Hip pain at night: why it disturbs sleep and what can help

During the day movement distracts from pain and keeps joints loose. At night you are still, usually in one position for hours, and you may be lying directly on the painful hip. That combination explains why mild daytime aches can become the main problem after dark.

Doctors take this seriously as a clue. Arthritis UK says that, when assessing hip pain, your doctor will ask how your symptoms started, what movements make them worse, how they affect daily activities and whether you are in pain at night. The pattern of night pain helps separate pressure-related causes from inflammatory ones.

Bursitis and related tendon problems on the outside of the hip are the classic cause of pain on the affected side. The NHS lists bursitis as causing pain that may spread to the thigh and feel worse when moving or lying on your side. Arthritis UK describes trochanteric bursitis as inflammation of the bursa at the top of the thigh bone, which causes tenderness over the bony point, often has no obvious cause and can happen in both hips. It adds that the muscles and tendons around the area are involved too, so it may be called greater trochanter pain syndrome or gluteal tendinopathy.

Arthritis is another group. The NHS lists osteoarthritis for pain that is worse when walking with stiffness after moving, in people over 45, and rheumatoid arthritis for pain and stiffness worse after not moving. It says prolonged morning stiffness can be a sign of rheumatoid arthritis, whereas for osteoarthritis stiffness is usually absent in the morning or lasts under 30 minutes. Arthritis UK also lists psoriatic arthritis and ankylosing spondylitis among inflammatory conditions that can cause hip pain.

Less common but important are avascular necrosis, where the blood supply to the ball of the thigh bone is lost, and infection. Arthritis UK links avascular necrosis with heavy alcohol use, long-term high-dose corticosteroids, sickle cell disease and radiotherapy, and says an urgent MRI is important if it is suspected. The NHS lists a hot swollen hip with a high temperature as a possible joint infection.

Arthritis UK gives specific advice for bursitis that applies to a painful hip. If lying down is uncomfortable, avoid sleeping on the side that hurts. A pillow placed behind your back can stop you rolling onto the painful side. The NHS suggests that extra cushions around an affected joint while you sleep can help protect and support it.

Practical measures during the day also matter, because they reduce how inflamed the hip is by evening. The NHS recommends ice wrapped in a towel for up to 20 minutes every 2 to 3 hours, paracetamol or ibuprofen gel, or ibuprofen tablets if needed, avoiding heavy carrying and low chairs, losing weight if overweight, and gentle hip stretching. Its bursitis page suggests resting and avoiding activities that put pressure on the joint.

Arthritis UK says not to use over-the-counter painkillers for more than two weeks without speaking to a GP, and that exercise should start gently as soon as pain begins to ease, to avoid the hip becoming stiff and weak.

See a GP, the NHS says, if hip pain is stopping you doing normal activities or affecting your sleep, if it is getting worse or keeps coming back, if it has not improved after 2 weeks of home treatment, or if you have stiffness for more than 30 minutes after waking. In many areas you can refer yourself to NHS community MSK services, such as physiotherapy, without a GP.

For bursitis in general, Arthritis UK says to see a GP if you have a high temperature or feel hot and shivery, the skin over the swollen area is broken, you cannot move the joint, you have a sharp shooting pain, or it has not improved after a week or two of self-treatment. It also advises seeing a doctor straight away if you feel feverish or unwell or have been losing weight.

The NHS says to ask for an urgent GP appointment or contact NHS 111 for severe hip pain that began suddenly without a fall, a swollen hip that feels hot, a change in skin colour around the hip, or hip pain with feeling generally unwell and a high temperature. Call 999 or go to A&E after a fall or injury if the pain is severe, you cannot put weight on the leg, or you have tingling or numbness.

Arthritis UK says trochanteric bursitis usually improves with rest, painkillers and physiotherapy, though it can occasionally last longer and is sometimes linked to problems in the lower back. Steroid injections are usually very helpful for conditions affecting the trochanteric area, often given with a local anaesthetic. A physiotherapist can show strengthening and stretching exercises and help with posture.

The NHS lists strong painkillers, physiotherapy, occupational therapy, steroid injections and specialist referral as possible treatments depending on the cause, and mentions that some people with a damaged joint may eventually need a hip replacement. For infection-related bursitis, the NHS bursitis page says antibiotics are usually taken for at least 7 days and that a steroid injection is not given if infection is the cause.