Should You Avoid Ibuprofen at Night?

There’s a good reason why ibuprofen is a staple of medicine cabinets everywhere. The nonsteroidal anti-inflammatory drug, or NSAID, blocks COX enzymes in the body, which leads to a reduction of inflammation and its uncomfortable symptoms. This makes the over-the-counter medicine effective at treating everything from headaches and sore muscles to fevers and arthritis pain. And the side effects are typically minimal compared to some prescription pain-relievers. 

But that doesn’t mean they’re nonexistent: Sometimes, ibuprofen can have unpleasant consequences that may not be worth the relief. Here’s what you need to consider.

Should You Skip Ibuprofen at Night?

Some research has shown that taking ibuprofen before bed can potentially lead to restless nights. This phenomenon was reported in 1994, when scientists studied how well a group of 37 test subjects were able to sleep with and without the drug. The participants who took ibuprofen had lower sleep quality overall compared to the placebo group, with more time spent awake and longer delays before reaching deep sleep. 

The suppression of melatonin, fluctuations in body temperature, and the decrease of prostaglandin D2 (a lipid that helps regulate sleep as well as pain response) were all cited as potential causes. The findings were published in the journal Physiology & Behavior.

It’s important to note, however, that the study consisted of a small sample size of subjects, so it may not be fully representative of the larger population. And a more recent study of 30 people, published in 2006, conflicted with its findings: The study’s authors wrote that “ibuprofen did not produce any clinically or statistically significant alterations in the character and quality of nighttime sleep.” Another small study of the NSAID aspirin from 1980 found that it increased certain stages of sleep while decreasing others. (One exception may be NSAID medications like Advil PM, which contain an antihistamine that, according to GoodRx, will help you fall asleep and stay that way if you’re experiencing pain at night.)The topic is far from settled, and more research is needed to reach a definitive conclusion. 

A more recent animal study published in Scientific Reports in 2020 showed that taking the pain reliever at night could possibly interfere with the body’s natural healing process. The study looked at the effects of NSAIDs on mice healing from surgery. For three days after surgery, the mice were given daily doses of the medicine as part of their postoperative routine. Two weeks after their surgeries, the mice who received doses during the active parts of their days were able to put weight on their limbs, while the mice who were dosed before rest periods recovered more slowly. 

The study authors speculated this had something to do with the genes that govern the rodents’ circadian rhythms. While inflammation is the cause of many bothersome pains, it’s also an important step in healing: Post-surgery, it will kill bacteria and signal that cells need to come to the area to rebuild tissues. But inflammation can also be destructive. During the day, cells that break down and reabsorb bone tissue are most active. So it’s possible that NSAIDS given when the animals were awake led to the overexpression of certain genes and anti-inflammatory proteins around their wounds that aided in healing. And because osteoblasts, the cells that rebuild bone, are most active when sleeping, “NSAID administration during the resting phase resulted in severe bone healing impairment,” the study’s authors wrote. 

Of course, there are some caveats here: The 2020 study looked at mice, not people, so it’s unclear if similar results would be seen in humans, and as a 2021 review of studies on the topic noted, “whether NSAIDs really interfere with healing after surgery or trauma cannot be answered definitively on the basis of the currently published literature.” 

The bottom line? You should check with your doctor before making any decisions about how and when you use ibuprofen.

Ibuprofen Risks To Consider

Timing isn’t the only factor to keep in mind when weighing the potential side effects of ibuprofen. One of the biggest risks associated with the drug is gastrointestinal damage. NSAIDs are hard on your stomach lining, and taking too much can even lead to bleeding. This is one reason that adults over age 50 are often warned against relying on NSAIDs, especially if they already have a history of ulcers or are taking blood thinners.

Patients with kidney problems should avoid the drug, too, as it temporarily reduces blood flow to the organs. NSAIDs are also known to raise blood pressure, so they may not be the best choice for those with hypertension, and they shouldn’t be taken by most people with heart problems, especially not on a regular basis. 

Fortunately, different pain relievers work in different ways. If you’re concerned that your ibuprofen use may be having adverse effects, talk to your doctor about possible alternatives.

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