Hip pain at night: causes, best sleeping positions, and tips for relief

Hip pain can show up during everyday activities — like walking, climbing stairs, sitting, or exercising — and it may feel more noticeable at night when you’re trying to get comfortable and sleep. 

If you’re wondering how to sleep with hip pain, don’t overthink it — small changes to your sleep position, pillow setup, and bedtime routine can make a meaningful difference. And while better positioning can help you feel more comfortable tonight, daytime movement and targeted exercises can help address the factors contributing to nighttime hip pain over time.

“When you hurt, you don’t sleep, and when you don’t sleep, your perception of pain can heighten,” says Sarah Melear, PT, DPT, a physical therapist at Hinge Health. “Breaking that pain-sleep cycle often starts with finding more comfortable positions and keeping your body moving during the day.”

Read on to learn the best sleeping positions for hip pain, why hip pain can feel worse at night, and how movement — especially targeted exercises recommended by Hinge Health physical therapists — can help you sleep more comfortably.

What is hip pain?

Hip pain is very common, especially if you're active: In fact, up to 40% of adults who play sports report chronic hip pain. It also occurs in about 15% of adults over the age of 60.

Some common causes of hip pain include:

• Arthritis. There are several different kinds that can contribute to hip pain, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

• Bursitis, or inflammation of the fluid-filled sacs that sit near your hip joint.

• Hip tendonitis

• Hip fracture

• Hip labral tear

• Sprains and strains

• IT band syndrome. This is when the iliotibial (IT) band — the long band of connective tissue that runs from your hip to your knee — becomes swollen and inflamed.

If you have any of the above conditions, you're at higher risk of developing hip pain at night, says Steven Goostree, PT, DPT, OCS, a physical therapist at Hinge Health.

Why is hip pain worse at night?

Hip pain may feel more noticeable at night because your body is still, your joints aren’t moving as much, and there are fewer distractions to take your mind off any discomfort or soreness you may feel in that area. Understanding why this happens can help you choose better nighttime and daytime strategies.

• You move less. “Movement helps your joints stay lubricated,” says Dr. Melear. When you stay in one position for hours, stiffness can build and make your hip feel more sore.

• Pressure builds in one area. Again, when you lie in one position for a long time, especially on your side, pressure can concentrate around your hip.

• Muscles may feel tighter. Muscle tightness from daytime activities, prolonged sitting, or doing more than your hip is ready for can become more noticeable when your body finally lays down to rest.

• You’re more aware of discomfort. During the day, your brain is busy with work, errands, and activity. At night, with fewer distractions, pain can feel louder. “Your parasympathetic nervous system, also known as the ‘rest and digest’ response, allows the brain to focus more on physical sensations, making pain feel sharper,” says Dr. Melear. 

But remember, the above factors often improve with better sleep positioning, regular movement, and exercises that support hip mobility and strength.

Causes of hip pain at night

Hip pain at night can happen for many reasons. Sometimes symptoms are related to a specific condition, and sometimes they reflect how much your hip has been asked to do during the day. Common contributors include:

• Hip osteoarthritis. Not everyone with arthritis in their hip feels symptoms, but for those who do feel pain, it can be more intense after periods of stillness — including sleep. 

• Hip bursitis. Bursitis is irritation of the small fluid-filled sacs (bursa) that cushion your hip. It can feel more intense when you lie directly on the affected side.

• Muscle tightness. Tight hip flexors, glutes (butt muscles), hamstrings (back of thigh muscles), or IT band can contribute to hip discomfort, especially after prolonged sitting or repetitive activity.

• Hip labral issues. The labrum is a ring of cartilage that helps support your hip socket. Certain sleep positions may irritate the area and contribute to nighttime discomfort.

• Pregnancy-related changes. Hormonal changes, weight changes, and shifts in posture can affect your hip comfort during pregnancy, especially while sleeping.

• Doing more activity than your hip is prepared to do. A long walk, intense workout, or sudden increase in activity can show up as hip pain later that night. That doesn’t mean movement is bad or that your hip isn’t resilient, it just means your hip may need a more gradual build-up.

Best sleeping positions for hip pain

There’s no single “right” way to sleep with hip pain. The best sleep position is the one that helps you feel supported and relaxed. In general, using pillows to keep your hips, pelvis, and spine in a comfortable position can reduce pressure on sensitive areas.

• Sleep on your back with a pillow under your knees. Back sleeping helps distribute your body weight more evenly. Placing a pillow under your knees can reduce tension through your hips and lower back, which may be helpful if you’re also wondering how to sleep with lower back and hip pain.

• Sleep on your non-painful side with a pillow between your knees. If you have right hip pain, try sleeping on your left side. If you have left hip pain, try sleeping on your right side. A firm pillow between your knees helps keep your top leg from dropping forward, which can reduce strain on your hip, pelvis, and lower back.

• If you sleep on the painful side, add cushioning. Some people can’t fall asleep unless they’re on their preferred side. If that’s the side that hurts, try adding a soft mattress topper or extra cushioning under your hip, and place a pillow between your knees to support your pelvis.

• If you sleep on your stomach, support your hips. Stomach sleeping can be comfortable for some people, says Dr. Melear, but it may increase pressure through the hips or lower back. If you prefer this position, try placing a thin pillow under your pelvis or lower abdomen to help keep your spine and hips more supported.

Tips to sleep better with hip pain

If hip pain wakes you up or makes it hard to get comfortable as you try to fall asleep, making a few simple changes can help you feel more supported at night. Consider these strategies from Hinge Health physical therapists:

• Use pillows strategically. Build on the recommended sleep positions above by experimenting with pillow height or placement so your hips and lower back feel supported. "You want to be able to relax into the position, not feel like you have to hold yourself in it," says Dr. Melear. You can also try using a pregnancy pillow or body pillow. Full-length support can help keep your hips, pelvis, and spine aligned.

• Reassess your mattress. If your hips feel achy at night, try simple changes first — like adding a mattress topper or rotating your mattress — to see what lets you wake up feeling less stiff. Wear and tear over time can lead to sagging, which means less support and more pressure on your hip joints, especially if you're a side sleeper. If you notice sagging or damage, sleep better away from home, or your mattress is more than six to eight years old, it may be time to replace it. Look for a firm to hard mattress — if it sags when you're on it, it's too soft.

• Create a pre-sleep routine. A warm bath or shower before bed increases blood flow to the hip area — helpful when you're about to lie down for seven to eight hours. Gentle stretching (five to 10 minutes), diaphragmatic breathing, or another relaxation practice can also help your body prepare for sleep. Keep your room cool, and avoid strenuous exercise close to bedtime, since it can make you feel more alert instead of relaxed.

• Time your pain relief. If you take medication, ask your provider whether timing it before bed may help reduce pain during the night.

• Change positions gradually. If you need to roll over, move slowly and use pillows to support the transition. Gentle abdominal bracing (see the exercises below) before rolling over can also make position changes more comfortable.

Treatments for nighttime hip pain

The best treatment for hip pain at night usually combines immediate comfort strategies with longer-term movement habits. In other words, sleep positioning can help with hip pain tonight, while doing physical therapy and targeted exercises consistently can help reduce recurring symptoms over time.

• Try physical therapy and targeted exercises. Targeted exercises, such as the ones above, help strengthen and stretch various muscle groups that support your hips. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active during the day. Movement helps prevent stiffness that can show up at night. “Try not to stay in any one position, including sitting, for more than 30 minutes without a short movement snack break,” says Dr. Melear.

• Apply heat or cold therapy before bed. A warm bath, shower, or heating pad can increase blood flow and help relax tight muscles before sleep. But if you’re managing a new hip injury and need to reduce swelling, applying an ice pack to the tender area can help.

• Take over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can help ease pain so you can do your targeted exercises and stay active when you have hip pain. Other options are topical NSAIDs or pain relief creams. If you have a medical condition or take other medications, check in with your provider to make sure these OTC options are ‌safe to take.

• Adopt sleep hygiene habits. A supportive mattress, quality pillows, and a cool room can all help you sleep more comfortably. It may also help to create a calming pre-sleep routine, such as taking a warm bath, practicing diaphragmatic breathing, or doing five to 10 minutes of gentle stretching. Avoid strenuous exercise close to bedtime, since it can make you feel more alert instead of relaxed.

• Make lifestyle modifications. Factors like sleep, stress, nutrition, and certain activities can all play a role in how you feel. In fact, many people are surprised to learn that pain isn’t just about what’s happening physically — your daily habits and overall well-being can have a real impact, too. Staying curious about how your routines affect your muscles and joints can help you identify where small changes might help reduce pain. For example, you might notice your pain is less noticeable on low-stress days. “Reducing stress can decrease tissue sensitivity and perception of pain,” says Dr. Melear. 

• Consider complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for hip pain relief, such as massage, acupuncture, or chiropractic care.

• Ask about TENS therapy. TENS, or transcutaneous electrical nerve stimulation, uses gentle pulses to quiet your pain response and help reduce hip pain. One option is the wearable device Enso, available through Hinge Health. It’s small, wireless, and portable. Note: Enso is not intended to be used during sleep.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

When to see a doctor

Hip pain at night often improves with sleep position adjustments, exercises, and activity modifications. But if your hip pain is severe, getting worse, or causing significant sleep disruption despite trying these strategies, see a healthcare provider. It’s also a good idea to get care if you have:

• Severe pain that wakes you multiple times a night

• Hip pain accompanied by fever, redness, or swelling

• Difficulty bearing weight during the day

• Pain after an injury or fall

• Symptoms lasting more than a few weeks without improvement

• Progressive weakness or limited range of motion

PT tip: walk more during the day

“Those sustained positions you’re in at night are often what contribute to hip pain — not sleeping itself,” says Dr. Melear. “Walking is pretty much the opposite of what you do when you lie down and rest. It gets you out of prolonged positions and promotes normal mechanics of the hips.” Even short walking breaks throughout the day can help your hips stay mobile and make nighttime positioning more comfortable.

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Martinez, R., Reddy, N., Mulligan, E. P., Hynan, L. S., & Wells, J. (2019). Sleep quality and nocturnal pain in patients with hip osteoarthritis. Medicine, 98(41), e17464. doi:10.1097/md.0000000000017464

2. Whale, K., & Gooberman‐Hill, R. (2022). The importance of sleep for people with chronic pain: Current insights and evidence. JBMR Plus, 6(7). doi:10.1002/jbm4.10658

3. Radwan, A., Fess, P., James, D., Murphy, J., Myers, J., Rooney, M., Taylor, J., & Torii, A. (2015). Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials. Sleep Health, 1(4), 257–267. doi:10.1016/j.sleh.2015.08.001

4. Berkel, van, Dieuwke Schiphof, Waarsing, J. H., Jos Runhaar, John, Patrick J.E. Bindels, & Sita M.A. Bierma-Zeinstra. (2023). Nocturnal pain and fatigue in middle-aged persons with hip symptoms suspected to be osteoarthritis, is there a link in 10-year follow-up of the CHECK study? Osteoarthritis and Cartilage Open, 5(3), 100363–100363. doi:10.1016/j.ocarto.2023.100363

5. Yoji Toyomura, Ohashi, Y., Fukushima, K., Uchida, K., Akira Norisugi, Osaki, Y., Uchiyama, K., Naonobu Takahira, Inoue, G., & Masashi Takaso. (2026). Nocturnal pain and pain sensitivity–related symptoms are associated with poor sleep quality in patients with hip osteoarthritis. Osteoarthritis and Cartilage Open, 8(2). doi:10.1016/j.ocarto.2026.100817

6. Alaia, M. J. (2020, July). Hip Strains. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/hip-strains/

7. Johnson, R. (2021, June). Approach to hip and groin pain in the athlete and active adult. UpToDate. https://www.uptodate.com/contents/approach-to-hip-and-groin-pain-in-the-athlete-and-active-adult?search=Approach%20to%20Hip%20and%20Groin%20Pain%20in%20the%20Athlete%20and%20Active%20Adult&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

8. Paoloni, J. (2021, October). Approach to the adult with unspecified hip pain. UpToDate. https://www.uptodate.com/contents/approach-to-the-adult-with-unspecified-hip-pain

9. Robson, E. K., Hodder, R. K., Kamper, S. J., O’Brien, K. M., Williams, A., Lee, H., Wolfenden, L., Yoong, S., Wiggers, J., Barnett, C., & Williams, C. M. (2020). Effectiveness of Weight-Loss Interventions for Reducing Pain and Disability in People With Common Musculoskeletal Disorders: A Systematic Review With Meta-Analysis. The Journal of Orthopaedic and Sports Physical Therapy, 50(6), 319–333. doi:10.2519/jospt.2020.9041

10. Sheth, N. P., & Foran, J. R. H. (2022, February). Hip Bursitis. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/hip-bursitis/