Pins and needles in the hands at night: causes, red flags and when to get it checked

The median nerve passes through a narrow tunnel at the wrist along with the flexor tendons. If the space tightens or swelling occurs, the nerve is compressed, especially at night when the wrists are flexed and fluid redistributes. Waking and shaking the hand restores circulation to the nerve and eases symptoms.

• Carpal tunnel syndrome: median nerve compression, often with no clear cause.

• Pregnancy and hormonal changes, with fluid retention, usually settling after birth.

• Diabetes, underactive thyroid, rheumatoid arthritis and other conditions that thicken the tissues.

• Neck problems (cervical radiculopathy) causing arm and hand tingling, often with neck pain.

• Ulnar nerve compression at the elbow, with little and ring finger tingling.

• Peripheral neuropathy from B12 deficiency, alcohol or diabetes, affecting both hands and feet.

• Thoracic outlet syndrome and posture-related nerve compression.

• Multiple sclerosis, stroke and rare conditions, which usually have additional features.

Weakness or wasting of the thumb base, constant numbness, symptoms in both hands and feet, neck pain with arm symptoms, symptoms of sudden onset with speech or facial changes, loss of balance, and unexplained weight loss warrant prompt assessment.

• Call 999: tingling or numbness with sudden facial droop, speech difficulty or weakness.

• GP within days: new hand weakness, wasting, or constant numbness.

• GP within weeks: night symptoms persisting for more than a few weeks despite a splint.

• Routine: occasional night tingling that responds to position change.

The doctor asks which fingers, when, what relieves it, hand use, pregnancy, diabetes, thyroid, neck pain and other symptoms. They check sensation by finger, thumb strength and muscle bulk, perform Tinel and Phalen tests, examine the neck and elbow and look for signs of other conditions.

• Blood tests: glucose or HbA1c, thyroid function, B12 and inflammatory markers if indicated.

• Nerve conduction studies: confirm and grade median nerve compression and exclude other causes.

• Ultrasound of the median nerve: an alternative to show swelling.

• MRI of the neck: if cervical radiculopathy is suspected.

• Pregnancy test if relevant.

Wear a neutral-position wrist splint at night, avoid prolonged wrist flexion, take breaks during repetitive tasks, and consider changing your workstation. Gentle nerve gliding exercises may help. A corticosteroid injection can give temporary relief, and carpal tunnel release surgery is highly effective for persistent or severe cases.

The NHS route is a GP, then nerve tests and hand surgery referral. Private hand surgeons offer direct access to nerve conduction studies and surgery.