Why Might Knee Pain Worsen at Night?

Reviewed by Garrett Kneese, MD, MPH

Family Medicine

Knee pain can feel worse at night because natural body changes—like increased inflammation, joint stiffness from less movement, and poor sleep quality—can make pain signals seem stronger.

Explanation

At night, when you are trying to rest or sleep, your body isn’t distracted by daily activities. This can let you notice pain more clearly. Inflammation, which is the body’s natural way to protect itself from injury, may build up during the day. When you’re lying down and not moving much, your joints can become stiff, which may contribute to knee pain. Studies have shown that people with widespread pain who also have trouble sleeping might feel knee pain more intensely. Sleep disorders or poor sleep quality can make the pain seem worse because the brain’s ability to manage pain signals may be diminished. With fewer distractions at night, your mind may focus more on the pain, making it feel even more uncomfortable. Keeping a good sleep routine, managing joint inflammation, and following appropriate pain management strategies may help ease the discomfort during the night.

(References)

Dai Z, Neogi T, Brown C, Nevitt M, Lewis CE, Torner J, Felson DT. Sleep Quality Is Related to Worsening Knee Pain in Those with Widespread Pain: The Multicenter Osteoarthritis Study. J Rheumatol. 2020 Jul 1;47(7):1019-1025. doi: 10.3899/jrheum.181365. Epub 2019 Nov 15. PMID: 31732550; PMCID: PMC7225049.
Roizenblatt M, Rosa Neto NS, Tufik S, Roizenblatt S. Pain-related diseases and sleep disorders. Braz J Med Biol Res. 2012 Sep;45(9):792-8. doi: 10.1590/s0100-879x2012007500110. Epub 2012 Jul 5. PMID: 22760852; PMCID: PMC3854323.
Lee NK, Won SJ, Lee JY, Kang SB, Yoo SY, Chang CB. Presence of Night Pain, Neuropathic Pain, or Depressive Disorder Does Not Adversely Affect Outcomes After Total Knee Arthroplasty: A Prospective Cohort Study. J Korean Med Sci. 2022 Nov 7;37(43):e309. doi: 10.3346/jkms.2022.37.e309. PMID: 36345255; PMCID: PMC9641149.
Dai Z, Neogi T, Brown C, Nevitt M, Lewis CE, Torner J, Felson DT. Sleep Quality Is Related to Worsening Knee Pain in Those with Widespread Pain: The Multicenter Osteoarthritis Study. J Rheumatol. 2020 Jul 1;47(7):1019-1025. doi: 10.3899/jrheum.181365. Epub 2019 Nov 15. PMID: 31732550; PMCID: PMC7225049.

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