Why Is Pain Worse At Night?

Why is Pain Worse at Night? The Role of Hormones, Food Sensitivities, and the Gut-Joint Axis

If you’re like many people, you may notice that joint pain worsens at night, making it difficult to fall asleep or stay asleep. While there are many causes of pain, it’s important to note that this discussion does not address pain related to conditions like cancer, which may have different underlying mechanisms and cause night pain. Instead, we’ll explore how everyday factors such as hormones, food sensitivities, and the gut-joint axis contribute to increased pain at night and offer practical solutions to help you reduce that discomfort. This article is for informational purposes only. Always see your provider to assess the origin of night pain.

1. Hormonal Fluctuations at Night

Hormones are key in regulating inflammation and pain perception throughout the day. In the evening, cortisol levels, a natural anti-inflammatory hormone, decrease. This drop makes the body more susceptible to inflammation, especially in people with chronic pain conditions like arthritis. Many people think of cortisol as causing inflammation, and it can. However, this usually occurs when cortisol levels are too high or when cortisol is too low and persistent inflammation can result. We need cortisol at optimal levels to naturally address inflammation (higher in the morning and gradually lowering into the evening so we can fall asleep).

What you can do:

• Regulate cortisol by exposing yourself to natural light in the morning and practicing stress-reducing activities like meditation and mindfulness.
• Consider magnesium supplements to relax muscles and improve sleep quality, which may reduce overall pain perception. Click this link for more information about the different types of magnesium: Magnesium: A Key to Easing Muscle, Joint Pain…
• Adaptogens such as Ashwagandha, Rhodiola or Rehmannia can be helpful as well. Consult with your health care provider about whether these are fine for you to take.

Low Estrogen and Progesterone in Women

Estrogen has an anti-inflammatory effect and plays a vital role in maintaining the health of cartilage, the smooth tissue that cushions joints. When estrogen levels decline, such as during menopause, women often experience hot flashes at night and more joint pain due to increased inflammation. The drop in estrogen and progesterone also affects collagen, which is crucial for joint flexibility and repair. Lower collagen production can lead to stiffer, more painful joints at night.

How it contributes to pain at night:

• As estrogen and progesterone levels drop, the body becomes more prone to inflammation, especially during rest when cortisol (the anti-inflammatory hormone) is low.
• If estrogen levels are too low, women may also experience bone loss during menopause, increasing the risk of joint pain and discomfort, particularly in weight-bearing joints like the knees and hips, which can feel worse after a long day of activity or while lying down.

What you can do:

• Exercise: Engage in weight-bearing exercises like walking or strength training to maintain bone and joint health.
• Dietary support: Include calcium-rich foods and vitamin D to support bone density, as well as foods high in phytoestrogens (like soy) that may mimic estrogen’s effects in the body.
• Hormone replacement therapy (HRT): Talk to your healthcare provider about whether HRT or bioidentical hormones might be an option to alleviate joint pain and other menopause symptoms. Addressing your eating plan and gut issues before hormone replacement helps to determine if hormone replacement is necessary.
• Supplements: Consider supplements like collagen and omega-3 fatty acids, which help support joint health and reduce inflammation.

Low Testosterone

Testosterone plays a critical role in maintaining muscle mass and bone strength. When testosterone levels drop, which can occur as part of the natural aging process or due to certain medical conditions, men may experience more joint pain, particularly at night. Low testosterone is associated with increased inflammation and weaker muscles, leading to more strain on the joints, contributing to discomfort and pain.

How it contributes to pain at night:

• Similar to low estrogen, low testosterone reduces the body’s ability to repair and maintain cartilage and muscles that support the joints.
• Reduced testosterone also leads to decreased muscle mass, which places additional strain on the joints, particularly during periods of rest when muscle support is minimized.
• The body’s circadian rhythm naturally causes testosterone levels to be lower at night, meaning less hormonal protection against inflammation and muscle pain during sleep.

What you can do:

• Strength training: Engaging in regular resistance exercises helps maintain muscle mass, which can support joint function and reduce pain.
• Healthy diet: Focus on a diet rich in lean protein (beware of excess red meat as this can be inflammatory), healthy fats, and key nutrients like zinc, which support testosterone production and reduce inflammation.
• Hormone therapy: For men or women with clinically low testosterone, testosterone replacement therapy (TRT) may be an option, but this should be discussed with a healthcare provider as other hormones contribute to the production of testosterone. Your eating plan and addressing gut issues should be addressed before hormone replacement to see if hormone replacement is necessary.
• Sleep and stress management: Poor sleep and high stress can further lower testosterone levels. Practicing good sleep hygiene and managing stress through relaxation techniques can help maintain healthier testosterone levels and reduce joint pain at night.

2. Food Sensitivities and Nighttime Pain

Many people don’t realize that food sensitivities can trigger inflammation and worsen joint pain, especially at night. When you eat foods you’re sensitive to, such as gluten or dairy, your immune system reacts, causing a release of pro-inflammatory cytokines. These chemicals can worsen inflammation in the body, including in the joints. At night, when digestion slows, your body has more time to react to these triggers, causing more noticeable discomfort when lying in bed.

What you can do:

• Identify and avoid trigger foods by keeping a food diary or undergoing an elimination diet to pinpoint which foods cause reactions. Testing can help you determine these foods. Avoid IgG testing as these tests have been shown to be inaccurate. We utilize the ALCAT test to determine which foods are contributing to pain and inflammation. You can also start with a food diary where you keep track of your symptoms and with the help of a practitioner you can determine what foods or food groups may be the culprit.
• Eat dinner earlier (at least 3-4 hours before bed) to allow your body to fully digest food before sleep.
• Consider probiotics to support a healthy gut and reduce inflammation from food sensitivities. If you have never taken a probiotic start with a lower potency such as 10 or 20 billion CFU. Then gradually increase the potency if you tolerate it. I personally take this probiotic at 70billion but usually recommend to start with this Thorne probiotic at 20 billion. If you take either of these and you find that you are experiencing bloating or discomfort in the abdomen, this usually means there is an imbalance of bad vs good bacteria in the gut as these probiotics should be just adding to the good bacteria already present. If symptoms occur see your health practitioner. We have helped many be able to tolerate these supplements and improve their overall gut health.

*FYI if you click on the links above we may receive a small commission from Amazon should you buy from there.

3. The Gut-Joint Axis: How Gut Health Impacts Pain

The gut-joint axis is the communication between your gut and your joints. Poor gut health, often aggravated by food sensitivities or an imbalanced microbiome, can cause systemic inflammation that leads to increased joint pain. Disruptions in gut bacteria can send inflammatory signals through the bloodstream, affecting joint health. This inflammation worsens at night due to the body’s circadian rhythms and slower nighttime digestion.

What you can do:

• Support your gut health by eating prebiotic and probiotic-rich foods if tolerated (like garlic, onions, and fermented foods) that help maintain a balanced microbiome.
• Avoid inflammatory foods that can disrupt the gut-joint axis, such as processed sugars, refined carbohydrates, and trans fats.
• Gut reconditioning programs to reset gut health, such as those offered at newyouhealthandwellness.com, can help to optimize the health of the gut and decrease the inflammatory molecules, such as lipopolysaccharide, from increasing in the joints

4. Reduced Distractions at Night

During the day, our minds are often preoccupied with work, social activities, and other responsibilities. At night, when distractions are minimal, we become more aware of pain. Without the external stimuli of the day, your brain may focus more on internal signals like joint discomfort. Additionally, stress and anxiety tend to heighten pain perception, and these often become more pronounced at night.

What you can do:

• Practice mindfulness or meditation before bed to reduce anxiety and shift your focus away from pain.
• Use progressive muscle relaxation techniques to calm the body and reduce pain signals before going to sleep.
• Create a relaxing bedtime routine to ease into sleep, avoiding any mentally stimulating activities that can keep you focused on pain.
• Regular exercise each day, including cardiovascular and weight training, can help improve joint lubrication, improve the diversity of the microbiome, and help you fall asleep faster with fewer complaints of pain.

If you need help determining where your joint pain is coming from and how to address it, call New You Health and Wellness at 414-299-8121 for a 15 minute free discovery call and whether it’s arthritis, hormones, gut health or your eating plan, we can work out how we can help you

References

Solan, M. (2023, January 18). Do we feel pain more at night? Harvard Health. https://www.health.harvard.edu/blog/do-we-feel-pain-more-at-night-202301182877

Harding, A. T., & Heaton, N. S. (2022). The Impact of Estrogens and Their Receptors on Immunity and Inflammation during Infection. Cancers, 14(4), 909. https://doi.org/10.3390/cancers14040909

Fedotcheva, T. A., Fedotcheva, N. I., & Shimanovsky, N. L. (2022). Progesterone as an Anti-Inflammatory Drug and Immunomodulator: New Aspects in Hormonal Regulation of the Inflammation. Biomolecules, 12(9), 1299. https://doi.org/10.3390/biom12091299

Cheng, L., Wang, S. Lower serum testosterone is associated with increased likelihood of arthritis. Sci Rep 13, 19241 (2023). https://doi.org/10.1038/s41598-023-46424-1

Monda, V., Villano, I., Messina, A., Valenzano, A., Esposito, T., Moscatelli, F., Viggiano, A., Cibelli, G., Chieffi, S., Monda, M., & Messina, G. (2017). Exercise Modifies the Gut Microbiota with Positive Health Effects. Oxidative medicine and cellular longevity, 2017, 3831972. https://doi.org/10.1155/2017/3831972

Campos, M., MD. (2020, January 30). Food allergy, intolerance, or sensitivity: What’s the difference, and why does it matter? Harvard Health. https://www.health.harvard.edu/blog/food-allergy-intolerance-or-sensitivity-whats-the-difference-and-why-does-it-matter-2020013018736