Why Is Neuropathy Worse at Night?
Neuropathy, a nerve pain condition, is typically worse at night. It can seriously disrupt sleep, which can make you more aware of the pain and make good sleep even more difficult.
Khosro Farhad, MD, a Mass General Brigham neurologist, says there are things you can do to manage nighttime nerve pain. Dr. Farhad cares for patients at Massachusetts General Hospital and Wentworth-Douglass Hospital.
He explains why neuropathy is worse at night, gives tips for easing the pain, and offers guidance on when to see your primary care provider (PCP).
What is neuropathy?
Neuropathy is a disease of the nerves. There are two systems of nerves in your body:
Central nervous system, which includes your brain and spinal cord
Peripheral nervous system, which includes all other nerves in your limbs, organs, skin, and elsewhere in your body
What causes neuropathy?
Neuropathy affects peripheral nerves, so it’s often called “peripheral neuropathy.” Many underlying conditions can cause neuropathy, including:
Autoimmune conditions such as Guillain-Barre syndrome, lupus, rheumatoid arthritis, and Sjogren’s syndrome
Diabetes and prediabetes (borderline diabetes)
Genetic conditions
Bacterial or viral infections such as COVID, hepatitis C, Lyme disease, and herpes family viruses
Toxin exposure and some heavy metal toxicities
Vaccination reactions
Neuropathy symptoms
Neuropathy can cause pain and loss of sensation in almost any area of your body. These sensations may be mild or severe and feel:
Achey
Burning or cold
Electric
Itchy
Sharp
Shooting
Tingling
“Neuropathy symptoms typically fluctuate,” says Dr. Farhad. “You’ll likely have good and bad days with nerve pain.” Patients with neuropathy may experience numbness, nerve pain, problems with balance, coordination, and movement.
Nerves also control and regulate many automatically controlled bodily functions (autonomic functions). So certain types of neuropathy can also lead to problems with autonomic functions like:
Blood pressure and heart rate control upon standing or exertion
Digestive tract motility
Sexual and bladder function
Sweating and temperature regulation
Why does neuropathy get worse at night?
For many people with neuropathy, pain is more manageable during the day but flares up at night. Why is nerve pain worse at night?
“It isn’t known for sure, but there are some hypotheses,” says Dr. Farhad.
Gate control theory of pain
The gate control theory of pain may be the most likely explanation for worse nighttime nerve pain. This theory describes how your body may process pain signals. It says that nerves in your spine act as gatekeepers that allow pain signals to travel to your brain — or not.
If the gates are open, your brain receives the pain signal from your peripheral nerves, and you feel pain. If the gates are closed, your brain doesn’t receive the pain signal, and you don’t feel pain (or you feel less pain).
Several things can affect whether the pain gates in your spine open or close, such as:
Movement: Activity may close the gates.
Physical sensations and certain types of pressure: Pleasant physical sensations, such as a massage or gentle heat, may close the gates.
Stress: Anxiety and stress may open the gates and worsen nerve pain.
At night, when you’re lying in bed, the lack of movement may open the gates to more intense signals from nerve pain.
“We know that cold worsens most types of neuropathy pain,” says Dr. Farhad. “So, if your house or bedroom is cooler at night, the lower temperature may worsen nerve pain.”
Natural body rhythms
Dr. Farhad says another hypothesis about nighttime pain involves natural body rhythms that may increase your pain threshold during the day and decrease it at night.
During the day, your body may naturally produce certain hormones and chemicals that suppress pain. At night, your body makes less of these chemicals.
How to prevent and manage nerve pain at night
There are several ways to lessen nighttime neuropathy pain. Dr. Farhad suggests trying:
A warmer bedroom. While many people sleep better in a cooler room, a cold bedroom can cause neuropathy pain to flare up. Make sure you’re warm enough to be comfortable. If you use a fan in your bedroom, aim it away from your body.
Good sleep hygiene. Neuropathy can disrupt your sleep, but an unrestful pre-bed activity or sleeping space just makes things worse. Create a relaxing nighttime routine. Stop using screens an hour or two before going to bed. For good sleep hygiene, make your bedroom as dark and quiet as possible.
Soft socks. For some people with neuropathy, the touch of sheets and covers can make pain worse. If your feet get painful at night, try wearing soft socks. Dr. Farhad also recommends diabetic socks, which are available in most drugstores.
Timing your pain medication. “You may need only a partial dose or no pain medication during the day,” says Dr. Farhad. But if your pain is worse at night, take a dose of pain medication in the evening before you go to bed.
Topical pain relievers. Pain relievers you rub on your skin may help with nighttime pain. There are several over-the-counter options you can try such as capsaicin or lidocaine.
When to see your provider about nerve pain at night
If neuropathy is disrupting your sleep and simple measures aren’t helping, it’s time to see your primary care provider (PCP), says Dr. Farhad.
“Anyone with neuropathy needs to be evaluated for causes because so many are treatable,” he says. “Nerves have the capacity to regenerate, so treating the underlying cause can bring a dramatic improvement in pain.”
