  Also the temperature might be lower which may cause our heart to beat more slowly.  As a result, we have more carbon dioxide in our blood which, in turn, dilates our blood vessels putting pressure on our nerves and causing our nerves to become even more sensitive to pain.

Physical activity contributes, so self-care is so important.

You may just be worn out from the physical activity of the current day or the build-up from two or more active days in a row.  This is an important reason why we have to take care of ourselves (self-care) in order to not over-do it and make everything worse.

Lactic acid builds up in muscles when you exert yourself physically.  This is the process that causes muscles to become sore.  Physical activity also increases the blood flow around the joints.  As a result, you experience more inflammation and tenderness.  And when you suffer from chronic pain, more inflammation is our worst enemy!  All connective tissue problems worsen and our pain levels can skyrocket.

Heavy workload or even a high amount of mental stress can cause our brains to become overworked and make our never endings even more sensitive to pain stimuli. 

The soreness, aching and pain is telling you that you need rest – even though the pain itself is preventing you from getting that rest.

headache and blood pressure

Temperatures change at night and can increase pain.

The peripheral nervous system that tells your brain that you’re either hot or cold also transmits pain signals.  With our inflamed nerves due to our chronic illnesses, we are already super sensitive to changes in temperature, even during the daytime.

Nights are usually colder than days.  And temperature drops can affect pain levels.  Our damaged nerves might translate the temperature change into feelings of tenderness, tingling, or even sharp stabling pain.

And, as we have already discussed, lower temperatures cause your heart to beat more slowly, decreasing blood flow and causing a buildup of carbon dioxide dilating blood vessels and interfering with nerve endings causing increased perception of pain.


There are other reasons that cause pain levels to increase.  Mechanical factors can also increase pain when we lie down.

Laying down can compress spinal structures and can increase loading of elements of the spine.  So the pain related to our spinal issues such as herniated discs, nerve compressions and osteoarthritic changes is enhanced.

The spine is very important to us in many ways but when it in injured or inflamed, it can be the cause of intense pain all over the body.

The spine is very important to us in many ways but when it in injured or inflamed, it can be the cause of intense pain all over the body.

Also arterial blood flow to the lower extremities is impeded and venous return might be enhanced causing central pooling of blood and increased central edema (swelling).  This is a reason why body position at night can be so important to helping to control pain level and contribute to better sleep.

sleeping positions

So, what can we do about it?

  • Begin to relax your mind before going to bed.  This might include listening to your favorite music or practicing meditation or simply reading your favorite book.  But do this outside the bedroom.  We need to progress toward bedtime with our bodies so that hitting the bed is not a sudden event that causes distress rather than relaxation.
  • Use a relaxation strategy when you go to bed that gives you the best chance of getting to sleep.  Usually, this involves a standard routine that you practice every night.  It might also involve listening to a guided imagery session that allows your mind to move towards sleep in a more natural way.  After all sleep is our friend.  When we are asleep, we do not feel our pain.

sleep mask

  • Manage physical activity so that you don’t over exert yourself.  When you don’t practice good self-care habits, then you must deal with the consequences.  And it may take several days to recover and get back into a routine that keeps pain levels under as much control as possible.
  • Practice deep breathing techniques.  This effort will keep your “normal” blood oxygen levels higher and might help prevent carbon dioxide levels lower at night.
  • Make sure you have a good mattress and that you have the right pillows to support you.  The right body position can help with many mechanical issues that cause our pain to be worse at night.
  • Be certain that you have a proper schedule for your pain medications (and other medications).  You don’t want your last dose of pain medication to be too far removed from bedtime.  It will wear off over the course of the night and there’s nothing worse to waking up at 3 am in severe pain.  Also understand with your doctor and pharmacist how your medications might interact with each other and when is the best time to take them.  This task can provide enormous relief in some situations.
  • Manage room temperature as best as you can.  Temperature changes are so difficult to deal with in chronic disease.  Sometimes cooler rooms and blankets are better.  Sometimes we need a warmer room.  It just depends.


About mcreyscope

Retired / disabled survivor of Stage IV melanoma and paraneoplastic syndrome. Now in a fight with terminal treatment resistant Stage IV Prostate Cancer.
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