Is Hand Pain Keeping You Up at Night? Try These PT-Approved Tips and Exercises

Any pain that makes it difficult for you to get a good night’s rest can be downright frustrating, and hand pain at night is no exception. “People often tell me that nighttime hand pain is more aggravating,” says Mary Kimbrough, PT, DPT, a physical therapist at Hinge Health. “They can cope with it during the day, but they understandably need to sleep at night.”

The good news: “There’s always something we can do to help alleviate hand pain at night,” says Dr. Kimbrough. 

Read on to learn more about what causes hand pain at night and how to relieve it — including exercises from Hinge Health physical therapists — so you can get back to sleep.

What Causes Hand Pain at Night?

For some people, nighttime hand pain can make it difficult to fall asleep, while others are awakened in the middle of the night by pain. The pain can range from a dull ache to sharp, shooting sensations. Other symptoms may include numbness, tingling, burning, or swelling.

Symptoms of nighttime hand pain can be caused by any condition that results in pain during the day, such as:

• Arthritis. A frequent site of osteoarthritis in the hands is at the base of the thumb. According to the Arthritis Foundation, about 70% of people with osteoarthritis report sleep problems. Rheumatoid arthritis, an autoimmune inflammatory disease, often starts as pain in the small joints of the hands.

• Nerve irritation. When nerves in the arms or wrists get irritated or inflamed, this can cause tingling, numbness, burning, swelling, and weakness in the hands and fingers during the day and at night. When the median nerve that runs through the wrist gets compressed it can cause carpal tunnel syndrome, resulting in pain in the fingers. The ulnar nerve (one of the main nerves in your arm) can also get compressed, causing similar conditions: cubital tunnel syndrome results when the nerve compression is at the elbow, while ulnar tunnel syndrome occurs when the compression is at the wrist. In all cases, this can result in hand pain.

• Tendinitis. The swelling and inflammation of tendons in the hands can lead to pain and other symptoms that may affect your sleep. De Quervain’s tenosynovitis involves the thumb tendon and can cause pain from the base of the thumb into the forearm. Trigger finger occurs when a tendon in the palm becomes inflamed, causing one or more fingers to lock in a painful, flexed position. Ulnar tendinitis causes pain on the pinky side of the hand.

No matter what may be causing your hand pain, it can be worse at night for a variety of reasons, including:

• Lack of hand movement at night. “We like to say, ‘motion is lotion’ because movement increases blood flow and helps lubricate and bring nutrients to joints to help ease pain,” says Dr. Kimbrough. “While you're sleeping, you're not moving very much, which can cause a buildup of swelling and stiffening of the connective tissues that can feed into symptoms at night.”

• Sleeping position. “Certain sleeping positions can contribute to hand pain,” says Dr. Kimbrough. Bending the wrists and curling the hands may aggravate some conditions like carpal tunnel syndrome. A tightly bent elbow can lead to hand pain, especially if you have ulnar or cubital tunnel syndrome. Even rolling onto and sleeping on your hands may cause hand pain. Since you’re sleeping for six to eight hours (hopefully!), the prolonged time in these positions makes them more problematic.

• Certain daytime activities. Hours on the computer, styling hair, or working construction especially if you’re using tools that vibrate, can affect your hands at night. “If you’re spending a lot of your time during the day doing intense or repetitive hand motions, it can result in increased pain at night,” says Dr. Kimbrough.

• Downtime. Unlike during the day, when you’re busy with work, family, friends, errands, and chores, there’s nothing to distract you from pain when lying in bed at night. “Everything gets turned off at night, which can make you more aware of symptoms or pain,” says Dr. Kimbrough.

Hand Pain at Night: A Hinge Health Perspective

While movement and exercise are often first-line treatments for joint and muscle pain, it can be understandably challenging to build an exercise routine if you’re tired from lack of sleep and generally feeling sore. So when it comes to exercising, it’s best to start slow and gradually increase your level of activity as your energy improves. 

Many people worry that exercise will make their pain worse, may not be safe for their joints, or do more damage. All of these are myths. In fact, being sedentary is associated with worsening symptoms. Targeted exercises and stretches can help keep all the joints, muscles, and tendons in your arms, hands, and wrists healthy and strengthen weaker muscles that often accompany pain.

How to Cope When Hand Pain Strikes at Night

Nighttime hand pain can set up a vicious cycle of less sleep and more pain. Your body needs the time to heal, and research shows that being well rested can be a buffer against pain, so if pain is keeping you up at night, you’re not getting the restorative rest you need to feel better. The good news: You can break this cycle. Here are ways to get hand pain relief at night so you can sleep better.

• Use heat. Heat can help counteract the lack of movement that happens when you’re sleeping. It warms muscles and tendons, making them more flexible, and it increases blood flow, providing more lubrication and nutrition to joints. Before bed or when you wake up with pain, heat your hands for 10 to 15 minutes by soaking them in warm water or using a heating pad. “My patients say the heat is also calming and helps them relax and sleep,” says Dr. Kimbrough. If you have excessive swelling or redness in your hands, avoid heat and try ice instead to reduce the swelling first. 

• Try a brace. A hand brace can help you avoid sleeping in positions that compress your hand and fingers and aggravate painful conditions. There are braces to keep your wrist in a neutral position, your fingers extended, and your elbow straight. The right brace for you may depend on the underlying condition causing your hand pain. A physical therapist or healthcare provider can help you find a brace that’s right for you to wear at night. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Change sleeping positions. Sleeping on your back will make you less likely to compress your hands. Lie on your back with your arms down at your sides or place a pill on your belly and drape your arms over it, so your elbows are only partially bent, your wrists are straight, and your hands are open. It’s natural to move around as you sleep, but starting in this position may help. 

• Move a little. You don’t even have to get out of bed to do some therapeutic hand exercises that can help you get much-needed rest. A few reps of the exercises below may be all you need to increase circulation, ease stiffness, and relieve pain. You can do these moves before bed or in the middle of the night if pain breaks your sleep. 

• Practice good sleep hygiene. Hand pain may not be the only thing interfering with your sleep, so try to eliminate other factors that may contribute to poor sleep if you can. Avoiding caffeine at least six hours before bed, turning off electronic devices about an hour before bed, and reducing alcohol in the evening can all help. And try to get your body into sleep mode with a relaxing bedtime routine, like gentle yoga, deep breathing exercises, or a hot shower or bath. “Calming activities can help you get ready for sleep, especially if your pain is limiting your ability to fall asleep right away,” says Dr. Kimbrough.

• Consider over-the-counter (OTC) medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for hand pain at night. It’s important to ensure you can safely take these medications based on your medical history.

When to See a Doc for Hand Pain at Night

Hand pain at night rarely indicates something serious, but there are some circumstances when you should consult with a doctor. Here’s when:

• Your pain is not improving with conservative treatments.

• Your hands are stiff, swollen, or red in the morning for more than an hour after waking.

• You have a fever along with the pain.

• You have severe or progressive numbness, tingling, or weakness.

• You experience an acute injury like a fall that may have broken a bone in your hand.

These exercises can be done before bed to help prevent hand pain from waking you up at night. Or you can do them in bed if you're awakened by pain and can’t fall back to sleep. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Manage Your Workload

If you’re doing a lot of repetitive hand movements like typing, using a mouse, preparing food, styling hair, or gripping hand tools during the day, it’s important to take stretch breaks throughout the day, says Dr. Kimbrough. You may also benefit from an ergonomic assessment if you have a desk job. Simple adjustments to your workstation may help reduce muscle fatigue that could contribute to nighttime pain. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. 

Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Costa, F., Janela, D., Molinos, M., Moulder, R. G., Lains, J., Francisco, G. E., Bento, V., Yanamadala, V., Cohen, S. P., & Correia, F. D. (2022). Digital rehabilitation for hand and wrist pain: a single-arm prospective longitudinal cohort study. PAIN Reports, 7(5), e1026. doi:10.1097/PR9.0000000000001026

2. Osteoarthritis and Sleep. (n.d.). Arthritis Foundation. Retrieved from https://www.arthritis.org/health-wellness/healthy-living/managing-pain/fatigue-sleep/osteoarthritis-and-sleep 

3. Feng, B., Chen, K., Zhu, X., Ip, W.-Y., Andersen, L. L., Page, P., & Wang, Y. (2021). Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study. BMC Public Health, 21(1). doi:10.1186/s12889-020-10137-1

4. Sivertsen, B., Lallukka, T., Petrie, K. J., Steingrímsdóttir, Ó. A., Stubhaug, A., & Nielsen, C. S. (2015). Sleep and pain sensitivity in adults. PAIN, 156(8), 1433–1439. doi:10.1097/j.pain.0000000000000131