The short answer: knee pain at night is most often caused by osteoarthritis, bursitis, a tendon problem, gout or an old injury. It can feel worse in bed because a still joint gets stiffer and you finally slow down enough to notice. A pillow between or under your knees, heat or ice, and daily strengthening help many people. A hot, swollen knee with a fever needs urgent care.
Cleveland Clinic sports medicine specialist Wesley Baker, DO, puts it plainly: people with healthy knees usually don’t get pain at night. There’s typically a reason, and finding it is the first step to better sleep.
What causes knee pain at night?
Osteoarthritis is the most common cause, followed by bursitis, tendon problems, gout and injuries such as a torn meniscus. The clues below come from NHS and Cleveland Clinic guidance. Use them to guide a talk with your doctor.
| Cause | Typical clues | Night pattern |
|---|---|---|
| Osteoarthritis | Pain and stiffness, often in both knees, mild swelling, grating or crackling | Often worse at the end of the day; can wake you up |
| Bursitis | Warm, tender swelling, often at the front of the knee; kneeling or bending makes it worse | Pressure from swelling can hurt at rest |
| Tendinopathy | Pain between the kneecap and shin, often after running or jumping | Aches at night after overuse in the day |
| Gout | Sudden, very bad pain with a hot, red, swollen joint | Can strike suddenly at night |
| Injury (meniscus, ligament) | A pop at the time of injury, can’t straighten, knee locks or gives way | Pain can spike at any time |
| Rheumatoid arthritis | Swelling and stiffness that can last a long time in the morning | Can flare at night |
An attack of gout usually lasts 1 to 2 weeks if untreated, the NHS says, and it’s more common in men. Septic arthritis, an infection inside the joint, looks a lot like gout and needs urgent care.
Why is knee pain worse at night?
Your knee stiffens when it stops moving. Dr. Baker of Cleveland Clinic explains that moving joints stay lubricated and still joints don’t, so the effects of the day’s activity catch up with you in bed. With fewer distractions, you also notice pain more.
Arthritis UK says knee osteoarthritis pain may feel worse at the end of the day, and some people have pain that wakes them in the night. Poor sleep then feeds the pain. Cleveland Clinic notes that between 50% and 90% of people with long-term joint pain don’t sleep well, and a tired brain copes with pain less well.
What is the best sleeping position for knee pain?
Sleep on your back with a pillow under your knees, or on your side with a pillow between them. Both positions are recommended by Cleveland Clinic and the Arthritis Foundation. A side pillow stops your knees pressing together, and a pillow under bent knees can keep worn joint surfaces from pressing on each other.
- Side sleepers: put one or more pillows between your knees.
- Back sleepers: place a pillow or rolled blanket under your knees.
- Experiment: the Arthritis Foundation suggests trying one, two or even three pillows. If you kick them away in the night, just put them back.
- Check your mattress: replace or rotate one that sags. A Cleveland Clinic physiatrist suggests a firm mattress for knee pain, with a foam topper if you need it.
- Choose smooth sheets such as cotton or silk so you can turn easily. Friction that stops you moving can add to stiffness.
Skip gadgets that lock you in one position all night. An occupational therapist quoted by the Arthritis Foundation says joints stiffen when you don’t move. If you’ve had knee surgery, ask your surgeon which positions are safe. The same pillow tricks help a sore hip, as our guide to hip pain at night explains.
What can you do tonight for knee pain?
Ease the joint before bed, then set up your pillows. Try these steps:
- Take a warm bath or shower before bed. The Arthritis Foundation suggests warmth to soothe stiff joints.
- Pick heat or ice. Cleveland Clinic says arthritis pain usually does better with heat, while swelling and fresh overuse injuries usually do better with ice.
- Use ice safely. The NHS suggests a wrapped ice pack for up to 20 minutes every 2 to 3 hours. MedlinePlus warns not to fall asleep with ice on your skin.
- Raise a swollen knee on a pillow while you rest.
- Keep covers off a gouty knee. The NHS says to keep bedclothes off the joint during an attack.
- Ask about painkillers. A pharmacist can tell you which one suits you and when to take it. Check first if you take blood thinners or other regular medicines.
If back pain is keeping you awake too, see how to sleep with lower back pain.
What exercises help knee pain at night?
Daily strengthening and stretching help most, because stronger thigh muscles share the load on your knee. A Cleveland Clinic physical therapist warns that inactivity makes knee osteoarthritis worse. These come from Arthritis UK’s knee exercise sheet.
| Exercise | How to do it | Reps |
|---|---|---|
| Sitting straight-leg raise | Sit tall in a chair, straighten and lift one leg, hold, then lower slowly | Hold for a count of 10; 10 times each leg |
| Knee press | Lie down with a rolled towel under one ankle and push the back of that knee toward the floor | Hold for 5; at least 5 times each leg, daily |
| Quads with a roll | Legs out straight, towel under one knee, push down on it and pull your toes toward you | Hold for 5 seconds; 10 times each leg |
| Sit to stand | Stand up from a chair without using your hands, then sit back down slowly | As many as you can; 3 rounds, 1 minute rest |
| Step-ups | Step onto the bottom stair and back down, holding the banister if needed | As many as you can; 3 rounds, 1 minute rest |
Arthritis UK says the knee press helps stop your knee becoming permanently bent, which is worth doing if you sleep with a pillow under your knees. To stay generally healthy, the NHS suggests 150 minutes a week of moderate activity, such as cycling or fast walking. Swimming and cycling work the knee without pounding it. Our exercises at home routine adds more no-equipment moves. Curious whether diet plays a part? Read what a recent trial found on fiber for knee arthritis. For daytime relief, see our knee pain home remedies, and check what your knee pain’s location means.
When should you see a doctor for knee pain at night?
See a doctor if knee pain keeps waking you, or if home care isn’t helping after a few days. A Cleveland Clinic physiatrist says pain lasting more than three or four days in a row, or on and off for two to three weeks, should be checked. So should pain you need alcohol or sleep aids to get through.
Get urgent help the same day if:
- Your knee is hot, swollen or red and you have a fever or feel shivery. This can be a joint infection.
- You can’t put weight on your leg or can’t move your knee
- Your knee is badly swollen or has changed shape
- Your knee locks, gives way or clicks painfully
- Your calf below the sore knee is painful, swollen, numb or bluish
Also see a doctor if your pain comes with night sweats, weight loss you can’t explain, or a history of cancer.
Your next step
Tonight, put a pillow between your knees and try a warm shower before bed. Tomorrow, start the straight-leg raise. Upper back aching too? Read about back pain between the shoulder blades. If your back is part of what keeps you up, The Back Pain Reset below sets out ten-minute sessions for 28 days.
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Quick questions
Why does my knee hurt at night but not during the day?
When you stop moving, your knee joint gets less lubrication and stiffens, and in bed there’s nothing to distract you from the pain. Cleveland Clinic says the day’s activity often catches up with you at night. Arthritis, bursitis and tendon problems are common causes, so pain that keeps waking you is worth checking.
Is arthritis knee pain worse at night?
It often is. Arthritis UK says knee osteoarthritis pain may feel worse at the end of the day, and some people have pain that wakes them. Rheumatoid arthritis can also flare at night. Heat, a pillow between or under your knees, and daily strengthening exercises can make nights easier.
Should I put a pillow under my knee or between my knees?
It depends on how you sleep. Cleveland Clinic and the Arthritis Foundation suggest a pillow under your knees if you sleep on your back, and one or more pillows between your knees if you sleep on your side. If you’ve had knee surgery, ask your surgeon which position is safe.
What can help knee pain at night?
Try a warm bath before bed, heat for arthritis stiffness or ice for swelling, and pillows to support your knee. The NHS suggests a wrapped ice pack for up to 20 minutes every 2 to 3 hours. Regular daytime strengthening, like straight-leg raises, helps over time. See a doctor if pain keeps waking you.
Can gout cause knee pain at night?
Yes. Cleveland Clinic says gout can cause sudden, intense knee pain at night. The NHS describes sudden severe pain with hot, red, swollen skin over the joint. See a doctor the first time it happens, and get urgent help if you also have a high temperature, because a joint infection can look similar.
When is knee pain at night serious?
Get urgent help if your knee is hot, red and swollen with a fever, if you can’t put weight on it, if it’s badly swollen or misshapen, or if your calf below the knee is painful or swollen. Night pain with night sweats, weight loss you can’t explain or a cancer history also needs checking.
This article is general information, not medical advice. If your knee is hot and swollen with a fever, or you can’t put weight on it, get urgent medical help. Ask your doctor or pharmacist before taking painkillers, especially if you take other medicines, and ask your surgeon about sleeping positions after knee surgery.
Sources
- Cleveland Clinic. Knee Pain at Night: Causes and Solutions
- Cleveland Clinic. How To Keep Sore Hips, Knees and Shoulders From Ruining Your Sleep
- Arthritis Foundation. Position Yourself for a Good Night’s Sleep
- NHS. Knee pain
- NHS. Osteoarthritis
- NHS. Bursitis
- NHS. Gout
- NHS. Septic arthritis
- Arthritis UK. Osteoarthritis of the knee
- Arthritis UK. Exercises for the knees
- Cleveland Clinic. The Best Exercises for Osteoarthritis (OA) of the Knee
- MedlinePlus. Knee pain