Private carpal tunnel syndrome clinic in London, same-day physiotherapy.

Why the symptoms are worse at night

Most people sleep with their wrists curled, which narrows the tunnel further, and fluid redistributes when lying flat. The result is the classic story: waking at two or three in the morning with a hand that feels dead or burning, then shaking or hanging it out of bed until it settles. That pattern is close to diagnostic.

During the day, symptoms typically come on when holding a phone, driving, reading a newspaper or using tools — anything sustaining a wrist position.

What causes it

• Often no identifiable cause at all
• Pregnancy, particularly the later months — usually resolves after delivery
• An underactive thyroid, diabetes, rheumatoid arthritis
• Previous wrist fracture, or arthritis at the wrist
• Repetitive forceful gripping and prolonged vibration — the link with ordinary keyboard work is much weaker than commonly assumed
• Being significantly overweight, and the menopause

Treatment, in order

• A night splint holds the wrist straight while you sleep and is the single most useful first step. It needs wearing every night for at least six weeks before judging it. Many people abandon it after three nights because it feels awkward — persistence is what makes it work.
• Activity modification — breaking up sustained gripping, adjusting workstation and tool use, avoiding prolonged wrist flexion.
• A steroid injection into the carpal tunnel often gives good relief. The effect may be temporary, but a good response also helps confirm the diagnosis.
• Nerve conduction studies measure how well the nerve is working. They confirm the diagnosis, grade severity, and are usually required before surgery.
• Surgery — carpal tunnel decompression — is a short procedure under local anaesthetic that releases the ligament over the nerve. It is highly effective, particularly for night symptoms, which often resolve immediately.

Self-help while you wait

• Wear the splint every night without exception.
• Take breaks from sustained gripping; alternate tasks rather than pushing through.
• Shake the hand out and change position when symptoms start rather than persevering.
• Nerve gliding exercises may help — ask our physiotherapy team to show you rather than following a video.
• Have thyroid function and glucose checked if this has not been done.