Pain subsides – why pain is often worse at night

Sleep and pain – a vicious circle

A night with little sleep also has an impact on the next day. People who suffer from pain in particular know that this is often more noticeable during the day if sleep is restless. This is because our body is less able to use pain-relieving mechanisms when we do not get enough rest. In addition, inflammatory processes that occur in the body, for example in the context of rheumatism or endometriosis, can be exacerbated by a lack of sleep.

These effects not only affect our mood but also our general well-being. A vicious circle is created: a day already marked by pain is followed by a night of disturbed sleep, which in turn leads to an increase in pain the following day.

How pain affects our sleep at night

But what mechanisms are actually behind this vicious circle and how exactly does the pain affect our sleep?

Waking up in pain

While we sleep, our brain is partially shielded from external stimuli. But just like loud noises that can wake us up, severe pain can also trigger an awakening reaction. Those affected can be woken up by sudden, severe and long episodes of pain. This is further facilitated by the fact that people move on average more than 30 times a night. Movement-related pain is particularly likely to cause an awakening reaction. The result: constant waking makes deep sleep phases less likely, sensitivity to pain increases, the immune system is weakened and healing is delayed.

Stress due to constant pain

(Chronic) pain means constant stress for the body, but also for our psyche. Between doctor's visits, persistent lack of energy, cancelling appointments and the associated guilty conscience, we have to carefully plan the remaining energy throughout the day in order to cope with it.

This is a permanent stress load for our organism, which can have a negative impact on various functions of our body. For example, constant stress can make it harder to fall asleep and cause us to wake up more often during the night. In addition, healing processes in the body are inhibited and our sensitivity to pain increases.

Brooding and circling thoughts

The persistent pain and the associated limitations can be extremely stressful for those affected and lead to feelings of hopelessness, anxiety and depressive symptoms. It is therefore not surprising that these stresses and worries become constant companions, which are just as persistent as the pain itself. The constant brooding about the pain and the catastrophizing thoughts such as "This will never get better" keep those affected awake at night. Those affected then often ask themselves the question: "How can I stop the carousel of thoughts ?"

Less activation during the day

People who suffer from chronic pain often tend to be less active during the day because they participate less in social and physical activities such as dates or hobbies. But exercise and social interactions also have a positive effect on sleep: physical activity increases the so-called sleep pressure. This makes it easier to fall asleep faster in the evening. In addition, daylight and fresh air play a crucial role in our sleep-wake rhythm. Although it often takes some effort - a short walk around the block, a coffee with a friend, sitting on a bench and holding your face in the sun: all of these can reduce stress and promote fatigue.

For more tips, check out our blog article on good sleep hygiene. Sleep hygiene includes many strategies that promote healthy and restful sleep.

Why is my pain worse at night?

The perception of pain can often fluctuate throughout the day. But for many sufferers, the pain seems to be permanently increased at night. There can be several reasons for this:

The hormone level

One reason for this is our hormone levels, which follow a day-night rhythm. The production of our anti-inflammatory hormone cortisol reaches its lowest point around midnight. This can increase the intensity of pain in certain illnesses, making us feel the pain even more intensely.

Increase in nerve pain throughout the day

Nerve pain, such as that which occurs in diabetes mellitus, multiple sclerosis or shingles, can fluctuate over time. The intensity of the pain increases throughout the day and is often particularly bad during the night.

Less distraction at night

Our brain prefers to direct our attention to stimuli that require a quick response. This includes pain, which primarily serves a protective function for humans. If, for example, you touch a hot stove, the pain causes us to quickly pull our hand away. This quick action is particularly useful in the case of acute pain. However, for people with chronic pain, the constant increased attention to the pain can lead to severe stress. During the day, those affected can mitigate the perception of pain through everyday activities such as work, school, hobbies and appointments. Such distractions are eliminated at night, so that the pain comes to the fore and can be perceived as stronger and more prominent than usual.

Are you regularly unable to sleep because of the pain? This requires practice, because it is actually possible to direct your attention in a targeted manner. This distraction does not necessarily have to take the form of an external stimulus - an internal focus of attention, for example in the form of imaginary journeys or pleasant memories (such as your last holiday) is also conceivable. Or you could simply put on some nice, calm music and listen to the sounds - listening to music can even reduce the sensation of pain.

The most important mechanisms of mutual influence of pain and You will find sleep together again in this figure:

Support options for pain at night

We have seen that pain and sleep are closely intertwined. Therefore, good sleep hygiene helps you cope with pain, and effective pain management in turn promotes restful sleep. But what does good pain management mean ? That is easier said than done. Especially with chronic pain, the trigger is often no longer identifiable or cannot be cured. Nevertheless, there are many options and strategies to positively influence your own attitude towards and the way you deal with pain.