Pain signs
Is My Arthritic Dog's Night Restlessness Pain, or Just Age? What the Forms Ask About Nights, and What the Activity Monitors Found
Three validated arthritis pain forms vets use ask nothing about nights. The dementia checklist does. In the one masked trial, pain relief improved owner-scored sleep. How to find out which your dog has.
You cannot tell pain from age by listening to him at 2am, and neither can the standard forms. Three validated owner questionnaires for arthritis pain that vets use, the CBPI, the HCPI and LOAD, ask nothing about nights. The standard checklist that does is the one for canine cognitive dysfunction, so that is where a restless night tends to get written down. But in the one masked, placebo-controlled trial of sleep in these dogs that we found, owners of dogs with osteoarthritis scored their dogs' sleep better on an anti-inflammatory than before it, with no change on placebo, and a reanalysis found the dogs moved less between 11pm and 6am on the drug. The evidence is small. It is still enough not to let the nights be filed as age, or as dementia, until pain has been tried. Write a week of nights down, take the log to your vet, and ask for a pain trial with the log kept through it.
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The sound in the dark#
You probably know the sound before you know what it means. Nails on the kitchen floor at two in the morning. A long stretch of panting in a cool room. The thump of a dog lying down, then, a minute later, getting up again. You lie there and tell yourself he is old, and old dogs sleep badly.
Some do. But "he's old" is not a diagnosis. It is where a sign ends up when nobody has a better place to put it. And for night restlessness, the forms make the problem worse in a way nobody warns you about.
What do the forms actually ask about nights?#
We read each instrument at source, item by item, looking for any question about sleep, nights, restlessness, pacing or panting.
| Instrument | What it is for | Items | Any night item? | The nearest it gets |
|---|---|---|---|---|
| Canine Brief Pain Inventory (CBPI)[2] | Chronic pain, validated to detect treatment response[3] | 11: four pain-severity ratings, six function ratings, one overall impression, all over "the last 7 days" | No | "Ability to Rise to Standing From Lying Down" |
| Helsinki Chronic Pain Index (HCPI)[4] | Chronic osteoarthritis pain[5] | 11, rated over "the preceding week" | No | "Ease of movement after a long rest"; "vocalization (audible complaining, such as whining or crying out)", with no time of day |
| Liverpool Osteoarthritis in Dogs (LOAD)[6] | Osteoarthritis mobility[7] | 13 mobility items, plus background and exercise questions | No | "Stiffness in the affected leg after a 'lie down'" |
| DISHAA, cognitive dysfunction checklist[8] | Canine cognitive dysfunction | 18 signs, scored 0 to 3, "since 8 years of age" | Yes, two: "Pacing/restless/sleeps less/waking at night" and "Vocalization at night" | — |
Read the fourth column. Of these four standard forms, the only one with a box for night pacing is the dementia form, so that is where night pacing gets written down. Nobody chose that. The pain questionnaires were built to measure what a dog does when you can watch him: rising, walking, running, climbing, playing. They were never designed to score the hours the household is asleep. The cognitive checklist was designed to catch exactly those hours, because it scores sleep-wake changes as one of its six groups of signs, the S in DISHAA.
So a careful owner who sits down with both sets of forms can do everything right and still produce a record that points one way. Her pain scores may show some daytime stiffness, but they cannot register the night at all. Her cognitive checklist has two marks on it, because that form can. Nothing on either sheet says the night was never asked about on the first.
There is one way round this, and it is a form most owners have never been offered. Client Specific Outcome Measures (CSOM) has no fixed questions: you and your vet choose the activities your own dog finds hard, then score those same activities at every visit. In a placebo-controlled trial of 50 large-breed dogs with osteoarthritis, the owners' case-specific scores separated treatment from placebo (P < .001).[9] Nothing stops "settles within ten minutes of lying down at night" from being one of the activities. If your vet uses CSOM, ask for the night to go on it. The question can be asked at all: a modified CBPI written for a University of Edinburgh pain study adds an item the standard form lacks, "Ability to Settle at Rest/ Find a Comfortable Sleeping Position."[10] It was built for a study of visceral pain, not arthritis, and it is not the form your vet will hand you.
None of this means dementia is rare or that your dog does not have it. In a survey of 497 dogs aged 8 and over, owner answers put the prevalence of cognitive dysfunction at 14.2%, against 1.9% of dogs diagnosed by a vet.[11] It is common and it is missed. The point is narrower. Night restlessness on its own cannot tell the two apart, and the paperwork is lopsided.
“Because your dog can't tell you how much pain he or she is in.”
What the activity monitors found when the pain was treated#
One research group has looked at this directly, and its two papers on the same dogs seem at first to disagree.
The first paper found nothing. Knazovicky and colleagues fitted accelerometers (activity monitors on the collar) to client-owned dogs with painful osteoarthritis.[12] In the first part of the study, 60 dogs, average night-time activity was no different after two weeks of meloxicam, a prescription anti-inflammatory, than during two untreated weeks. In a second, masked crossover of 19 dogs, two weeks of meloxicam and two of placebo with a washout between, the average still did not move. The authors wrote: "Overall, we did not find evidence of nighttime restlessness, as measured by accelerometry, in dogs with naturally occurring OA."
But the owners' answers did move. In the masked arm, owners filled in a new six-item sleep questionnaire, called SNoRE, every week, without knowing which treatment their dog was on. Scores improved on meloxicam compared with the untreated baseline (P = 0.0012) and did not change on placebo (P = 0.42). The difference between drug and placebo directly (P = 0.0496) missed the authors' own stricter cut-off for multiple comparisons, so it is suggestive, not settled. SNoRE total scores also tracked the dogs' CBPI pain scores (r = 0.47).
Then a reanalysis looked at the clock. Four years later, Gruen, Samson and Lascelles reanalysed the activity data from 15 of the masked-arm dogs (mean age 10.3 years). Instead of averaging the whole night, they compared activity hour by hour across the 24-hour day.[13] A conventional model of the night total still found no treatment effect (P = 0.58). The hour-by-hour analysis found the dogs were less active between 11pm and 6am on meloxicam than on placebo, and more active between 7am and noon. In the authors' words, the dogs "were less active (and possibly sleeping) when receiving meloxicam rather than placebo."
So the two papers do not really contradict each other. The night's total movement was about the same. When it happened was not. Treated, the dogs moved less in the small hours and more in the morning, which is roughly what a better night followed by a better day would look like. An average over the whole night can hide a dog who is restless at 3am and still at 5am. That is a lesson about measurement before it is a lesson about dogs, and it applies to your memory of last week as much as to an accelerometer.
What we do not know#
Be careful with all of this. Both papers come from one group, the masked arm had 19 dogs, and the reanalysis 15 of them. Neither study had healthy dogs of the same age for comparison, so neither can say whether dogs with osteoarthritis sleep worse than dogs without it. The authors say so, and they also say the pain in their dogs may not have been bad enough to disturb sleep much. SNoRE was new and had not been validated when it was first used. The reanalysis argues it now has some criterion validity, but that is the same group checking its own instrument against the same dogs.
One detail is worth knowing, and worth holding loosely. In the first paper's discussion, the SNoRE items that changed most with treatment were the ones about twitching and dreaming, then shifting position and vocalising. The items about moving around and pacing changed least. In one small pilot, then, pacing (the very behaviour on the dementia checklist) was the night sign least touched by pain relief. That is a hint about where to look, not a test you can run at home.
No study we found measured whether a different bed changes how often an arthritic dog repositions at night. If he leaves his bed for the floor, write that in the log too. The bed guide covers what a bed can and cannot do, and a dog choosing cool tiles in summer may simply be hot.
So what would tip it one way or the other?#
No published test separates pain from cognitive dysfunction from a description of the night alone. A clinical article for vets on the two conditions, in Improve International's clinical library, notes that owners of dogs with either one may report "restlessness and anxiety," that the two are "often seen together," and that "careful questioning of the owner, as well as a thorough clinical examination, will often help" the vet tell them apart.[14] The same review says pain control is essential wherever pain is suspected to be contributing. Your job is to make the questioning easy, with answers written down rather than remembered.
| What you might notice | What it can point to | What to do with it |
|---|---|---|
| Stiff getting up by day, slow on the stairs, lies down earlier each evening | Pain is already on the table by day; the night may be the same pain, unscored | Fill in the CBPI or LOAD with your vet, and add the night log |
| Night signs, and also: gets stuck behind furniture, goes to the hinge side of the door, stares at walls, new house soiling | The rest of the DISHAA checklist is filling in too | Score the whole DISHAA, not just the night items, and take it with the log |
| The only DISHAA marks are the two night items, and perhaps "increased activity, including aimless pacing or wandering," which a night pacer will tick too | The checklist has found the night and little else | Ask about a pain trial before the night is put down to the brain |
| Up repeatedly and asking to go out | A bladder or thirst question as much as a pain one | Note how often and how much; tell the vet, who may want a urine sample |
| Sudden anxiety or standing and stretching, with a swelling belly, drooling or unproductive retching | Possible bloat | Emergency vet now, not a log |
Three of these rows (the first, third and fourth) are plain reasoning rather than findings, and we have labelled every row by what it points to, not what it proves. Dogs can have arthritis and cognitive dysfunction at the same time. A pain trial that helps does not rule the second out, and one that does not help does not rule pain out either. It may have been too short, the wrong drug or too low a dose. The result is information for the next decision, which is your vet's.
The night log: one week before anything changes#
A questionnaire your vet scores asks you to remember a week. The log below writes the week down while it is happening. Keep it for seven nights before any change: a new drug, a new supplement, a new bed. Then keep it through the change. Change one thing at a time, or the log cannot tell you which one worked.
| Column | How to fill it in |
|---|---|
| Lights out | The time the house went to bed |
| Times heard up | From the recording, each time he got up, as a time |
| Longest unsettled stretch | Start and end time of the longest run of getting up, lying down, panting or walking |
| Panting | Yes or no, and roughly how long, in a room you know is cool |
| Vocalising | Whining or crying, and when |
| What he did when up | Turned and lay back down, walked a loop, went to the door, went to the water bowl (needs a camera) |
| Where he was in the morning | His bed, the floor, somewhere new |
| Out to toilet | Did he ask, and did he go |
Then score the CBPI or LOAD with your vet in the same week, and the DISHAA too. Take all three, plus the log and two or three short clips. At the appointment, the sentence that does the work is short: "His pain scores do not ask about nights, so here is a week of his nights."
If your vet agrees a trial of pain relief is reasonable, ask how long it should run before you judge it, and keep the log going through it. In the masked trial above, each treatment period was two weeks. The drug, dose and duration are your vet's decision, not ours, and some pain medications are not safe for every dog.
The cheapest way to record a night, and the one thing worth buying#
Start with the phone you already own. Put it on a shelf with the voice recorder running, and in the morning play the stretch from midnight to 5am at double speed. Nails on a hard floor, a run of panting, a dog lying down with a thump: sound gives you the times for the first five columns of the log, for nothing.
What sound cannot give you is the column a sound recording cannot fill: what he did when he was up. A dog who gets up, turns once and lies down again looks like a dog trying to get comfortable. A dog who walks the same loop for twenty minutes looks like something else. Neither is a diagnosis, and the one pilot that looked found pacing was the night sign least changed by pain relief. But they are different things to show a vet, and a vet can only weigh what they can see. To see the difference you need a picture, in the dark, recorded all night, with nobody awake to watch.
#1 Pick
Kasa Smart (TP-Link)
Kasa Spot EC60 Indoor Camera, 1080p, Night Vision, microSD Recording
Our score
$19.99
Best for
A household that hears an old dog moving at night and needs a week of recorded nights to show the vet, rather than a memory of the one night someone happened to be awake
Try the free version first. Put your phone's voice recorder on a shelf for one night and listen to the stretch between midnight and 5am at double speed. If what you hear is nails on the floor, panting or a dog turning round and round, and you need to see which, this is the cheapest branded camera we found that records to a card all night with no subscription. Its job is evidence for one vet appointment. It is not a baby monitor for a dog who cannot move, and it cannot turn him or tell you why he is awake
Pros
- Records around the clock to a microSD card ("24/7 Local Recording," TP-Link's product page), and "will overwrite the oldest files when the microSD card filled." So it can run every night of a one-week log without you touching it, and without a subscription: TP-Link's Kasa Care plan stores clips "detected by motion or sound" in the cloud, and you do not need it for this
- Infrared night vision "up to 30 feet" and "even in total darkness" (datasheet), which covers a bedroom or a kitchen from a shelf. You do not have to leave a light on, and a light on changes the night you are trying to record
- Motion and sound detection with phone alerts, if you want to know when he gets up instead of reviewing the footage in the morning
- Made and supported by TP-Link, a large networking maker, not an unbranded seller, and it publishes a full datasheet, which is where every figure on this page comes from
Cons
- The microSD card is not included. Without one, the only way to keep footage is the paid cloud plan, so budget for a card. TP-Link disagrees with itself about the size: its product page says cards "up to 64 GB," its US datasheet for hardware version 4.0 says up to 256 GB. Buy 64 GB and you are inside both
- 2.4 GHz Wi-Fi only (datasheet). Some home routers broadcast a combined network that a 2.4 GHz-only device struggles to join. Check your router's settings before you buy
- 1080p at 15 frames per second, and infrared night footage is black and white. That is enough to see a dog stand up, turn round and lie down again, or pace. It is not enough to read his gums or his breathing rate from across the room
- Mains powered, with a plug-in adapter and no battery. It has to sit near a socket, and the cable has to be out of reach of a dog who chews
- Amazon did not serve us any review text when we read the listing, so we cannot report what its owners complain about most. We have not tested it. Everything above comes from TP-Link's own datasheet and product page
We recommend this camera for one job, a week of recorded nights, and that job needs nothing an expensive camera adds. It records around the clock to a microSD card, according to TP-Link's product page,[15] and overwrites the oldest footage when the card fills, so it runs all week untouched. Its infrared night vision covers a bedroom from a shelf without a light on. What it is bad at: the card is not included, it joins only 2.4 GHz Wi-Fi, it records at 15 frames a second (TP-Link's datasheet, summarised on the card above), night footage under infrared is black and white[16], and it needs a socket near his bed. We have not tested it, and Amazon served us no review text to report complaints from. If you already own any indoor camera that records to a card, use that one. Nothing here is special to dogs.
What to do this week#
Tonight, put your phone on a shelf and record the night. Tomorrow, start the log and keep it for seven nights. Fill in the whole cognitive dysfunction checklist, not just the night lines, and see whether anything besides the night is on it. Then book the appointment, with the log, and ask whether a pain trial is reasonable before the nights are filed as age.
The delay this site exists to shorten usually starts with a sign that has nowhere to go. Night restlessness has somewhere to go: the one form with a box for it. Make sure the forms that do not have that box get their chance first. How to tell if your dog is in pain covers the daytime instruments in more detail, Is my dog's limp getting better? covers how to judge whether a treatment is working without fooling yourself, and arthritis in dogs covers the condition itself. If your dog can no longer get up on his own, his nights are a different problem, and this page is the one to read.
Frequently asked
- Is my old dog restless at night because of arthritis pain?
- It can be, and you cannot tell from the hallway. In the one masked, placebo-controlled trial of sleep in these dogs that we found, 19 dogs with osteoarthritis took an anti-inflammatory for two weeks and a placebo for two weeks. Owners who did not know which was which reported better sleep on the drug than before it, and no change on the placebo, though the direct drug-versus-placebo comparison narrowly missed the study's own threshold for significance. A reanalysis of the activity-monitor data found the dogs were less active between 11pm and 6am on the drug. Both papers are small and neither had healthy dogs for comparison, so the honest answer is that pain is a real candidate, and the way to find out is a pain trial your vet directs, with the nights written down before and during.
- How do I tell the difference between dementia and arthritis pain at night?
- No published test separates them from a description of the night alone, and the two often turn up together in the same old dog. Two things help. First, look at the rest of the cognitive dysfunction checklist (DISHAA): getting stuck behind furniture, going to the hinge side of a door, not recognising people, new house soiling. If the only boxes you can tick are the two night ones (and perhaps the aimless pacing item, which a night pacer ticks too), the checklist has found the night and little else. Second, ask your vet whether a trial of pain relief is reasonable, and keep a written night log for a week before it and through it. If the nights change, that is information no questionnaire would have given you.
- Do the arthritis pain questionnaires ask about sleep?
- No. We read the Canine Brief Pain Inventory (11 items), the Helsinki Chronic Pain Index (11 items) and the LOAD questionnaire (13 mobility items) at source. None asks about nights, sleep, restlessness or pacing. The nearest are questions about getting up from lying down and stiffness after rest. The standard checklist that does ask about nights is the cognitive dysfunction one, which has two night items out of 18. One form can: Client Specific Outcome Measures (CSOM), where you and your vet choose the activities to score, so settling at night can be one of them.
- Should I film my dog at night?
- If you hear him and cannot tell what he is doing, yes, for a week, before any change of treatment. Start free: your phone's voice recorder on a shelf will tell you when he gets up, how long the panting lasts and whether his nails are on the floor. A camera adds what sound cannot: whether he gets up, turns once and lies down again, or walks the same loop for twenty minutes. Take the log and a few clips to the vet.
- Is night restlessness in an old dog an emergency?
- Usually not, but one pattern is. A dog who suddenly looks anxious or keeps standing and stretching, with a swelling belly, drooling, or retching without bringing anything up, may have gastric dilatation-volvulus (bloat). The American College of Veterinary Surgeons calls it life-threatening and says it needs immediate attention. That is a call to an emergency vet tonight, not a log.