Peripheral neuropathy-when nerves outside your brain and spinal cord misfire-often feels worse at night, disrupting sleep and amplifying pain, says neurologist Dr Khosro Farhad of Mass General Brigham. As evening sets in and movement drops, your spinal “pain gates” may open, allowing nerve pain signals to flood your brain. Cooler bedroom temperatures can further intensify this discomfort.
The article highlights the gate control theory, which explains how movement and soothing sensations (like warmth or massage) can close those neural gates and dampen pain, while staying still or feeling cold can do the opposite. Biological rhythms also play a role: natural pain-fighting hormones drop at night, making you more vulnerable to pain when you’re trying to sleep.
Dr Farhad recommends creating a warmer, more comfortable sleeping environment-reducing cold drafts and, if needed, wearing soft or diabetic socks to lessen nighttime discomfort. Good sleep hygiene, such as dimming lights and avoiding screens before bed, also helps prevent pain from disrupting rest.
He also suggests optimising pain management timing: taking medication in the evening instead of just during the day and considering topical treatments like lidocaine or capsaicin for local relief. These measures can help reduce pain peaks and improve sleep quality.
Finally, Dr Farhad advises that persistent nighttime neuropathy should prompt a visit to your GP. Since many causes are treatable and nerves can regenerate once underlying issues are addressed, early evaluation could lead to significant pain relief and recovery.