A good night’s sleep shouldn’t be interrupted by hip pain, yet for many people, discomfort begins the moment they lie down. Whether it’s a dull ache, a sharp twinge, or stiffness that builds through the night, hip pain can make rest nearly impossible.
There are many possible causes of hip pain at night. Some are minor and respond well to rest or postural changes, while others may signal an underlying joint, muscle, or nerve condition that needs medical attention. Understanding what’s causing your pain is the key to lasting relief and to getting back to restful, uninterrupted sleep.
Why Does Hip Pain Get Worse at Night?
Hip pain often becomes more noticeable at night because your body is at rest and positioned differently than when you’re standing or moving. Lying down changes how pressure is distributed across your joints, tendons, and muscles, sometimes placing added strain on irritated areas. With less movement and distraction, discomfort that went unnoticed during the day can become more pronounced.
Common reasons include:
- Pressure from side-sleeping or a firm mattress
- Tight muscles or tendons that shorten during rest
- Inflammation from arthritis or bursitis that flares with inactivity
- Misalignment of the spine or pelvis while sleeping
- Nerve compression or reduced circulation
Tip: If your hip pain wakes you at night or makes it hard to find a comfortable position, note when and where it hurts. That information can help your provider pinpoint the cause more quickly.
Common Causes of Hip Pain at Night
Hip pain at night can stem from a variety of conditions that affect the joint, surrounding muscles, or even the nerves in the lower back. Here’s a look at some of the most common culprits, and how lying down can make them feel worse.
Hip Bursitis
Bursae are small, fluid-filled sacs that cushion the bones, tendons, and muscles around your joints. When the bursa near the hip (usually the trochanteric bursa) becomes irritated or inflamed, it can cause sharp or burning pain along the outside of the hip.
Because this area bears weight when lying on your side, symptoms often worsen at night or when pressure is applied. A softer mattress or changing positions may bring temporary relief, but persistent bursitis typically requires medical evaluation.
Osteoarthritis or Degenerative Changes
As cartilage inside the hip joint wears down over time, the bones begin to rub together, causing stiffness, swelling, and a deep, aching pain. This discomfort often radiates toward the groin, thigh, or buttocks.
At night, when you’re still for long periods, circulation and joint fluid movement slow down. That reduced motion allows inflammation to build and makes the joint feel stiffer and more painful when you try to move again. Gentle stretching before bed or using a pillow between the knees can help keep the hips aligned and ease morning soreness.
Sciatica or Nerve Irritation
The sciatic nerve runs from the lower back down through the hips and legs. When it becomes compressed or irritated, it can trigger pain that radiates down one side of the body, a sensation that often worsens when lying flat or on the affected side.
This pain isn’t limited to the hip joint itself, but because the nerve passes so close to it, people often describe the ache as hip-related. Supporting the lower back with a pillow or adjusting sleeping posture may reduce nerve pressure.
Tendon or Muscle Strain
The hip’s stability depends on strong muscles and tendons, including the hip flexors and gluteal tendons. Overuse, sudden movement, or prolonged sitting can strain these tissues, leading to soreness that flares up at night.
When you lie still, blood flow slows slightly, and tight tendons have less flexibility, which can make pain feel sharper when you shift or roll over in bed. Gentle stretching or warm compresses before sleep can help loosen these areas.
Hip Labral Tear or Structural Issues
The labrum is a ring of cartilage that cushions and stabilizes the hip joint. Tears in this tissue, often caused by repetitive motion, sports injuries, or structural misalignment, can lead to pain deep inside the hip, along with clicking or catching sensations.
Because the hip joint is in a different position while lying down, pressure changes inside the joint can intensify this pain at night. In some cases, labral tears may require imaging and specialist evaluation to determine whether surgical repair is needed.
Why Hip Pain May Radiate Down the Leg at Night
If your hip pain travels down your thigh or leg, the discomfort may not be coming solely from the hip joint itself. Nearby nerves, especially the sciatic and femoral nerves, run through the hip and upper leg. When these nerves become irritated or compressed, whether by inflammation, tight muscles, or changes in spinal alignment, they can send pain signals along their entire path.
This type of pain is often described as shooting, tingling, or burning, and it may worsen when lying flat or on one side because of increased nerve pressure or reduced circulation.
A few clues can help you tell the difference between types of pain:
- Sharp, burning, or tingling pain: Often linked to nerve irritation (sciatica or femoral nerve compression).
- Deep, aching discomfort: More likely caused by joint inflammation or muscle strain.
- Pain that radiates below the knee: Usually points to nerve involvement rather than hip arthritis alone.
If the pain continues to spread, feels sharp, or is accompanied by numbness or weakness, it’s best to have it evaluated by a specialist. Early treatment can prevent further irritation and help restore mobility.
Tips to Relieve Hip Pain While Sleeping
If hip pain keeps you from getting comfortable at night, a few simple adjustments can often make a big difference. These techniques can help reduce pressure, improve alignment, and ease inflammation while you rest:
- Try sleeping on your back with a small pillow under your knees to take pressure off your hips and lower back.
- If you prefer sleeping on your side, place a firm pillow between your knees. This keeps your hips level and reduces strain on the top hip.
- Check your mattress and pillow support. A sagging bed or overly firm surface can worsen joint pain. A medium-firm mattress or a memory foam topper often provides the best balance.
- Apply gentle heat before bed to loosen tight muscles, or use an ice pack after activity to calm inflammation.
- Stretch or move lightly during the day. Gentle motion, like walking or low-impact yoga, keeps circulation flowing and helps prevent stiffness at night.
When to See a Hip Specialist
Occasional hip discomfort after a long day or workout is normal, but persistent or worsening pain deserves attention. If your pain lasts more than a week, radiates down your leg, or keeps you up at night frequently, it may be time to consult a hip specialist.
At Andrews Institute Ambulatory Surgery Center, we work with experienced orthopedic surgeons who specialize in diagnosing and treating hip conditions. Whether your pain stems from arthritis, bursitis, or a soft tissue injury, a professional evaluation can identify the cause and help you find relief sooner.