Sleep is probably the last thing you’d think of that could hurt your knees. So, if achy knees are waking you up at night or making it hard for you to fall asleep, you may be wondering what’s going on.

Knee pain affects one in four adults, and nighttime knee pain can make things worse during the day. “Knee pain at night can set up a vicious cycle of waking up and not being able to get back to sleep — this lack of sleep can, in turn, increase pain day and night,” says Caitlin Shaw, PT, DPT, a physical therapist at Hinge Health. But take heart: There’s a lot you can do to ease the pain so you can sleep well and feel better during your waking hours, too.  

Here, learn more about what causes knee pain while sleeping and how to relieve it, especially with exercises from Hinge Health physical therapists.

Why Is Knee Pain Worse at Night?

Nighttime knee pain can be caused by any condition that results in pain during the day, such as injuries like knee sprains, bursitis, or tendinitis, as well as doing too much of an activity without adequate preparation, wearing worn-out or unsupportive shoes, or medical issues. One of the most common conditions resulting in knee pain while sleeping is osteoarthritis. According to one study, 75% of people with knee or hip osteoarthritis reported pain at night. Gout, another type of arthritis, can also cause nighttime knee pain, even though it is typically related to foot pain.

No matter what’s contributing to your knee pain, it can be worse at night for a variety of reasons, such as:

Fewer distractions. You don’t have as much time to think about your knee pain when you’re busy with work, family, friends, errands, and chores. “We tend to have more down time at night, which can make us more inclined to focus on our symptoms,” says Dr. Shaw. “It’s like, ‘Oh, yeah, now I feel it.’”

Less movement. During the day, you’re more on the go, and all that activity keeps your joints lubricated. There’s more blood flow, bringing nutrients to your joints. But at night, when you move less, “you don’t have as much lubrication,” says Dr. Shaw. “You don’t have the fluid flowing through the joint, so symptoms can become more noticeable.” Staying in one position while you sleep can place different stresses on the joint depending on whether the knee is straight or bent. The lack of movement can also cause the knee joint and surrounding muscles to become tight and stiff, increasing discomfort.

Lack of sleep. Sleep is your body’s time to repair and recover. This healing time can help to reduce pain intensity, but if you’re not getting enough sleep for any reason, you’re missing out on this opportunity and may experience more pain. Research shows that the less you sleep, the more intense your pain may be, including at night. This can set up a vicious cycle of more pain and less sleep, which is why it’s crucial to address nighttime knee pain. 

How to Cope When Knee Pain Strikes at Night

Here are some strategies for knee pain relief at night, along with ways to prevent it.

Add pillows. Strategically placing pillows around a sore knee joint can reduce pain while you sleep. If you’re a side sleeper, place a pillow between your knees to relieve pressure. If you sleep on your back, place a pillow or bolster underneath your knees because a slight bend minimizes forces on your knees.

Stay warm. Cold weather can make joints feel stiffer and more painful, especially if you have arthritis. Layer on the blankets to keep joints warmer, more flexible, and less painful.

Use heat and ice. Before bed, heat your knee for 15 to 20 minutes. “Heat brings blood flow to the area, which helps bring nutrients needed for healing,” says Dr. Shaw. Then, ice your knee for 10 to 15 minutes to reduce inflammation. You can also use heat, ice, or both if you wake up at night with knee pain.

Practice deep breathing or meditation. “When knee pain strikes at night, it can send you into that fight-or-flight mode, making it harder for you to fall back to sleep,” says Dr. Shaw. “Breathwork or meditation can calm everything down so you can get back to sleep.” You can also use these practices before bed to help you fall asleep.

Try over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for knee pain at night. It’s important to make sure that you are safely able to take these medications, based on your medical history.

Many of the above exercises aren’t traditional static stretches where you hold a position. Instead, they are dynamic stretches, which means they are movement-based. Dynamic stretching increases blood flow to warm up muscles around the knee joints and lubricate the joints to prevent stiffness and pain. You can do all of the exercises before bed to minimize nighttime pain. If you wake up in the middle of the night with pain, try the last two moves to see if you can ease the pain without getting out of bed. 

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.

PT Tip: Create a Relaxing Bedtime Routine

“Establishing a sleep ritual before bed can decrease stress levels so you sleep better,” says Dr. Shaw. Stress not only makes it harder to sleep, but it also increases pain, which can also affect the quality and quantity of your sleep. Instead, get into the habit of winding down before you turn off the lights. Take a warm bath or shower. Read a book. You can even turn some of the strategies above into a relaxing bedtime routine. For example, heat your knee, then do some gentle stretching. Next, ice your knee, and finally, meditate or do some deep breathing. Then, tuck in.

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. Bunt, C.W., Jonas, C.E., and Chang, J.G. (2018). Knee Pain in Adults and Adolescents: The Initial Evaluation. American Family Physician. 98(9):576-585. https://www.aafp.org/pubs/afp/issues/2018/1101/p576.html 

2. van Berkel, A.C., Ringelenberg, R., Bindels, P.J.E., Bierma-Zeinstra, S.M.A., and Schiphof, D. (2023). Nocturnal pain, is the pain different compared with pain during the day? An exploratory cross-sectional study in patients with hip and knee osteoarthritis. Family Practice. 40(1):75-82. doi:10.1093/fampra/cmac074

3. Sivertsen, B., Lallukka, T., Petrie, K.J., Steingrímsdóttir, Ó.A., Stubhaug, A., and Nielsen, C.S. (2015, August). Sleep and pain sensitivity in adults. Pain. 156(8):1433-1439. doi:10.1097/j.pain.0000000000000131