Why does pain feel worse after a bad night’s sleep?

If you live with persistent pain, what’s the bet you’ve already been given plenty of advice about sleep?

“Have you tried going to bed earlier?”

“Maybe you need a better mattress?”

“Have you tried relaxing before bed?”

Usually, people mean well. But when you’re already exhausted, uncomfortable and struggling to get a decent night’s sleep, advice like this can feel rather frustrating. If it were that simple, you’d probably have sorted it out by now.

The reality is that pain and sleep have a complicated relationship. Pain can make it difficult to fall asleep or stay asleep, and a poor night’s sleep can leave you feeling more sensitive to pain the following day.

You might recognise the pattern. You have a particularly uncomfortable night, wake up feeling stiff and sore, and even ordinary activities seem harder than usual. By the afternoon, you’re exhausted, perhaps a little irritable, and already worrying about how you’ll sleep tonight.

It’s an unpleasant cycle, but understanding what’s happening can help you find ways to make things a little easier.

Why does a bad night’s sleep make pain feel worse?

You may have noticed that the same pain feels quite different depending on how well you’ve slept.

On a good day, you might be able to get on with things without paying it too much attention. After a night of broken sleep, however, that familiar ache might suddenly feel much more intense.

Why?

Sleep does far more than help us feel rested. It plays an important role in how our nervous system processes sensations, manages stress and regulates pain.

When you’ve had very little sleep, your nervous system may become more sensitive to signals from your body. At the same time, the brain’s ability to regulate those signals can be affected.

You’re also likely to have less energy, less patience and fewer resources available to deal with everyday challenges.

The important thing to understand is that more pain doesn’t necessarily mean more damage.

Your pain is real, but its intensity isn’t determined solely by what’s happening in your muscles, joints or other tissues. Your nervous system, sleep, stress levels and general wellbeing all influence how strongly you experience it.

This doesn’t mean that every increase in pain is harmless or should be ignored. It simply means there may be more going on than an injured or deteriorating body part.

What does the research tell us?

Research supports the relationship between poor sleep and persistent pain.

A large systematic review published in 2024 examined studies involving more than 116,000 people. Researchers found that people experiencing sleep problems were more likely to develop chronic musculoskeletal pain later on.

The relationship also appeared to work in the other direction, with chronic pain associated with certain subsequent sleep difficulties, although the long-term evidence for this was less conclusive.

This doesn’t mean that poor sleep inevitably causes chronic pain, or that one bad night will make your condition worse.

What it tells us is that sleep deserves attention when we’re trying to understand and manage persistent pain.

And importantly, it’s only one part of the picture.

What if the pain itself is keeping you awake?

This is where things can become particularly frustrating.

Perhaps you struggle to find a comfortable position. You finally settle, only to wake up an hour later because your hip, shoulder or back is aching.

Maybe turning over hurts, or you wake repeatedly without being entirely sure why.

And then there’s the worrying.

You look at the clock. It’s 2:30am. You need to get up at seven, and you know from experience that tomorrow is likely to be harder if you don’t sleep.

So you start thinking:

“If I don’t sleep, my pain will be worse tomorrow.”

“How am I going to manage work?”

“I really need to fall asleep now.”

Unfortunately, the harder we try to force ourselves to sleep, the more alert we can become.

Over time, bedtime itself can start to feel stressful. Instead of associating your bed with rest, you begin associating it with discomfort, frustration and the anticipation of another difficult night.

This isn’t something you’re deliberately doing, and it’s certainly not a case of simply thinking the wrong thoughts. It’s a response that the nervous system can learn over time.

The good news is that learned responses can also change.

Why do I sometimes wake up feeling worse than when I went to bed?

This is a particularly common concern, especially if you experience back, neck or joint pain.

You go to bed feeling reasonably comfortable, but wake up stiff, sore or struggling to move normally.

It’s understandable to wonder whether something has become worse overnight.

Sometimes there are physical reasons for morning discomfort, including the positions you’ve slept in, prolonged stillness or an underlying inflammatory condition.

But poor sleep can also increase pain sensitivity, meaning sensations that would normally be manageable may feel stronger first thing in the morning.

And if you’ve experienced painful mornings repeatedly, you may begin to anticipate them. You might find yourself checking how your back feels before you’ve even got out of bed.

That expectation can add another layer of tension and alertness.

Waking up with more pain doesn’t automatically mean you’ve caused damage during the night.

Depending on your condition, gentle movement, a warm shower, breakfast, daylight or simply allowing yourself time to get going may help.

You don’t necessarily need to force yourself through the pain, but you may not need to treat every uncomfortable morning as a setback either.

If morning pain is new, progressively worsening or accompanied by other concerning symptoms, it should be assessed rather than assumed to be sleep-related.

So, will improving my sleep make my pain go away?

Not necessarily, and it’s important to be clear about that.

Sleep isn’t a magic cure for persistent pain.

If you have an underlying medical condition, an injury or another factor contributing to your symptoms, improving sleep won’t automatically resolve it.

However, better sleep may help reduce some of the sensitivity, fatigue and emotional strain that can make living with pain more difficult.

You may find you have more energy for exercise, rehabilitation, work or simply doing the things you enjoy.

And there’s something else worth remembering:

You don’t need to sleep perfectly to make progress with pain.

If you’re already struggling with insomnia, the last thing you need is another reason to worry about not sleeping enough.

Pain can improve even while sleep remains difficult. Both can be addressed together, without making one a condition for improving the other.

What can you actually do when pain is affecting your sleep?

Rather than trying to follow every piece of sleep advice you’ve ever heard, it can help to start with a few manageable changes.

1. Make yourself comfortable, rather than searching for the perfect sleeping position.

There isn’t one ideal sleeping position for everyone.

If lying on your side is uncomfortable, try a pillow between your knees. If you sleep on your back, a pillow beneath your knees might help.

Small adjustments can sometimes make a difference. You don’t need to train yourself to sleep in a position that feels unnatural or uncomfortable.

2. Try to keep a reasonably consistent waking time.

Your body responds to regular patterns. Getting up at roughly the same time and exposing yourself to daylight can help support your natural sleep-wake rhythm.

That doesn’t mean you can never have a lie-in or need to follow a rigid schedule. The aim is consistency, not perfection.

3. Give yourself permission to stop trying so hard to sleep.

If you’ve been lying awake for ages and are becoming increasingly frustrated, it may help to get out of bed for a little while.

Sit somewhere comfortable, read something undemanding or do something quiet until you begin to feel sleepy again.

The idea is to gradually reduce the association between your bed and the struggle to fall asleep.

4. Keep moving during the day, within your capabilities.

Daylight, regular activity and gentle movement can all support sleep.

For many people with musculoskeletal pain, avoiding movement entirely can increase stiffness and reduce confidence in their body.

But activity needs to be appropriate for you. If you have a condition involving post-exertional malaise, such as ME/CFS, the approach is different and activity must remain within your individual energy limits.

5. Notice whether worrying about sleep has become part of the problem.

Do you start dreading bedtime?

Do you calculate how many hours of sleep you have left?

Do you worry that a bad night means tomorrow’s pain will be unbearable?

These are understandable responses, particularly when you’ve had plenty of difficult nights before.

But noticing these patterns can be helpful. Learning to respond to them differently may gradually make bedtime feel less threatening.

6. Get help if sleep continues to be a problem.

Persistent insomnia deserves proper attention.

Cognitive behavioural therapy for insomnia (CBT-I) is a well-supported treatment that goes beyond general advice about sleep routines.

It’s also worth speaking to your GP if you’re experiencing significant snoring, gasping during sleep, restless legs, persistent daytime sleepiness or possible medication-related sleep problems.

You don’t have to solve everything through lifestyle changes.

How can Osteopathy and an integrated pain approach help?

When someone comes to us with persistent musculoskeletal pain, we’re interested in more than just where it hurts.

We want to understand how the pain is affecting everyday life, including sleep, movement, work, energy levels and confidence.

For example, we might explore whether:

• A particular position or movement is making it difficult to settle comfortably at night.
• Pain is causing you to wake frequently or avoid changing positions.
• You’ve become increasingly worried about what your pain means, especially at bedtime.
• Your activity patterns during the day are affecting your comfort and recovery.
• Your nervous system may have become more sensitive to sensations that aren’t necessarily a sign of ongoing tissue damage.
• Another health condition, medication or sleep disorder might need further investigation.

Depending on what we find, your care might include osteopathic treatment for an appropriate musculoskeletal complaint, advice on comfortable movement and positioning, or a gradual approach to rebuilding confidence in activities that have become difficult.

For some people, particularly those experiencing persistent pain where nervous system sensitivity appears to be playing a significant role, we may also explore pain-recovery approaches informed by Pain Reprocessing Therapy (PRT).

These approaches focus on helping you better understand your pain responses and, where appropriate, gradually feel safer with sensations and movements that have become associated with danger.

Where sleep difficulties need more specific care, we may recommend speaking to your GP, a counsellor or a sleep specialist.

The aim isn’t simply to treat a painful body part. It’s to understand the different factors that may be contributing to your experience and work out what might help.

A few questions we often hear

Can one bad night’s sleep make my condition worse?

A single poor night can make you feel more sensitive to pain, tired and less able to cope with everyday demands.

But that doesn’t automatically mean your condition has deteriorated or that you’ve damaged your body.

If you wake up feeling worse, try not to immediately assume something has gone wrong. Consider how you’ve slept, how you’re feeling generally and whether the discomfort changes as you get moving.

Should I stay in bed and rest if I’ve slept badly?

That depends on your condition and how you’re feeling.

Sometimes extra rest is exactly what you need. But for many common musculoskeletal complaints, spending the entire day in bed can leave you feeling stiffer and may make it harder to sleep the following night.

Gentle, manageable activity may be more helpful than complete inactivity. The exception is where your medical condition requires a different approach to activity and energy management.

Is pain that wakes me up at night something to worry about?

Not always. Many musculoskeletal conditions can make certain sleeping positions uncomfortable.

However, new, severe, unexplained or progressively worsening night pain should be assessed, particularly if it’s accompanied by symptoms such as fever, unexplained weight loss, neurological changes or significant illness, or if you have a history of cancer.

Don’t assume that all night pain is simply a result of poor sleep or a sensitive nervous system.

What if I’ve tried everything and still can’t sleep?

You may have tried dozens of things already, from changing your mattress to cutting out caffeine, adjusting your routine or taking supplements.

If nothing seems to help, that doesn’t mean you’ve failed.

It may mean that general sleep advice isn’t addressing what’s actually keeping you awake.

Persistent insomnia, pain-related sleep disruption and other sleep disorders can require different approaches. A more individual assessment can help identify what needs attention.

You don’t have to get sleep right to get better

When you’re living with pain, it can sometimes feel as though there’s an endless list of things you’re supposed to do: exercise more, relax more, manage stress, eat better and, of course, sleep properly.

It can become exhausting just trying to keep up with the advice.

But recovery isn’t a checklist, and sleep isn’t another thing you need to get right.

If you’ve been sleeping badly, it makes sense that you might feel more uncomfortable, tired or emotionally stretched. It doesn’t necessarily mean that your body is deteriorating, or that you’re losing the progress you’ve made.

Sometimes the most helpful starting point is simply understanding why sleep and pain affect each other, finding a few things that make your nights more comfortable and taking some of the pressure off yourself.

You don’t need to fix everything at once.

And if pain is regularly interfering with your sleep, it’s worth talking about. It’s an important part of your health, not something you just have to put up with.

Further reading

• Runge N, et al. The bidirectional relationship between sleep problems and chronic musculoskeletal pain: a systematic review with meta-analysis. PAIN, 2024. https://pubmed.ncbi.nlm.nih.gov/38809241/
• NICE. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NG193). https://www.nice.org.uk/guidance/ng193