How to Sleep With Hip Pain: Positions That Help Tonight

You rolled onto your side, and there it is again: a deep ache at the point of your hip that pulls you right out of sleep. You shift, you stuff a pillow somewhere, you try the other side, and now you are wide awake at 2am, doing the math on how many hours are left. If you are trying to work out how to sleep with hip pain, you are not being dramatic. Night is often when a sore hip hurts most.

Here is the short answer. Sleep on the side that does not hurt, with a firm pillow between your knees so your top leg stays level. If both hips hurt, lie on your back with a pillow under your knees. Soften the pressure point with a mattress topper or extra cushions, ice the hip in the evening, and when pain wakes you, change position slowly and calm your body down before you try to sleep again. If the pain is new, getting worse, or still there after two weeks of home care, get it checked.

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Why does hip pain get worse at night?

Lying down puts weight on parts of the hip that get a break during the day. When you lie on your side, the bony point at the outside of your hip (the greater trochanter) takes a lot of your body weight, all night, in one spot.

That spot matters. A small fluid sac called a bursa sits right over it. When it gets irritated, it is called trochanteric bursitis, and the American Academy of Orthopaedic Surgeons says the pain is typically worse at night, when lying on the affected hip, and when getting up from a chair. The same page notes that lying on one side for a long time can itself irritate the hip.

The NHS hip pain page lists a few other common causes, each with its own pattern:

Bursitis: pain that can spread into the outer thigh and feels worse when moving or lying on your side.
Osteoarthritis: more common over 45, with pain that is worse when walking and stiffness after moving.
Rheumatoid arthritis: pain and stiffness that are worse after not moving, for example when you wake up.
A strain or tendon problem: pain, swelling or bruising after hard or repetitive exercise.

The NHS is clear that you should not try to diagnose the cause yourself. The patterns are useful for one thing: telling a doctor or physio exactly when it hurts. “It is worst when I lie on my left side after about an hour” is a far more helpful sentence than “my hip hurts.”

The best sleeping positions for hip pain

There is no single perfect position. The goal is simple: keep weight off the sore spot and keep your hips and knees lined up so nothing twists for six hours.

If you sleep on your side

Lie on the side that does not hurt. This keeps your weight off the sore point. If both sides hurt, see the back position below.
Put a firm pillow between your knees. Without it, your top knee drops toward the mattress and pulls on the outside of the top hip. Many people find a firm pillow, or a folded blanket, that keeps the top leg roughly level with the hip makes the biggest difference of anything on this list.
Hug a second pillow. It stops you rolling forward onto your front, which twists the hip again.
Bend your knees a little, not tucked up tight to your chest.

If you sleep on your back

Back sleeping takes pressure off both hips at once. A pillow under your knees softens the pull on the front of the hips and lower back. If you tend to roll onto your side in your sleep, a pillow along each side of your body can act as a gentle bumper.

If you sleep on your stomach

Lying on your front usually turns one leg out and twists the hips and lower back. If it is the only way you can fall asleep, a flat pillow under your hips can keep things more level, but most people with sore hips do better learning one of the positions above over a week or two.

Your mattress, topper and pillows

A very firm mattress pushes back hard on the bony point of a side sleeper’s hip. A very soft or sagging one lets the hips sink below the shoulders, so the joint sits twisted all night. Either can turn a sore hip into an awake hip.

You do not have to buy a new mattress tonight. A mattress topper a few inches thick spreads the pressure on the hip point, and the NHS advice on bursitis says extra cushions around the affected joint while you sleep can help protect and support it. If your mattress is old or has a dip where you lie, our page on sleeping on an uncomfortable mattress walks through the cheap fixes first.

What to do in the hour before bed

A sore hip settles better if you do not take it straight from the sofa to the mattress.

Ice it after a busy day. The NHS suggests an ice pack, or a bag of frozen peas wrapped in a towel, on the painful area for up to 20 minutes at a time, every 2 to 3 hours.
Skip the low sofa. The NHS warns that low chairs put extra pressure on your hips. A firmer, higher chair for the evening is kinder to the joint.
Do a few gentle stretches. Slow and easy, never into sharp pain. The NHS links to these hip exercises from Arthritis UK, and our bedtime stretches work well as a wind-down too.
Ask about pain relief. The NHS lists paracetamol or ibuprofen gel (or ibuprofen tablets if needed) for hip pain. A pharmacist can tell you what is safe for you, especially if you take other medicines.
Set up your pillows before you lie down, so you are not building a fort in the dark at 2am.

How to stop pain from waking you up at night

You may not be able to stop every wake-up while the hip is healing. What you can stop is a 2-minute wake-up turning into a 2-hour one. The pain wakes you, and then the frustration, the clock and the worry about tomorrow keep you up.

Move slowly. Bend your knees, keep them together, and roll as one unit onto your back or your good side. Quick twisting moves are what make the hip flare.
Put the knee pillow back. It has usually slipped out. That alone is often the reason you woke.
Do not check the clock. Knowing it is 3:12 adds a second problem to the first.
Breathe out longer than you breathe in. The NHS breathing exercise is a gentle place to start: breathe in for a count of up to 5, out for a count of up to 5, for at least 5 minutes. Some people prefer the 4-7-8 breathing method, which stretches the out-breath further.
Let the rest of your body go. Pain makes you brace without noticing: jaw tight, shoulders up, good leg tense. Our guide to relaxing your body to sleep walks through it from head to toe.
If you are still awake after about 20 minutes, get up. The American Academy of Sleep Medicine recommends getting out of bed if you do not fall asleep after 20 minutes and doing something quiet, in low light, away from screens. Walking a little often eases a stiff hip too. Come back when you feel sleepy.

For more on the getting-back-to-sleep part, see how to fall back asleep in the middle of the night.

Why a bad night makes the next day’s pain worse

Pain and sleep feed each other, and not only in the direction you would expect. A 2013 review in The Journal of Pain by researchers at Johns Hopkins found that poor sleep reliably predicted new and worsening chronic pain, and that sleep problems predicted pain more strongly than pain predicted sleep problems.

That is actually good news. It means protecting your sleep is part of treating the hip, not a side issue. Every night you get through with less tossing and turning gives the joint and your patience a better day. If you lie down and your body feels buzzing and braced even when the hip is quiet, that is a separate problem worth fixing, and our page on physical tension that keeps you awake is a good next read.

When to see a doctor about hip pain at night

Most hip pain at night is not an emergency, but some of it needs a proper look. The NHS says to see a GP (your regular doctor) if:

hip pain is stopping you doing normal activities or affecting your sleep
the pain is getting worse or keeps coming back
the pain has not improved after 2 weeks of treating it at home
your hip is stiff for more than 30 minutes after waking up

Get urgent help, the same day, if the severe pain started suddenly without a fall, your hip is swollen and feels hot, the skin around it has changed colour, or you feel unwell with a high temperature. After a fall, if you cannot walk or put weight on the leg, or you have tingling or loss of feeling in the hip or leg after an injury, call emergency services (911 in the US).

A physical therapist is often the person who helps most with night pain. They can find which movements and positions set it off and give you exercises for the muscles around the hip.

Quick answers

Which side should I sleep on with hip pain?

The side that does not hurt, with a firm pillow between your knees. If both hips are sore, try your back with a pillow under your knees.

Is a firm or soft mattress better for hip pain?

Usually something in between. Too firm presses on the hip point, too soft lets your hips sink and twist. A topper is the cheapest way to test softer before you spend money.

Why does my hip only hurt when I lie down?

Lying on your side puts your body weight on the outside of the hip for hours. With bursitis in particular, that is exactly when it hurts most. It is worth mentioning that pattern to your doctor.

Does a pillow between the knees really help?

For many side sleepers, yes. It keeps the top leg from dropping and pulling on the hip. It needs to be firm and thick enough to keep the knees about hip-width apart. A thin pillow squashes flat by midnight.

Other pain that keeps you up

If it is not only the hip, these guides cover the same problem for other spots:

Tonight, keep it simple

Good side down, firm pillow between the knees, a softer surface under the hip, and a slow breath out when it wakes you. You do not have to fix the hip tonight. You only need to give your body a fair chance to rest, so tomorrow you wake up clearer instead of sore and running on coffee.

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