For the 50% of American adults who suffer with musculoskeletal (MSK) pain, discomfort can make it hard to fall asleep and stay asleep. Conditions like hip and back pain flare up at night, causing strain and forcing sufferers to delay their bedtimes. Lack of sleep has a massive impact on your daily life as well, worsening productivity, impairing mental and emotional health, and negatively impacting wellbeing. In addition to discomfort, chronic pain may also cause residual worry and stress that makes it difficult to fall asleep in the first place.

Indeed, one of the most common causes of insomnia is MSK pain. The phenomenon is so prevailing, it even has its own name: “painsomnia.” Sleep deprivation and pain are bidirectional, meaning they uniquely impact one another — while MSK pain can be the cause of a bad night’s rest, the reverse is also true; poor sleep patterns can take a toll on your joints.

Why is joint pain worse at night?

Patients with MSK pain often note that their discomfort is worse at night. This could be because our muscles and joints have undergone another day of strain and pressure. It could be a result of hours of standing, sitting, or sustained posture. However, researchers have several theories to explain increased pain after sundown.

For example, the body’s circadian rhythm may be responsible. Patients with arthritis release less of the anti-inflammatory chemical cortisol during the night, increasing inflammation-related pain. The nighttime release of pro-inflammatory cytokines (proteins which mitigate infections) may also intensify arthritic pain. When a high volume of cells travel to inflamed tissue, the body’s immune system responds, compromising comfort. Beside this, the body also releases a higher level of prolactin at night, which can spike inflammatory cytokines.

How can I fall asleep while in pain?

There's hope for managing your sleep better. While you may have developed a pattern of poor sleep that is hard to break, simple lifestyle changes can make a difference. The key to tackling pain at night is to create healthy habits and improve your sleep environment. By making these changes, both the quality and quantity of your sleep can improve. If pain keeps you awake, here are things you can do to ease your symptoms and get some much-needed rest.

1: Stretch at night to ease pain

While it may seem counterproductive to wake your muscles before a long rest, stretching before bed can lessen the stiffness in your joints. While sleeping, your body is more constricted as it lies flat for hours and moves infrequently. It’s important to give your joints a healthy stretch before undergoing hours of stillness.

In doing so, your joints loosen up and become more receptive to restful sleep. Stretching has likewise been shown to improve sleep quality by helping people fall asleep faster, as well as waking up more refreshed.

Never fear, your nightly stretches don’t need to be invasive. Get started with simple exercises to improve your sleep quality:

• Stand straight with your legs together, then bend forward from your waist, reaching for the floor. After fifteen seconds of letting your arms and head hang loosely, look up and place your hands on your hips — then slowly rise back up again. Repeat this once.
• Stand straight with your legs together, and raise your right arm above shoulder height while bending your right knee until your forearm touches your knee—hold this position for 10 seconds; then repeat on the opposite side.
• Lie face down on the mat; put your right hand behind your head and lift your left leg off the mat—hold this position for 20 seconds before switching sides.
• Lie on your back with your knees bent. Slightly tilt your pelvis to reduce any gap between your back and the surface. Place your hands on your ribcage, and practice inhaling to expand or inflate your ribcage and exhaling to retract it. Perform 5 times.

2: Keep a cool room temperature

Try setting your room temperature at or around 65 degrees. Keeping your body at a cooler temperature prompts the production of melatonin, a hormone that helps you fall asleep and stay asleep more easily.

It may help to keep the AC on when you're at home, but only turn it on when you need it at night before bedtime; otherwise, use an electric fan or two to circulate air in the room and keep things cool. If possible, make sure your bedroom is well ventilated by opening windows. If you live in a colder climate, putting your heater on an intermittent timer may help your home achieve optimal temperatures at night.

Another trick may be sleeping without sheets or blankets. This allows for better airflow throughout the night and makes it easier for you to cool down quickly once under covers. You should also try removing any large or heavy items from your near proximity, where you tend to sleep—even thick pillows can add heat against your body while sleeping!

3: Utilize warm compresses before sleep

Warm compresses can be helpful when you're experiencing symptoms of pain. While not a long-term solution, the heat will help relieve your joint stress and allow for a better night's sleep. You can use a hot water bottle or heating pad, or simply apply heat with a washcloth or warm shower/bath prior to bedtime.

4: Try mindfulness meditation to fall asleep faster

Research has shown that mindfulness meditation can help you fall asleep faster, stay asleep longer, and improve your sleep quality. The theory behind this practice is that it will help you focus on your breath, while slowing down the chatter in your mind. When it’s time to go to bed, you won’t be dwelling on pain, obligations, or conflicts. Mindfulness has even been known to promote positive feeling in general, which can greatly improve sleep quality.

It may take some practice before you can meditate effectively (the Mayo Clinic recommends starting with just 5 minutes a day), but with time and patience, it can become an invaluable tool for easing joint pain at night.

5: Give your mattress a makeover

The right mattress is one of the best ways to ensure that you sleep comfortably, wake up with fewer aches and pains, and that your physical health is intact. It's also an affordable step for improving the quality of your sleep at home without making major changes or seeking intense clinical interventions like injections, surgery, and imaging. Different types of mattresses are suitable for different conditions, so be sure to do proper research before finding one which suits your needs.

If upgrading your mattress is not in your scope, try new bedding with a cooling cover or pad/gel insert. This may help regulate temperature throughout the night as different parts of your body warm and cool at different rates. Cooling fabrics keep temperatures even while allowing air circulation, optimizing comfort and resulting in better rest overall — which is critical for MSK sufferers.

Finally, try a new pillow or pillowcase. Your pillows should always be clean and free from lumps so they can hold your neck and head evenly while sleeping. A better, more supportive pillow may result in improved rest.

6: Find out if there's a better way of treating your pain

If you haven't already, make sure your clinical care team is one who specializes in MSK. Intense joint pain should never be treated by professionals without the licensed standing as a Doctor of Physical Therapy (physical therapists) or either Medical or Osteopathic Doctors. While physical therapists are the gold standard for treating MSK conditions, plenty of solutions in the market offer health coaches for treating joint care. However, health coaches significantly lack the licensure and education for prescribing clinical solutions to MSK pain.

When it comes to pain management, medications are often the first step for doctors treating patients with MSK joint pain. But there are risks associated with many of these drugs: side effects like nausea or drowsiness can cause problems during work and sleep times, so it's important to consider all possible side effects before opting for medication as your primary solution. In some cases (like surgery), medication isn't even an option—and if this is true for you, a physical therapist might play an important role in easing your symptoms while helping facilitate lifestyle changes that will strengthen muscles and reduce stress on joints over time.

7: Increase physical movement during the day.

Science has concurred time and time again that daily movement is the best step to take for your health. Exercise increases blood flow and oxygen to muscle tissue, which is important for recovery from injury and prevention of pain. It helps improve muscle strength, range of motion, and balance — all of which support healthy joints.

For pain sufferers, exercise may seem unthinkable. You don’t necessarily need to run, jump, and lift to see improvement. The support offered through physical therapy can improve your odds against pain by focusing on flexibility, strength and endurance of muscles around weak or injured joints. Physical therapy is for all ages and stages of joint pain. Performing physical therapy daily will make the greatest impact on your pain and improve fatigue, depression, and stress.

Find other ways to improve sleep:

• 5 Stretches for a Frozen Shoulder
• 3 Exercises to Relieve Your Tech-Neck
• How MSK Problems Affect Sleep

With a solution like Sword Health, a physical therapist can help develop an exercise program tailored specifically to your needs, especially if you have a special condition like arthritis or back pain, which makes exercising more difficult than usual. A comprehensive approach to treating joint pain, including diet, exercise, and lifestyle changes, can help you get better sleep. When you employ these habits daily, you'll sleep longer, deeper, and more soundly.

You’re not alone. Joint pain and sleep deprivation may be part of a bigger picture.

When it comes to your MSK joint pain, remember that you're not alone. Millions of people globally are up at night, suffering through debilitating “painsomnia.” A large part of the battle is learning how to work with—and around—your condition. Understanding what's really going on in your body can improve your mental state and coping skills, and help you take the necessary steps to better sleep (and in turn, better health).

Hopefully, you have new ideas for managing your joint pain at night. If you're currently struggling with MSK pain, take heart in the fact that there are many ways to address it. Your joints may be trying to tell you something about your lifestyle, so it's time to stop ignoring them!

Learn more about how Sword can lower your company’s MSK costs and help individuals live fuller, healthier, and happier lives. See if you are covered.