The sensation of hands feeling intensely hot or “on fire” at night is a disruptive experience known as nocturnal paresthesia. This burning, tingling, or numbness frequently signals an underlying issue involving the peripheral nervous system (the network of nerves outside the brain and spinal cord). While this discomfort significantly impacts sleep quality, it is usually a symptom of a manageable condition requiring careful diagnosis. Understanding the root causes of this nerve irritation is the first step toward finding relief.
Localized Nerve Compression
The most frequent mechanical cause of nocturnal hand burning is the compression of a major nerve as it passes through a narrow anatomical space. Carpal Tunnel Syndrome (CTS) is the most common example, involving the median nerve. This nerve travels through the carpal tunnel, a confined passageway in the wrist formed by small bones and a thick ligament.
Pressure on the median nerve within this tunnel can increase due to inflammation, swelling of the surrounding tendons, or repetitive motion that forces the wrist into a bent position. The compression irritates the nerve, causing it to misfire and send abnormal signals that are interpreted as burning, tingling, or pain. Repetitive motions, such as heavy typing or using vibrating tools, are known risk factors because they can lead to swelling of the synovial tissue around the tendons, further constricting the space.
Risk factors like pregnancy, thyroid disorders, and wrist fractures can also lead to swelling that mechanically compresses the nerve. Individuals often shake or hang their hands to alleviate the symptoms, a behavior that temporarily restores nerve function by improving blood flow or shifting the wrist position. The localized nature of the compression means the burning sensation typically follows the path of the median nerve.
Systemic Conditions Affecting Nerve Function
When the burning sensation is not caused by localized compression, it may be a manifestation of a broader health issue impacting the peripheral nervous system, known as peripheral neuropathy. This generalized nerve damage often begins in the longest nerve fibers, which are those that reach the hands and feet. The damaged nerve fibers become hypersensitive or send scrambled signals, resulting in the characteristic burning pain.
Metabolic disorders are a leading systemic cause, with diabetes being the most common culprit. Chronically elevated blood sugar levels can damage the small blood vessels that supply the nerves, leading to nerve fiber injury over time. This diabetic neuropathy often presents as a symmetrical burning, numbness, and tingling in both hands and both feet.
Other systemic issues include nutritional deficiencies, particularly a lack of Vitamin B12, which is essential for healthy nerve maintenance and repair. Hypothyroidism, an underactive thyroid, can also cause fluid retention that leads to nerve compression and generalized inflammation. Excessive alcohol consumption can also be directly toxic to nerve tissue, leading to a specific form of neuropathy.
Why Symptoms Worsen During Sleep
Symptoms worsen at night due to a convergence of physiological and positional factors that exacerbate existing nerve vulnerability. Many people naturally sleep with their wrists flexed or bent inward, which significantly reduces the space within the carpal tunnel. This prolonged pressure on the already compromised median nerve is a primary reason symptoms become more intense and wake a person from sleep.
Fluid shifts in the body also contribute to nocturnal symptoms. During the day, gravity causes fluid to accumulate in the lower extremities, but when lying flat, this fluid redistributes and can increase swelling in the hands and wrists. This internal fluid retention adds pressure to the nerves, regardless of whether the underlying issue is compression or systemic neuropathy.
Body temperature naturally drops during the sleep cycle, and damaged nerves can be highly sensitive to these cooler conditions. The change in temperature can make nerves more easily excitable, causing them to interpret normal sensations as painful or burning. The lack of daytime distractions also plays a role, as the quiet of the night removes the mental focus that might otherwise mask mild discomfort.
Immediate Steps for Comfort and Medical Consultation
For immediate relief from a burning hand episode at night, gentle movements can often help. Shaking the hands vigorously, hanging them over the side of the bed, or running cool water over the wrists can temporarily reduce discomfort by improving circulation and slightly decompressing the nerve. Applying a cold pack to the wrist area can also help to reduce localized inflammation and cool the hypersensitive nerve endings.
Wearing a wrist splint at night is an effective preventative measure, as it holds the wrist in a neutral, straight position. This simple device prevents the wrist from bending during sleep, minimizing the pressure on the median nerve throughout the night. Adjusting the sleeping position to avoid lying directly on the hands or arms can also prevent mechanical compression.
If the burning sensations persist, interfere with sleep regularly, or are accompanied by muscle weakness, numbness, or loss of grip strength, a medical consultation is necessary. A primary care physician can perform an initial assessment and may refer you to a neurologist or an orthopedic specialist. Identifying the underlying cause, whether localized compression or a systemic condition, is the only way to establish a long-term, effective treatment plan.