Tingling in the hands at night: why it happens and the remedies

The tingling and numbing sensation at night in the fingers of one or both hands can be determined by various causes, but they generally indicate compression to the nerves, which are the structures responsible for transmitting sensory and motor information to the brain and vice versa.

This compression can occur due to several causes, such as:

• cervical hernias, which compress the nerve as it exits the spinal cord;
• synovial cysts, cysts that appear in the hand, especially on the wrist, which can go on to crush nerve structures in it;
• incorrect posture during the day or in rest;
• intense and prolonged exertion during the day or work that continuously stresses the tendons of the hand and wrist causing tendonitis, such as, for example, writing at a computer;
• carpal tunnel syndrome: this is the main cause, especially if the first 3 fingers (thumb, index, middle and half ring fingers) are losing feeling. This syndrome generates a compression to one of the 3 main nerves of the arm: the median nerve, in its passage inside the narrow channel at wrist level called, precisely, “carpal tunnel”.

The sensation of crushing nerve structures may be exacerbated during the night hours as:

• standing still due to gravity also creates fluid stasis, which can compress the nerve more in some cases;
• during rest, some positions can crush the nerve.

"In the early stages of carpal tunnel syndrome, tingling occurs mainly at night, but as the condition progresses, it also occurs during the day, eventually affecting the muscles and leading to more complex problems," Dr. Pegoli explains.

Compression affecting one or more nerves can affect anyone, particularly if one is in occupations that place a lot of stress on the hand and its structures. Women over 40, then, are much more likely than men to develop carpal tunnel syndrome, for causes that are not yet fully known.

You should always consult your physician for an evaluation of your health status if the symptomology of nighttime numbness occurs consistently or continuously.
The nerve that remains compressed for long, in fact, does not receive adequate vascularization and undergoes progressive degeneration and death, which, if intervened at too late a stage, can cause the subject to suffer even permanent loss of sensation and strength.

With visual and objective examination, the specialist will proceed to analyze the area of interest by prescribing electromyography, which will provide a definite diagnosis and measure the degree of nerve(s) suffering, if any. The electromyography performed by the neurologist will, in fact, go on to evaluate:

• nerve conduction (electroneurography), by means of some surface electrodes;
• muscle activity, by means of needle electrodes placed subcutaneously.

Depending on the triggering cause, some tricks may help to partially reduce the feeling of falling asleep in the hand, such as:

• mattress and pillow that can provide the necessary comfort and support for the body as well as the spine;
• sleep in an appropriate position: avoid resting with hands under the pillow, with wrists bent or with arms raised above the head;
• try to rest the hand and nerve structures throughout the day and not overload them as much as possible.

Conservative therapy

If nerve suffering is at an early stage, the doctor may proceed by prescribing conservative therapy using:

• night wrist brace, customized and made by hand therapists, which can keep the limb in a neutral position;
• neurotrophic drugs, which improve the function of cells in the nervous system;
• physiotherapy with the possible use of equipment as well to help with perceived pain

Surgical intervention

In cases where compression to the nerve structure cannot be managed with conservative therapies, surgery may eventually be required.

Regarding, for example, cervical hernia, depending on its location, the neurosurgeon has various techniques at his or her disposal with a surgical approach that can be anterior or posterior, while the hand surgeon can deal with issues at the wrist.

The endoscopic microsurgical technique, for example, goes to eliminate the compression exerted by the hernia without demolishing or damaging parts of the spine, with rapid recovery times and no immobilization. Usually, the day after the operation, the patient can already be discharged and return to his or her daily routine.

As for the carpal tunnel, however, an endoscopic procedure conducted with a small camera passed through a mini-incision of about 5 mm allows the hand surgeon to free the nerve with just a few drops of local anesthesia at the wrist and without stitches.

Mobilization of the wrist and fingers and return to daily life are immediate, so much that the patient can use his or her hands as early as the same day of surgery and start driving the next day.