Monday, May 20, 2024
DIABETES Diabetic Neuropathy

Why Is Neuropathy Worse at Night: Causes and Treatment for Nerve Pain

Neuropathy in the feet can cause significant discomfort. These symptoms worsen at night and can disrupt normal sleep cycles for individuals that suffer from this condition. 

Neuropathy symptoms include tingling, burning, and sharp, shooting pain in the feet. 

This article discusses why neuropathy happens at night and treatment solutions to help alleviate symptoms to ensure a restful night of sleep. 

What is Neuropathy?

Neuropathy in the feet, also known as peripheral neuropathy, is a condition characterized by damage to the peripheral nerves in the feet. 

These nerves are responsible for transmitting signals between the central nervous system (the brain and spinal cord) to the rest of the body. 

When there is damage to the nerves, individuals experience tingling, numbness, and burning pain. 

bedroom during winter time


Why Is Neuropathy Worse at Night Time?

Eliminate distractions

Fewer Distractions 

During the day, daily activities can decrease awareness of nerve pain in the feet. Fewer distractions at night can make the neuropathic pain feel worse.

Also, wearing ill-fitting shoes during the day can impinge on foot nerves, and make nerve pain more pronounced at night. 

For more information on how footwear can impact foot health, refer to this supplemental article: Bad Shoes and foot problems

Another reason nerve pain is worse at night is due to fluid accumulation in the legs. If your day involves long periods of standing or sitting, you might experience an increase in leg swelling by nightfall. 

This additional fluid accumulation places pressure on the nerves, thereby intensifying the symptoms of neuropathy.  

Cooler Temperatures 

In individuals with neuropathy, the influence of temperature can affect symptoms. Peripheral nerves, typically responsible for conveying temperature changes to the brain, are impaired due to nerve damage. 

Consequently, the brain may misinterpret these temperature fluctuations as pain. This can exacerbate the neuropathic symptoms, leading to intensified burning and tingling sensations in the feet, particularly during the night.  

Many individuals prefer cooler temperatures for sleep, with the Sleep Foundation suggesting an optimal bedroom temperature of around 65 degrees Fahrenheit. 

This preference aligns with the body’s natural inclination to lower its core temperature in preparation for sleep. However, sleeping conditions that are excessively warm or cool can disrupt this delicate balance, leading to potential sleep disturbances.

woman in blue shirt using laptop

Stress Can Make Nerve Pain Worse

Physical and emotional stress has detrimental effects on your health. This is particularly true for individuals with neuropathy, as stress can exacerbate the associated pain, especially at night.

Cortisol, a key hormone with anti-inflammatory properties, plays a critical role in preventing nerve damage induced by inflammation. Yet, an excess of cortisol, often resulting from chronic stress, can disrupt vital bodily functions.

Under normal circumstances, cortisol levels are lowest at night, gradually increasing towards morning. 

However, neuropathy itself acts as a stressor, potentially maintaining high cortisol levels during the night. This imbalance not only disrupts sleep but can also intensify the discomfort of neuropathy.

Increased Pain Sensitivity  

A consequence of disrupted sleep is a reduced pain tolerance, creating a vicious cycle of increased pain and less restful sleep.

A study conducted by A.Staffe in the PLOS One Journal studied 24 participants subjected to 24 hours of sleep deprivation. They found that the participants exhibited an increased sensitivity to pressure and temperature variations after just one sleepless night. 

This indicates that even a single night of sleep deprivation can impair pain perception and make pain worse at night.

How Can You Stop Neuropathy Pain At Night?

Medications Can Treat Peripheral Neuropathy Symptoms

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 and chronic 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

Compression Stockings 

As previously noted, the swelling that accumulates in the legs and feet during the day can lead to nerve compression, intensifying neuropathic symptoms. 

One potential solution to this issue is the use of compression stockings during daytime hours. Compression stockings can significantly reduce swelling, hence alleviating nerve compression that can cause neuropathy worse at night.

Jobst 15-20mmHg compression stockings, available on Amazon, are a popular choice. Crafted for durability, a single pair can last up to six months, effectively reducing swelling over time. 

However, it’s essential to note that these stockings should be avoided by those with peripheral vascular disease due to the risk of restricting blood flow.

Exercise 

Routine exercise can help reduce inflammation, improve blood flow to the legs, and also improve muscle strength.

Routine exercise therapy has been shown to preserve and promote the function of peripheral nerves according to M. Cooper in Frontiers in Neuroscience

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 therapy can also help relax the body and mind.  

Practice Good Sleep Hygiene to Reduce Chronic Pain

  • 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. Your body position is different in bed than during the day. 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. 

Conclusion

In conclusion, for neuropathy patients, understanding and managing their symptoms at night can significantly improve their quality of life. Utilizing resources provided by a reputable neuropathy center or a medical center specializing in neuropathy can prepare patients with the necessary tools and knowledge to alleviate nighttime discomfort. 

From maintaining good sleep hygiene, regular exercise, use of medications, and use of compression stockings are several strategies that can be used to reduce neuropathy symptoms.  With the right approach, individuals living with neuropathy can successfully reduce nighttime pain, ensuring restful sleep and better overall well-being.

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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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