Hip Pain at Night: Causes and Sleep Fixes

Few things are more frustrating than hip pain that wakes you up at 2 AM. You shift positions, punch your pillow, and try to find some angle that does not hurt. Nothing works. By morning you are exhausted and your hip feels worse than when you went to bed.

Nighttime hip pain is not random. There are specific reasons it gets worse when you lie down, and there are specific fixes that work. This guide covers both.

Why Does Hip Pain Get Worse at Night?

Your hip does not suddenly break down at bedtime. Several factors combine to make pain more noticeable when you lie down.

Pressure on the joint. Side sleepers place direct pressure on the greater trochanter, the bony point on the outside of your hip. If your mattress is too firm, it does not let your hip sink in enough, compressing the bursa and surrounding tissues.¹

Reduced blood flow and stiffness. When you stop moving, your joint fluid (synovial fluid) thickens. This reduces the natural cushioning inside the joint and increases stiffness.²

Your body’s inflammation cycle. Cortisol, your body’s natural anti-inflammatory hormone, drops to its lowest levels between midnight and 4 AM. Less cortisol means less natural pain control during the hours you are trying to sleep.³

Fewer distractions. During the day, your brain processes thousands of sensory inputs that compete with pain signals. At night, with fewer inputs, pain becomes the loudest signal in the room.⁴

Common Causes of Nighttime Hip Pain

The cause of your hip pain determines the fix. Here are the most common reasons your hip hurts at night.

Trochanteric Bursitis

This is the number one cause of lateral hip pain at night. The bursa, a fluid-filled cushion on the outside of your hip, becomes inflamed. Lying on the affected side compresses it directly. Learn more in our full guide to hip bursitis treatment and exercises.

Feels like: Aching or sharp pain on the outer hip, worse when lying on that side.

Osteoarthritis

Degenerative changes in the hip joint cause stiffness and aching that worsen after periods of inactivity. Sleep is the longest period of inactivity in your day. About 30% of adults over 60 have hip osteoarthritis.

Feels like: Deep, aching pain in the groin or front of the hip. Stiffness when you first get out of bed.

Hip Flexor Tightness

If you sit all day, your hip flexors can become chronically tight. Certain sleeping positions (like the fetal position) keep them shortened all night, leading to anterior hip pain and stiffness.

Feels like: Tightness or pulling in the front of the hip. Worse in fetal position.

Piriformis Syndrome

The piriformis muscle sits deep in your buttock. When it tightens, it can compress the sciatic nerve, causing deep buttock and hip pain that can worsen with certain sleeping positions.

Feels like: Deep pain in the buttock that may radiate down the back of the leg.

Sleep Position and Mattress Issues

Sometimes the problem is not your hip itself but how you are sleeping on it. A mattress that is too firm will not let your hip sink in enough (side sleepers). A mattress that is too soft will not support proper alignment.

Research finding: A medium-firm mattress reduced hip and shoulder pain in side sleepers by 48% compared to a firm mattress.⁵

Pregnancy-Related Hip Pain

The hormone relaxin loosens pelvic ligaments during pregnancy. Combined with a shifting center of gravity and the requirement to sleep on your side, hip pain at night is extremely common in the second and third trimesters.

Referred Pain from the Spine

Disc herniations or facet joint problems in the lower back can send pain signals to the hip region. If your hip pain comes with sciatica symptoms, the source may actually be your spine.

Sleep Position Fixes

Side Sleepers

Place a firm pillow between your knees, extending it from your groin down to your ankles if possible. This keeps your pelvis level and reduces the compressive forces on your hip by approximately 20%.⁶ Sleep on the side that does not hurt. Avoid curling into the fetal position, which shortens hip flexors and compresses the joint.

Back Sleepers

This is the best position for hip pain. Place a pillow or bolster under your knees to take tension off your hip flexors and lower back. A small rolled towel under your lower back can provide additional support.

Stomach Sleepers

This is generally the worst position for hip pain because it forces your lower back into extension. If you cannot change habits, place a thin pillow under your pelvis to reduce that extension. Consider gradually transitioning to back sleeping.

Mattress Considerations

If your mattress is more than 7-8 years old and you wake up with hip pain regularly, it may be time for a new one. Look for medium-firm support. Side sleepers need enough give to let the hip and shoulder sink in while still supporting spinal alignment.

Bedtime Stretch Routine (10-15 Minutes)

Do these stretches in bed or on the floor right before sleep. They reduce muscle tension, improve blood flow, and help your hip settle into a comfortable position for the night.

Stretches (Hold 30 seconds each, both sides)

1. Supine Figure-4 Stretch

Lie on your back. Cross one ankle over the opposite knee. Pull the uncrossed leg gently toward your chest. You will feel a deep stretch in your outer hip and buttock.

30 seconds, 2 times each side.

2. Supine Knee-to-Chest

Lie on your back. Pull one knee gently to your chest with both hands. Keep the other leg straight or bent for comfort. This stretches the hip joint and low back.

30 seconds, 2 times each side.

3. Supine Hip Flexor Stretch

Lie at the edge of your bed. Pull one knee to your chest and let the other leg hang off the edge. Gravity does the stretching for you.

30 seconds, 2 times each side.

4. Side-Lying IT Band Stretch

Lie on your unaffected side. Cross your top leg behind your bottom leg and let it drop toward the floor. You should feel a stretch along the outer hip and thigh.

30 seconds, 2 times.

Gentle Strengthening Before Bed

5. Glute Bridge

Lie on your back with knees bent. Squeeze your glutes and lift your hips. Hold for 5 seconds. Lower slowly. Stronger glutes take pressure off the hip joint during sleep.

2 sets of 10-12 reps.

6. Side-Lying Clamshell

Lie on your unaffected side with knees bent at 45 degrees. Keep your feet together and open your top knee. Hold for 3 seconds. This strengthens the gluteus medius, which is often weak in people with nighttime hip pain.

2 sets of 12-15 reps.

For a complete hip exercise program beyond this bedtime routine, see our full guide to exercises for hip pain relief.

Treatment Options Beyond Exercise

Ice. Apply an ice pack to the painful area for 15-20 minutes before bed. Wrap it in a towel. This is especially helpful for bursitis flare-ups. For more on when to use ice versus heat, see our heat vs. ice guide.

Over-the-counter anti-inflammatories. Ibuprofen or naproxen taken 30 minutes before bed can reduce inflammation and help you sleep. Do not use these long-term without talking to your doctor.

Topical pain relief. Menthol-based creams or diclofenac gel applied to the hip can provide localized relief without the side effects of oral medications.

Physical therapy. If your nighttime hip pain has lasted more than 2-3 weeks, a physical therapist can identify the root cause and create a targeted treatment plan.

If you also deal with shoulder pain when sleeping, many of the same sleep position strategies apply. Side sleepers are particularly vulnerable to both.

Warning Signs: When to See a Doctor

• Night pain that wakes you repeatedly and does not improve with any position change (possible tumor, infection, or avascular necrosis)
• Hip pain with unexplained fever or weight loss
• Pain that gets progressively worse despite 2-3 weeks of stretching and sleep modifications
• Groin pain with noticeably decreased hip range of motion (possible osteoarthritis or labral tear)
• History of corticosteroid use combined with hip pain (increased risk of avascular necrosis)
• Sudden inability to bear weight
• Night pain in children or adolescents (must rule out Legg-Calve-Perthes disease, slipped capital femoral epiphysis, or infection)

How Long Until It Gets Better?

Cause	Expected Timeline
Sleep position or mattress issue	Days to 2 weeks
Hip flexor tightness	2-4 weeks with daily stretching
Mild bursitis	2-6 weeks
Piriformis syndrome	4-8 weeks
Osteoarthritis	Ongoing management, improvement in 4-8 weeks with consistent exercise

Frequently Asked Questions

Why does my hip only hurt at night?

Several factors combine at night: direct pressure from sleeping positions, reduced cortisol (your body’s natural anti-inflammatory), joint stiffness from inactivity, and fewer mental distractions that normally mask pain during the day.

What is the best sleeping position for hip pain?

Back sleeping with a pillow under your knees is best. If you are a side sleeper, use a firm pillow between your knees and sleep on the side that does not hurt. Avoid the fetal position.

Should I sleep on the side that hurts?

No. Sleep on the opposite side with a pillow between your knees, or switch to sleeping on your back. Lying on the painful side compresses the irritated structures.

Can a mattress cause hip pain?

Absolutely. A mattress that is too firm does not let the hip sink in (side sleepers). One that is too soft does not support spinal alignment. Medium-firm mattresses reduced hip pain by 48% in one study.⁵

Does hip bursitis hurt more at night?

Yes. Lying on the affected side directly compresses the inflamed bursa. Reduced movement during sleep also increases stiffness. Bursitis is the most common cause of nighttime lateral hip pain.

What exercises help hip pain at night?

Gentle stretches before bed work well: the figure-4 stretch, knee-to-chest, supine hip flexor stretch, and glute bridges. Do them nightly for the best results.

Related Conditions

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Footnotes

1. Orthopedic Associates of NJ. “Hip Pain at Night: What’s Causing It.” ↩

2. Arthritis Foundation. “4 Causes of Hip Pain at Night.” ↩

3. Cutolo M, et al. “Circadian rhythms in RA.” Ann Rheum Dis. 2005;64(4):611-3. ↩

4. Finan PH, et al. “The association of sleep and pain.” Sleep Med Rev. 2013;17(3):173-83. ↩

5. Radwan A, et al. “Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment.” J Chiropr Med. 2015;14(3):169-78. ↩ ↩²

6. Biomechanical analysis. “Pillow placement and hip joint loading in side sleepers.” Clinical Biomechanics. ↩