Why does neuropathy hurt more at night

What works well for one kind of chronic pain may not work well for another, and your body will respond in its own unique way. Here are some strategies that may help you reduce your nighttime pain and get better sleep. If your chronic pain is caused by pinched or compressed nerves, adjusting your sleep position may relieve some of the pressure. For example, people with sciatica who prefer to sleep on their side often find it helpful to sleep with their affected leg on top.

People with hip or knee pain may find relief by sleeping with a pillow between their legs. Experiment with different room temperatures when you sleep. It may take some time to find the best temperature for you: cool enough to help you sleep, not cold enough to make your pain worse.

Exercise during the day can help reduce some kinds of chronic pain, and it may help you rest better too. Talk with your pain management doctor about what kinds of exercise are appropriate and safe for you. Develop a sleep routine that helps prepare your body for rest. This might include turning off the TV and other screens hours before bedtime, reading a book, or taking a warm bath. Anything that helps you relax and unwind before you head to sleep. The stress of chronic pain can make it even harder to rest.

Try meditation or deep breathing exercises to lower your stress and help reduce your perception of pain. They also give you something else to focus on instead of your pain. For example, if you have rheumatoid arthritis, your doctor may recommend modified-release corticosteroids to prevent nighttime inflammation.

Acquired neuropathies are either symptomatic the result of another disorder or condition; see below or idiopathic meaning it has no known cause. Genetically-caused polyneuropathies are rare. Genetic mutations can either be inherited or arise de novo , meaning they are completely new mutations to an individual and are not present in either parent. Some genetic mutations lead to mild neuropathies with symptoms that begin in early adulthood and result in little, if any, significant impairment.

More severe hereditary neuropathies often appear in infancy or childhood. Charcot-Marie-Tooth disease, also known as hereditary motor and sensory neuropathy, is one of the most common inherited neurological disorders. The small-fiber neuropathies that present with pain, itch, and autonomic symptoms also can be genetic. As our understanding of genetic disorders increases, many new genes are being associated with peripheral neuropathy. The bewildering array and variability of symptoms that neuropathies can cause often makes diagnosis difficult.

A diagnosis of neuropathy typically includes:. Muscle and nerve ultrasound is a noninvasive experimental technique for imaging nerves and muscles for injury such as a severed nerve or a compressed nerve. Ultrasound imaging of the muscles can detect abnormalities that may be related to a muscle or nerve disorder. Certain inherited muscle disorders have characteristic patterns on muscle ultrasound. Treatments depend entirely on the type of nerve damage, symptoms, and location.

Your doctor will explain how nerve damage is causing specific symptoms and how to minimize and manage them. With proper education, some people may be able to reduce their medication dose or manage their neuropathy without medications.

Definitive treatment can permit functional recovery over time, as long as the nerve cell itself has not died. Correcting underlying causes can result in the neuropathy resolving on its own as the nerves recover or regenerate.

Nerve health and resistance can be improved by healthy lifestyle habits such as maintaining optimal weight, avoiding toxic exposures, eating a balanced diet, and correcting vitamin deficiencies. Smoking cessation is particularly important because smoking constricts the blood vessels that supply nutrients to the peripheral nerves and can worsen neuropathic symptoms.

Exercise can deliver more blood, oxygen, and nutrients to far-off nerve endings, improve muscle strength, and limit muscle atrophy. Self-care skills in people with diabetes and others who have an impaired ability to feel pain can alleviate symptoms and often create conditions that encourage nerve regeneration. Strict control of blood glucose levels has been shown to reduce neuropathic symptoms and help people with diabetic neuropathy avoid further nerve damage. Inflammatory and autoimmune conditions leading to neuropathy can be controlled using immunosuppressive drugs such as prednisone, cyclosporine, or azathioprine.

Plasmapheresis—a procedure in which blood is removed, cleansed of immune system cells and antibodies, and then returned to the body—can help reduce inflammation or suppress immune system activity. Agents such as rituximab that target specific inflammatory cells, large intravenously administered doses of immunoglobulins, and antibodies that alter the immune system, also can suppress abnormal immune system activity.

Medications recommended for chronic neuropathic pain are also used for other medical conditions. Among the most effective are a class of drugs first marketed to treat depression. Another class of medications that quiets nerve cell electrical signaling is also used for epilepsy. Common drugs include gabapentin, pregabalin, and less often topiramate and lamotrigine. Carbamazepine and oxcarbazepine are particularly effective for trigeminal neuralgia, a focal neuropathy of the face.

Local anesthetics and related drugs that block nerve conduction may help when other medications are ineffective or poorly tolerated. Medications put on the skin topically administered are generally appealing because they stay near the skin and have fewer unwanted side effects.

Lidocaine patches or creams applied to the skin can be helpful for small painful areas, such as localized chronic pain from mononeuropathies such as shingles. Another topical cream is capsaicin, a substance found in hot peppers that can desensitize peripheral pain nerve endings. Doctor-applied patches that contain higher concentrations of capsaicin offer longer term relief from neuropathic pain and itching, but they worsen small-fiber nerve damage. Weak over-the-counter formulations also are available.

Lidocaine or longer acting bupivicaine are sometimes given using implanted pumps that deliver tiny quantities to the fluid that bathes the spinal cord, where they can quiet excess firing of pain cells without affecting the rest of the body. Other drugs treat chronic painful neuropathies by calming excess signaling. Because pain relievers that contain opioids can lead to dependence and addiction, their use must be closely monitored by a physician.

However, what is particularly interesting with peripheral neuropathy is that its symptoms significantly worsen at night, when compared to other types of the condition. Peripheral neuropathy especially reacts to changes in temperature, which are known to increase the pain levels.

The reason this happens lies in the damage of the peripheral nerves. When peripheral nerves are damaged, the brain translates the changes in temperature as pain, which then causes the sensations of tingling, burning, and sharp pain.

The body experiences changes in temperature mostly during the night. As the circadian rhythm adjusts to the nighttime, and the melatonin production increases, the body temperature lowers in the hope to make us feel sleepy. That is when the body becomes cooler, and neuropathic patients start experiencing an increase in pain levels.

Sleep disorders are primarily related to the increase in pain levels during nighttime in the majority of chronic pain patients. Even with proper treatment, medications, and therapy, neuropathic patients cannot simply decrease the pain intensity as the nighttime arrives. That is why the connection between neuropathy and sleep disorders is bidirectional; the pain prevents proper sleep, while the lack of proper sleep further aggravates neuropathy.

Patients that suffer from neuropathy are more likely to develop sleep disorders. Studies have shown a direct association between neuropathy and insomnia, restlessness, sleep fragmentation, etc. It is believed that antidepressants, opioid receptor agonists, and serotonin can reduce pain-related sleep disturbances in both depressed and non-depressed patients.

That is why neuropathic patients are often prescribed antidepressants to reduce nerve pain levels and improve their sleep quality. Because chronic nerve pain intensifies during the nighttime, so does the chance of further health deterioration increase. The reason we mention this is because nerve pain or neuropathy during nighttime can be worsened by the development of sleep apnea syndrome, or obstructive sleep apnea.

Neuropathy in diabetic patients is characterized by a higher BMI, as well as by the presence of serious sleep complaints, which further aggravate both the neuropathy and sleep apnea.

Type 2 diabetic patients with peripheral neuropathy are most likely to experience higher pain levels, decreased sleep efficiency, and sleep apnea. Alongside the regular neuropathy treatment, these patients are offered the help of CPAP machines , which are designed to provide breathing assistance during the night.

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