Joint pain at night is very common. Many people can function during the day with mild discomfort but find that pain becomes sharper, deeper, or sleep-disrupting once they lie down. When pain reliably appears between bedtime and early morning, it is considered joint pain at night, and arthritis is a very common cause—especially in older adults. This pattern is also frequently discussed in our broader guide to night leg pain.
However, other conditions (bursitis, tendon problems, crystal arthritis such as gout or CPPD, and referred pain from the spine) can also trigger nighttime symptoms. Understanding the pattern helps narrow the cause and guides when to seek care.
Common Causes of Joint Pain at Night
A very common cause is arthritis—typically osteoarthritis or inflammatory arthritis. Crystal arthritis (gout/CPPD) is another important cause of sudden, severe night pain.
Osteoarthritis (OA)
Degeneration of cartilage leads to increased friction between bone surfaces.
Typical night pattern:
- Deep, mechanical ache
- Worse after immobility
- Often improves briefly when you change position or walk
OA-related nighttime discomfort can resemble pain when lying down, another pattern that often disrupts sleep.
Inflammatory Arthritis (e.g., Rheumatoid Arthritis)
An autoimmune process inflames the synovium (joint lining).
Typical night pattern:
- Warm, swollen, throbbing joints
- Morning stiffness often lasting >1 hour
- Frequently affects both sides of the body
Some symptoms overlap with nerve-based conditions; compare with neuropathy leg pain at night if burning or tingling sensations are present.
Crystal Arthritis (Gout or CPPD)
Gout is the sudden flare-ups caused by urate or calcium pyrophosphate crystals in the joint.
Night pattern:
- Severe, abrupt pain that may wake you
- Red, hot, intensely tender joint
- Symptoms peak rapidly and often involve the big toe, ankle, or knee
Because gout and CPPD can cause abrupt, severe pain that wakes you from sleep, they are sometimes mistaken for night leg cramps, but the joint is typically hot, red, and visibly swollen.
Why Joint Pain Gets Worse at Night
Several physiologic and mechanical factors increase pain sensitivity after bedtime.
| Factor | How It Contributes to Night Joint Pain |
|---|---|
| Lower nighttime cortisol | Cortisol levels naturally fall overnight. Because cortisol helps regulate inflammation, lower levels allow inflammatory activity to become more noticeable. |
| Immobility | Hours without movement cause synovial fluid to circulate less effectively → stiffness, pressure, and discomfort. |
| Circadian rhythms of inflammation | Inflammatory chemicals also follow a daily rhythm, often rising at night and early morning. |
| Less sensory distraction | With fewer external inputs, the brain perceives chronic pain more intensely. |
| Sleep position | Unsupported or rotated hips/knees can load an inflamed joint and aggravate symptoms. |
If nighttime discomfort feels more like an urge to move rather than true joint pain, see restless legs syndrome at night to help differentiate these conditions.
Night Pain vs Morning Stiffness
Both are common in arthritis but represent different processes.
- Night joint pain:
Wakes you or prevents sleep. Often improves temporarily with movement or changing position. - Morning stiffness:
Limited mobility after waking, lasting minutes to hours.
More prominent in inflammatory arthritis.
A helpful reframe: reduced movement and nighttime inflammatory activity contribute to the morning stiffness many people notice.
Osteoarthritis vs Inflammatory Arthritis at Night
| Feature | Osteoarthritis (OA) | Rheumatoid / Inflammatory Arthritis |
|---|---|---|
| Cause | Cartilage degeneration | Autoimmune synovial inflammation |
| Night pain | Deep, mechanical ache; stiffness from immobility | Swollen, warm, throbbing joints; often symmetric |
| Morning stiffness | Usually <30 minutes | Often >1 hour, sometimes severe |
| Heat/cold | Heat often helps stiffness | Cold may ease swelling |
If your joints remain swollen, warm, or stiff for more than an hour after waking, an inflammatory process is more likely.
When to Worry About Joint Pain at Night
Most nighttime joint pain is not dangerous, but certain signs require same-day urgent evaluation or emergency care.
Seek urgent or emergency medical attention if:
A joint becomes hot, red, and severely swollen
Possible septic arthritis (joint infection) or a crystal arthritis flare (gout/CPPD).
Both require same-day assessment; septic arthritis is an emergency.
You cannot bear weight or move the joint suddenly
Could indicate fracture, infection, or acute inflammatory arthritis.
You have fever with significant joint pain
Can signal joint infection or systemic inflammatory disease.
You develop sudden leg swelling with calf or thigh pain
Possible deep vein thrombosis (DVT)—needs immediate evaluation.
Joint infections can progress quickly and threaten joint function. When in doubt, seek care promptly.
For symptoms that start after flying or long travel, see leg pain after flight for additional red-flag guidance.
How to Ease Joint Pain at Night
1. Improve sleep alignment
- Pillow between knees for side sleepers
- Pillow under knees for back sleepers
- Replace sagging or unsupportive mattresses
2. Use heat or cold appropriately
- Heat → helps stiffness, especially in OA
- Cold → helps swelling or acute inflammatory pain
3. Discuss medication timing with your clinician
Nighttime NSAIDs or acetaminophen may help, but only as advised due to GI, kidney, cardiovascular, and dosage risks.
Inflammatory arthritis often requires prescription therapy (DMARDs/biologics) that treats the underlying process.
4. Gentle stretching before bed
Light range-of-motion exercises reduce immobility-related stiffness. If your legs feel heavy, tight, or fatigued at night, the heavy legs guide may help clarify whether circulation or venous issues are contributing.
5. Persistent symptoms deserve evaluation
Night joint pain can be a sign that arthritis is more active, crystal disease is developing, or another structure (tendon, bursa, or spine) is responsible.
FAQ: Joint Pain at Night
Why do my joints hurt at night?
Lower nighttime cortisol, circadian changes in inflammation, immobility, and poor sleep positioning can all make joint pain more noticeable.
Is joint pain at night always arthritis?
No. Arthritis is a common cause, but bursitis, tendon problems, crystal arthritis (gout/CPPD), infection, and pain referred from the spine can mimic joint pain.
Can sleeping position cause joint pain?
Yes. Misalignment of the hips or knees can load an inflamed joint and worsen symptoms.
When should I see a doctor?
If joint pain at night persists for several weeks, interferes with sleep, or is accompanied by swelling, warmth, redness, or morning stiffness lasting >1 hour.
Is night joint pain dangerous?
Usually not. But a hot, red, swollen joint, fever, or inability to bear weight requires urgent evaluation.
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