Wednesday, May 31, 2023
DIABETES Diabetic Neuropathy

Why Is Diabetic Neuropathy Worse at Night?

Neuropathy in the feet can be incredibly uncomfortable. Neuropathy sensations can vary from burning, tingling, and shooting pain. There is no question that if you suffer from neuropathy at night, you may have difficulty falling asleep. 

Diabetic neuropathy occurs due to chronically elevated blood sugar levels. This results in nerve damage in the legs and feet.

But why does diabetic neuropathy feel more painful at night?

In this article, we’ll discuss all the reasons why diabetic neuropathy pain is worse at night, and what you can do about it.

Let’s dive in…

increased pain ankle

Increased Pain Sensitivity at Night Can Cause Neuropathy Pain to Worsen

If you have neuropathy in your feet, you may notice that your sleep pattern is regularly disrupted. You may wake up multiple times in the middle of the night due to discomfort. Sleep time becomes fragmented. The likelihood of insomnia is higher. The problem is that when you sleep less, your pain tolerance is also less

study done by A.Staffe in PLOS One Journal examined 24 participants who underwent 24 hours of sleep deprivation. After the sleep deprivation period, they found that these participants experienced mechanical and thermal hyperalgesia (1). This means increased sensitivity to temperature changes and pressure. The studied showed that even one night of total sleep deprivation impaired the participants’ perception of pain. 

People who suffer from neuropathy can’t sleep due to pain, and this in turn worsens their sensitivity to pain at night. 

bedroom during winter time

Cooler Temperatures Can Cause Neuropathy Pain to Worsen

Most people prefer to sleep in cooler temperatures. Sleep Foundation states that the best bedroom temperature for sleep is around 65 degrees Fahrenheit. Your core body temperature naturally reduces in preparation for sleep. Sleeping in an environment that is too hot or too cold can disrupt sleep. 

The peripheral nerves notify your brain of temperature changes. However, with neuropathy, nerve damage is present. So your brain may interpret changes in temperature as being painful. Thus, you may experience worsening burning and tingling sensations in your feet at night. 

Fewer Distractions at Night Can Make Neuropathy Pain Worse

When you are working and on your feet during the day, you may not notice neuropathy pain very much. When you lay down in bed at night, however, you may experience worsening neuropathy symptoms due to heightened awareness and reduced distractions.

Also, many people wear ill-fitted shoes during the day that could be causing nerve impingement and pain due to poor fit of the shoes. They may not notice foot pain during the day due to distractions. However, when they remove their shoes at night to go to bed, they may suddenly notice worsening nerve pain.

Read more about how Bad Shoes Can Cause Foot Pain in this supplemental article. 

Also, when you stand or sit for prolonged periods during the day, you may notice increased swelling in your legs at night. Increased swelling in the legs can compress the nerves and cause neuropathy pain to feel worse. 

woman in blue shirt using laptop

Stress Can Cause Neuropathy Pain to Worsen at Night

Stress that you experience during the day can impact your health negatively. This includes physical stress from a labor-heavy job, as well as emotional stress that can occur due to worry.  

Cortisol is an important anti-inflammatory hormone that helps prevent nerve damage associated with inflammation. However, too much cortisol due to chronic stress can be harmful and disrupt body processes. 

Cortisol levels are lowest at night and increase in the morning. Neuropathy is a stressor, and this can cause cortisol levels to stay high at night. This, in turn, disrupts your sleep and can cause worsening neuropathy pain. 

So this brings us to…

woman wearing sleep mask

How Do You Sleep With Diabetic Neuropathy Pain?

Medications for Diabetic Neuropathy Pain at Night

Anticonvulsants such as Gabapentin and Pregabalin can help reduce neuropathy pain at night.

Pregabalin is FDA approved for neuropathy. These medications can also help improve sleep duration and sleep quality. Talk to your doctor about whether these medications would be a good option for you. 

Opioids are occasionally used to treat neuropathy pain, but in general, should be avoided to help treat neuropathy pain at night. Opioids do not help with insomnia and can increase your chance of developing sleep apnea at night. 

Melatonin can be used effectively to reduce nerve pain and promote quality sleep. Melatonin has pain-relieving and anti-inflammatory effects. Your body has a natural supply of Melatonin. Taking a Melatonin supplement can help regulate your body’s sleep/wake cycle and result in a more restful sleep at night. 

To read more about treatment for diabetic neuropathy, check out Diabetic Neuropathy in the Feet- A Simple Treatment Guide

feet in bed

Other Treatments for Diabetic Neuropathy Pain at Night

Compression Stockings Can Help Reduce Neuropathy Pain at Night

As mentioned previously, swelling in the legs and feet accumulated during the day can cause the nerves in your legs and feet to become compressed. Make sure to wear compression stockings during the day, and remove them at night. 

You don’t need to wear compression stockings at night because your legs are already elevated. Wearing stockings during the day, however, can help push fluid back to your heart and reduce nerve pain. 

I recommend Jobst 15-20mmHg compression stockings from Amazon. One pair of stockings will last for 6 months. These socks are very effective in reducing swelling. Avoid wearing compression stockings if you have peripheral vascular disease.

Exercise Can Help Reduce Neuropathy Pain at Night

Routine exercise can help reduce inflammation, improve blood flow to the legs, and also improve muscle strength. Exercise can also help reduce blood glucose levels. This is important if you suffer from diabetic neuropathy. Improvement in blood glucose levels can help reduce nerve damage and thus nerve pain.

Routine exercise has been shown to preserve and promote the function of peripheral nerves (2). If you suffer from neuropathy pain at night, try walking for 30 minutes. Stop exercising 1 hour before you go to bed.

This can help reduce neuropathy pain and improve the quality of sleep. Yoga can also help relax the body and mind.  

Eliminate distractions

Practice Good Sleep Hygiene if You Suffer From Peripheral Neuropathy

  • Avoid all distractions. Turn off electronic devices when you are about to go to sleep. Make sure the room is dark. Use a fan or white noise machine to block out noises.
  • Try to sleep at the same time every day. Having a predictable sleep schedule can help increase your chances of getting quality sleep. 
  • Exercise daily. Stop exercising 1 hour before bedtime.
  • Avoid sleeping positions that cause further nerve impingement. If you have a compressed nerve (sciatica), make sure to sleep on your side with a pillow between your knees, or on your back with pillows underneath your knees to prevent nerve compression. 
  • Avoid taking long naps during the day. Reduce your nap time during the day to less than 30 minutes. Try taking naps in the afternoon, and avoid evening naps. 

Do you suffer from neuropathy pain at night? What has helped reduce your pain? I would love to hear your thoughts! Leave a comment below!

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  1. Staffe AT, Bech MW, Clemmensen SLK, Nielsen HT, Larsen DB, Petersen KK. Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation, and facilitates temporal summation of pain in healthy participants. PLoS One. 2019 Dec 4;14(12):e0225849.
  2. Cooper MA, Kluding PM, Wright DE. Emerging Relationships between Exercise, Sensory Nerves, and Neuropathic Pain. Front Neurosci. 2016 Aug 23;10:372.
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  7. Aaron Vinik, MD, PhD, FCP, MACP, FACP, Birol Emir, PhD, Bruce Parsons, MD, PhD, Raymond Cheung, PhD, Prediction of Pregabalin-Mediated Pain Response by Severity of Sleep Disturbance in Patients with Painful Diabetic Neuropathy and Post-Herpetic Neuralgia, Pain Medicine, Volume 15, Issue 4, April 2014, Pages 661–670,
  8. Daniel Bates, MD, B Carsten Schultheis, MD, PhD, Michael C Hanes, MD, Suneil M Jolly, MD, Krishnan V Chakravarthy, MD, PhD, Timothy R Deer, MD, Robert M Levy, MD, PhD, Corey W Hunter, MD, A Comprehensive Algorithm for Management of Neuropathic Pain, Pain Medicine, Volume 20, Issue Supplement_1, June 2019, Pages S2–S12,
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Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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