Hip pain at night (sleeping): causes and symptoms

Chronic (long-term) hip pain at night affects around one in five people aged over 65 and is more common in women, particularly those aged 40–60 years. It can disturb your sleep and/or make it difficult to fall asleep. When hip pain affects the outer side of your hip, it is called lateral hip pain.

There are many different causes of hip pain, including overuse during the day when exercising, the position that you sleep in, moving in bed and your joints swelling at night. 

What causes hip pain when sleeping?

A variety of conditions can cause hip pain when sleeping. The most common causes are bursitis, osteoarthritis, sciatic-piriformis syndrome and tendonitis. Other causes include injury to your muscles or soft tissues, pregnancy, the position you sleep in and your bed or pillows. Sometimes hip pain is caused by pain from elsewhere, such as your lower back, radiating down to your hips — this is called referred pain. 

Hip pain can feel different depending on the underlying cause. If hip pain is caused by an injury that is largely healed, you may have lingering pain that feels like pins and needles. Severe arthritis can cause hip pain that feels as if someone is grabbing your hips. Hip pain can also feel achy or like burning.

Sleep position

If you often wake up with hip pain, the cause may be the position you sleep in or a mattress that is too soft or too hard.

If you sleep on your back, try sleeping on your side. If you sleep on one side, try sleeping on the other side and place a pillow between your legs to keep your hips aligned.

A mattress that isn’t the correct firmness for your body can cause pressure points that make your hips sore. Try out a softer or firmer mattress.

Bursitis

Your hip joints contain small fluid-filled sacs called bursae that act as cushions to help your joints move smoothly. Overuse of your hip joint, such as through playing certain sports, running or often lifting heavy items, can cause your bursae to become inflamed — this is called bursitis. 

Bursitis symptoms include:

• Pain after sitting for long periods of time
• Pain along the outer side of your hip and upper thigh
• Pain or stiffness on movement
• Pain that worsens when walking long distances, squatting or climbing up and down the stairs
• Pain that worsens at night when you lie down on the affected hip
• Sharp pain and tenderness that develops into an ache

Hip bursitis doesn’t cause pain when standing. With rest and treatment, bursitis usually gets better after a few days or weeks. 

Hip osteoarthritis and other types of arthritis

Osteoarthritis is the most common type of arthritis affecting the hip. However, psoriatic arthritis, rheumatoid arthritis and septic arthritis can also cause hip pain. 

Hip osteoarthritis causes the cartilage in your hip joint to wear out over time, causing the bones in your hip joint to rub together, which leads to inflammation, pain and stiffness. It is a chronic, degenerative condition. However, treatment can reduce or prevent further joint damage. 

Hip rheumatoid arthritis is an autoimmune condition ie your immune system mistakenly attacks the tissues in your hip joint. It is also a chronic condition. As with osteoarthritis, treatment can reduce or prevent further damage. 

Symptoms of hip arthritis, include:

• A clicking, grinding or popping sound when you move your hip (crepitus) 
• Pain in your buttocks, groin, knee or thigh
• Pain that disturbs your sleep
• Pain that worsens with rainy weather and is worse in the morning or after sitting or resting 
• Pain when bending, getting up from a chair or walking
• Your hip locking or sticking

Hip tendonitis

Tendons attach your muscles to your bones and help hold your joints together. Hip tendonitis occurs when the tendons become swollen and damaged. This may occur due to overuse injuries, often sitting with your legs crossed or often standing with your weight on one hip.  

Hip tendonitis symptoms include:

• A dull, deep ache in your groin that worsens when climbing stairs
• Hip pain at night
• Pain in your buttocks if your hamstring tendon is also swollen and damaged

Sciatic-piriformis syndrome

Sciatic-piriformis syndrome occurs when your sciatic nerve is compressed, causing numbness, pain and tingling from your lower back to your buttocks and sometimes down to your leg and foot. At night, you may feel a burning sensation in your calf or a throbbing pain in your foot, which wakes you up.

Pregnancy

Pregnancy applies extra pressure on your hips and spine, which increases the further along your pregnancy you progress. This can cause lower back and hip pain. Hip pain can also be caused by your ligaments and muscles loosening up in preparation for childbirth. 

To help prevent hip pain and sciatica, wear supportive shoes during the day and if you’ve been sitting or lying down for long periods, get up to stretch your muscles. At night, sleep on your side instead of your back — you can place a rolled-up blanket behind your back to lean on or use a pregnancy pillow. You can also place a pillow in between your legs to help keep your hips aligned. 

A less common cause of hip pain during pregnancy is a labral tear. This occurs when the ring of cartilage that lines the rim of your hip joint socket (the labrum) and holds the head of your thigh bone in place, tears. Some labral tears will get better on their own with rest, however, more severe tears may need surgery. 

Another less common cause of hip pain during pregnancy is a hernia, where part of one of your organs or internal tissue pushes through a weakness in the surrounding tissue. In pregnancy, this is usually caused by the increasing pressure in your abdomen as your baby grows. 

Greater trochanteric pain syndrome

Weak muscles in your buttocks (gluteal muscles) can strain the front of your hip as it tries to compensate for this weakness. This squeezes the tendons that attach your gluteal muscles to your hip bones and pelvis, and irritates your greater trochanteric bursa that sits between the bony lump on your thigh bone (greater trochanter) and the muscles and tendons that cover it. The resulting hip pain and tenderness, which is often worse at night, is called greater trochanteric pain syndrome (GTPS).

Exercise-related causes

Strenuous exercise (eg dancing, football, running) can cause overuse injuries that result in hip pain. Damage to any of the tissues in your hip joint can occur, causing bursitis, tendinopathy, iliotibial band syndrome or other injuries.

A sudden change in the duration, frequency or intensity of your exercise can also cause a hip injury and consequently hip pain.

Other causes

• Accident or injury — hip dislocation, hip fracture or other hip injuries caused by an accident can cause hip pain at night
• Age — osteoarthritis and hip bursitis are more common in older adults; hip pain at night is also more common in menopausal and post-menopausal women
• Being overweight or obese — carrying excess weight puts a greater strain on your hip joints, making it more likely that you will develop osteoarthritis
• Referred pain — pain in your back, knee or pelvis can spread to your hips

How to manage hip pain at night

Treatments for immediate relief

If your hip pain has woken you up at night, try changing your sleeping position and/or placing a wedge-shaped pillow under your hip, or if sleeping on your side, placing a pillow in between your legs to keep your hips aligned. If you have sciatic piriformis syndrome, placing a pillow under your knees can help reduce pain.

You can also take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), eg ibuprofen and naproxen, to reduce inflammation and relieve pain. Long-term use of oral NSAIDs is not recommended due to side effects, so speak to your doctor about how often and how long you should take them. Your doctor may also prescribe topical NSAIDs ie gels and creams, which you can rub into your hip.

Ice packs and heat packs can also provide instant, temporary relief when placed on your hip for up to 20 minutes at a time. Ice packs help reduce swelling while heat packs can relieve pain caused by arthritis, muscle spasms or stiffness. Make sure that you wrap your ice pack in a towel to avoid direct contact of the ice with your skin and use a heat pack in the form of a hot water bottle or heating pad.

Treatments for long-term relief

For frequent hip pain, you may need to speak to your doctor about treatments for long-term relief. You may also need a firmer mattress if you have hip bursitis. You can add a foam topper to your mattress too so that your weight is better spread, which will reduce the pressure on your hips. 

If you have hip arthritis, your doctor may recommend medications, including disease-modifying antirheumatic drugs (DMARDs) and biologics. If you have severe hip arthritis, your doctor may recommend: 

• Arthroplasty ie total hip replacement surgery
• Arthroscopy — surgery to remove bone spurs or loose pieces of cartilage in your hip joint
• Hip resurfacing — surgery to remove and replace damaged bone in your hip joint

If you have severe bursitis, your doctor may recommend: 

• Removing fluid from the inflamed bursa 
• Steroid injections into your inflamed bursa 
• Surgery to remove inflamed bursa

Other treatments that your doctor may recommend, depending on the underlying cause of your hip pain, include:

• Hyaluronic acid injections to lubricate your hip joint
• Physiotherapy and/or regular massage
• Steroid injections into your hip joint

Lifestyle changes

Regular exercise can help prevent future hip pain, particularly hip and back strengthening exercises, as well as yoga and Pilates to improve the flexibility of your hips. Regular walking and other aerobic exercises that are not intense can also help. 

If you have arthritis, your doctor may recommend you follow an anti-inflammatory diet, which includes foods containing antioxidants and omega-3 fatty acids, as well as lemon juice and turmeric. Following an anti-inflammatory diet may also help other hip conditions alongside regular exercise and medication, if needed. 

Medications

Depending on the underlying cause of your hip pain at night, your doctor may recommend medication. However, some medications eg prednisolone and certain rheumatoid arthritis medications, can cause insomnia and further worsen your sleep. You should therefore inform your doctor of any side effects from your medication. 

You can take over-the-counter painkillers (eg paracetamol) to manage your pain and apply ice or heat packs to your hip. 

Exercise

To relieve hip pain at night, you can speak to a physiotherapist about exercises to strengthen and stretch the muscles in your buttocks, hips, pelvis and thighs.

You should also avoid exercises that aggravate your hip pain, which are usually high-impact exercises eg running, step aerobics, and walking up and down inclines. Instead, replace high-impact exercises with low-impact exercises eg cycling, swimming, tai chi, water aerobics, walking or yoga.

Whichever form of exercise you perform, always make sure you warm up beforehand and cool down afterwards.

Preventing hip pain at night

The types of activity you engage in during the day can affect how much hip pain you experience at night. So try to avoid high-impact exercises in the day and switch to low-impact exercises.

Also, avoid sitting for long periods and practice daily hip stretching exercises — you can perform these at night too if your hip pain wakes you up. To stretch your hip flexor muscles, stand up and hold onto the wall, a chair or table for balance. Then cross your legs and reach down towards your toes as far as you can. Hold this position for 20–30 seconds and then repeat with your legs crossed the other way. 

To help you get a good night’s sleep and reduce your hip pain at night, try to practice good sleeping habits. This includes: 

• Avoiding drinking caffeine for at least five hours before bedtime and avoiding drinking alcohol to fall asleep as alcohol doesn’t result in good quality sleep
• Avoiding using digital devices (eg smartphones, TV, laptop) for at least an hour before bedtime
• Going to bed and waking up at the same time every day 
• Making your room dark, quiet and cool so you don’t wake up from overheating
• Relaxing before bedtime 
• Taking a warm bath one to two hours before bedtime to relax your muscles and trigger the release of hormones called endorphins that can ease the sensation of pain — make sure the bath temperature isn’t too hot as this will make you feel more awake

You should also avoid relying on sleep medication to fall asleep as over time you will need higher and higher doses for it to be effective.

When to see a doctor

If your hip pain is often disturbing your sleep, you should see your GP. Disturbed sleep can affect your physical health and mental wellbeing.  

Your GP will ask you about your symptoms and medical history. They may perform a physical examination to check for pain, swelling and tenderness around your hip, and for your range of motion — reduced range of motion is a sign of arthritis. They may also refer you for blood tests or imaging tests, such as an X-ray or MRI scan to rule out certain conditions or confirm a suspected diagnosis. 

You should go to A&E if  your hip pain is caused by an accident or injury, and/or if you have any of the following symptoms: 

• A deformed joint
• Can’t move your leg or hip
• Can’t bear weight on your affected leg
• Severe hip pain 
• Signs of infection ie a fever, chills and/or redness in your hip area
• Sudden swelling of your hip