Hip bursitis, or trochanteric bursitis, involves the inflammation of the fluid-filled sacs (bursae) that cushion the hip joint. Bursae primarily reduce friction between the greater trochanter—the bony point on the outside of the hip—and the overlying muscles and tendons. When inflamed, the bursa causes pain and tenderness on the outer hip, often spreading down the thigh. While painful throughout the day, the discomfort often spikes intensely at night, severely disrupting sleep.
Physical Reasons for Increased Night Pain
The most direct cause of pain amplification at night involves mechanical pressure on the inflamed bursa during rest. For side sleepers, lying on the affected hip compresses the swollen bursa directly against the greater trochanter bone. This continuous compression irritates the inflamed tissue, leading to sharp, intense pain that can wake a person from sleep.
Even when lying on the unaffected side, the hip’s biomechanics can still contribute to pain. This position often causes the top leg (the affected side) to rotate internally or drop across the body’s midline. This movement stretches the tendons of the gluteal muscles, which increases tension and friction across the inflamed sac, resulting in indirect irritation.
The lack of movement during prolonged sleep causes stiffness around the hip joint. During the day, regular activity helps to circulate fluid and prevent the area from seizing up. However, long periods of immobility allow inflammatory byproducts to pool, making the pain feel worse upon waking or when shifting position.
Biological Factors That Amplify Pain Sensation
Beyond mechanical factors, the body’s natural 24-hour cycle, or circadian rhythm, influences how pain is perceived, often worsening symptoms at night. Cortisol, a hormone with anti-inflammatory properties, naturally follows a rhythm, peaking in the morning and dropping to its lowest levels during the night. This nocturnal decline reduces the body’s ability to suppress inflammation, allowing it to intensify in the inflamed bursa.
The immune system’s activity also shifts according to the circadian rhythm. Pro-inflammatory cytokines, which are signaling molecules that promote inflammation, often become more active during the resting phase. Their heightened activity at night leads to increased swelling and irritation. This means the underlying inflammation is genuinely more pronounced in the early morning hours, aligning with peak pain sensitivity.
During the day, the brain is occupied with cognitive distractions like work and social interactions. At night, these distractions are eliminated, allowing the brain to focus intently on internal sensations. This heightened awareness of the hip pain makes it feel more severe than it did during the day.
Practical Strategies for Better Sleep
Adjusting sleeping posture is essential for minimizing nocturnal bursitis pain. The most accommodating position is sleeping on the back, as this evenly distributes body weight and relieves direct pressure on the bursa. If back sleeping is uncomfortable, lying on the unaffected side is the next best option, provided proper alignment is maintained.
Strategic use of support pillows can help maintain hip alignment and reduce tension on the bursa. Back sleepers should place a small pillow beneath the knees to relieve tension in the hip flexors and lower back. Side sleepers must place a firm pillow between their knees and ankles, which keeps the hips stacked and prevents the top leg from rotating inward and stretching the inflamed tendons.
Taking a nonsteroidal anti-inflammatory drug (NSAID) shortly before bed can maximize its anti-inflammatory and pain-relieving effect during the hours of peak biological inflammation. Applying cold therapy, such as an ice pack, to the outer hip for 15 to 20 minutes before lying down can also numb the area and reduce local swelling.
Ensuring the mattress offers a medium-firm level of support is also beneficial. This level of firmness provides both cushioning for the hip and adequate body alignment throughout the night.