Why Is Pain Worse at Night? 7 Somatic Exercises to Reduce Pain and Improve Sleep

If you’ve ever found yourself tossing and turning in bed, asking, “Why is my pain worse at night?”  you’re not alone. Many women I work with feel relatively okay during the day, only to be hit with leg pain, hip pain, shoulder pain, or even throbbing aches in their feet once the lights go out.

This nighttime pattern can be frustrating and exhausting. Not only are you uncomfortable, but lack of sleep also makes pain feel worse the next day, creating a vicious cycle of pain and exhaustion.

The good news? In many cases, this doesn’t mean your body is damaged. It’s actually a protective response from your nervous system. It's part of what’s often called mind-body syndrome or neuroplastic pain. Once you understand why your brain is creating pain at night, you can begin to calm it and reclaim your rest.

Common Types of Nighttime Pain

When women search online for help, some of the most common pain complaints at night include:

• Leg pain at night (including throbbing leg pain, aches in the thighs, or restless legs)

• Hip pain at night (often making it hard to lie comfortably on either side)

• Back pain at night (especially lower back pain)

• Shoulder pain at night (such as rotator cuff discomfort)

• Hand and wrist pain at night (numbness, tingling, or stiffness)

• Ankle and foot pain at night (sometimes sharp, sometimes achy)

If you’ve ever wondered “how to relieve severe leg pain at night,” “why do my legs pain at night,” or “how to relieve hand pain at night,” — the answer isn’t always about posture, position, or the perfect mattress or pillow. More often, the real driver is stress, fear, and a dysregulated nervous system.

Why Pain Feels Worse at Night: The Mind-Body Model

Let’s look at a few reasons the nervous system often ramps up pain at night:

1. Nighttime stillness removes distractions

During the day, your brain is busy; it's working, caring for others, and running errands. At night, when the world gets quiet, the nervous system finally has space to “process.” That can bring suppressed fear, grief, or stress to the surface, often showing up in the body as pain.

2. Fear of sleep itself can activate protection

If you’ve had nights of pain or insomnia before, your brain may now anticipate nighttime as threatening. Instead of winding down, your nervous system goes into a hyper-alert mode. Nighttime can trigger scanning for danger, creating pain, or keeping you awake “just in case.”

3. Blood flow and posture changes

When you lie down, blood flow redistributes, and your postural muscles are no longer as active. For someone with a sensitive nervous system, this shift can feel unsafe, leading the brain to interpret sensations as pain.

4. The survival brain struggles with stillness

From an evolutionary perspective, being still and unconscious (as in sleep) was risky. During times of threat, staying awake was necessary for short periods of time until danger passed.

In our modern world, our nervous system can feel like it's always under threat. If your nervous system is already dysregulated from stress, trauma, or perfectionism, the act of lying down can feel unsafe, even if you’re perfectly safe in bed.

How the FIT Criteria Explain Night Pain

One of the best ways to recognize stress-related or mind-body pain is using the FIT criteria:

F – Functional

Night pain often doesn’t match structural issues.

• Pain flares without a clear injury.

• Pain spreads over time; so maybe it started in your hip, then radiates to your knees or your back.

• The quality can be tingling, burning, or electric — sensations that don’t always line up with structural damage.

• Imaging often shows “degeneration” or “wear and tear,” but these findings are common in people without pain, too.

I – Inconsistent

Night pain is a classic example of inconsistency.

• Pain comes at night, but not as much during the day.

• Some nights you’re fine, other nights the pain is unbearable.

• Symptoms change depending on stress, fatigue, or even how worried you are about sleeping.

T – Triggered

Nighttime pain is often triggered by:

• Stressful days that haven’t been processed.

• Fear of not sleeping (“What if tonight is another bad night?”).

• Harmless positions (lying down, turning over).

• Even thinking about pain before bed can trigger it.

How the 5 F’s Keep Nighttime Pain Going

Many women with nighttime pain also fall into the 5 F’s cycle:

• Focusing – Lying in bed, scanning the body, waiting for pain to hit.

• Fighting – Forcing yourself to push through, clenching against the pain.

• Fixing – Googling mattresses, pillows, supplements, stretches, or Googling “how to relieve hip pain at night” at 2am.

• Fearing – Worrying that the pain means something is seriously wrong.

• Frustrated – Feeling angry at your body for betraying you.

The more we get stuck in this cycle, the more the nervous system stays on high alert and the harder it is to get the rest and healing we need.

Insomnia: When the Nervous System Is Afraid to Settle

If you struggle with both pain and insomnia, it’s not a coincidence. Insomnia is often the nervous system saying:

“It’s not safe to go offline. Stay alert.”

This hypervigilance makes it nearly impossible for the body to fully relax. Instead of entering deep sleep (where repair and recovery happen), your brain stays stuck in lighter states of awareness. That’s why you may wake up exhausted, even if you technically “slept.”

The cycle looks like this:

Stress → Nervous system on guard → Pain at night → Poor sleep → More stress → More pain → Less sleep

How to Relieve Nighttime Pain (Without More Fixing or Fighting)

The key is not to “fight” the pain but to calm the nervous system, create safety, and retrain the brain to see nighttime as restful instead of threatening. Here are a few somatic exercises you can try:

1. Somatic Orienting

• Sit or lie comfortably.

• Gently look around the room, letting your eyes land on safe, neutral objects.

• Notice colors, shapes, and textures.

• Let your body register: “I am safe right here, right now.”

This simple practice pulls you out of thought loops and into the present.

2. Breathwork for Safety

Try 4-7-8 breathing before bed:

• Inhale for 4 counts

• Hold for 7 counts

• Exhale slowly for 8 counts

This signals to your nervous system that it’s time to relax.

3. Body Scanning with Compassion

Instead of scanning for pain, scan with curiosity:

• Notice your feet. Say internally: “Thank you for supporting me today.”

• Notice your legs. “I appreciate your strength.”

• Move slowly up through the body, replacing judgment with gratitude.

This builds connection instead of fear.

4. Pendulation (a fancy word for moving back and forth)

Spend a few seconds noticing the pain, then move your attention to something that feels neutral, or even good. This is another way to train your brain that you are safe, and when your brain feels safe, pain reduces and sleep follows.

• Notice a body sensation that feels good. If it's hard to find one, you can create one. This can mean rubbing a soft blanket with your hand, noticing your breath, or gently massaging somewhere that is pain-free.

• Shift your attention to the pain. Give yourself a gentle reminder, "I am safe."

• Move your attention back to something positive.

• Do this several times to teach your brain that it can reduce the pain.

This builds connection instead of fear.

5. Gentle Movement Before Bed

If your legs or hips ache at night, try a few minutes of:

• Cat-cow stretches for the spine

• Supine twists to release tension

• Legs up the wall pose to calm circulation and the nervous system

6. Journaling Stress Before Sleep

Set a timer for 5–10 minutes and write freely about any worries, stress, or annoyances from the day. Don't put pressure on yourself to write it nicely; just allow it to come out. You can even rip it up and throw it away afterward.

This tells your brain: “I’ve acknowledged this. It’s safe to release it and rest now.”

7. Somatic Tracking

• Sit or lie in a comfortable position.

• Bring gentle attention to the area of your body where you notice pain, tension, or sensation.

• Instead of judging or resisting it, simply observe with curiosity: What does it feel like: warm, tight, pressure, buzzing, achy, tingly?

• Notice if the sensation changes in intensity, shape, or location as you observe it.

• Remind yourself: “This is my nervous system creating sensation. My body is safe.”

This practice helps retrain the brain to interpret sensations as non-threatening, reducing the fear-pain cycle over time.

Common Nighttime Pains and What They Mean in the Mind-Body Model

Moving Past Nightime Pain

If you’ve been wondering, “Why is my pain worse at night?” or Googling, “How to relieve leg pain at night,” the answer may not lie in your mattress or pillow. More often, night pain is a sign of a protective nervous system response and is part of the mind-body connection.

By learning to recognize the FIT criteria and the 5 F’s, you can start to see your symptoms for what they are: not signs of damage, but signals of stress. And when you calm the nervous system through orienting, breathwork, pendulating, journaling, somatic tracking, and gentle movement, you give your body the safety it needs to heal and finally, to rest.