Unbearable back pain at night: How to sleep? (9 tips)

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

In an era where everything is going too fast, many are those who regularly sacrifice their sleep to be more efficient at work, or simply to do more activities. Those who have back pain at night know how much more problematic the pain can be than you might imagine.

Interesting stat: Did you know that 80% of people with chronic low back pain also have sleep problems? Now I have a question for you: Is it the back pain during the night that causes the insomnia, or rather the poor quality of sleep that aggravates the pain? The answer…Both!

In this article, we are going to offer you 3 positions for those who have back pain at night. We'll also discuss situations to be concerned about (like potential cancer), the best mattress to try, and provide 9 tips to improve your sleep. 

Sleep postures to consider for relief

Let's start by discussing the link between pain and lack of sleep. It is easy to imagine that if our back makes us suffer at night, our quality of sleep will inevitably be affected. This is why it is important to find a comfortable sleeping position that can optimize your sleep, and reduce stress on the vertebrae lumbar.

Be careful though: contrary to popular belief, there is not necessarily a “best” sleeping posture per se. Similarly, there is no contraindicated posture that would be "bad" for the back (yes, sleeping on your stomach is not as bad as some people might claim!).

On the other hand, there are certain postures that reduce stress on the lumbar vertebrae. In the presence of lower back pain, I often recommend that my clients adopt one of the following three positions to see if there is a beneficial effect on the level of symptoms.

1. Lying on your back with a pillow under your knees

This position reduces the anteversion of the pelvis (lumbar hyperlordosis), which reduces stress on the facet joints. Basically, keeping your knees slightly bent will prevent your back from arching excessively, reducing the stress on your vertebrae. For people who see their symptoms worsen in extension (for example with prolonged walking), this position can be comfortable and thus improve the quality of sleep. 

2. Lying on your side with a pillow between your legs

Keeping a pillow between the legs reduces lumbar torsion. If you ever experience pain in one leg, it is best to sleep on your side so that the symptomatic leg is up. (For example, if the pain radiates down the left leg, try sleeping on the right side to keep the left leg up). This reduces the load on the symptomatic leg, and sometimes even reduces numbness when present.

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For added comfort, many of my patients opt for a knee pillow such as this one.

3. Lying on your stomach

Well, this may go against what you've heard in the past. Indeed, it is sometimes said that sleeping in this position will cause your spine in hyperextension and damage it. Not necessarily. Moreover, the prone position (and even the cobra position!) can potentially relieve symptoms, and are sometimes used in the McKenzie method.

On the other hand, make sure to avoid the position on the stomach if it ever aggravates your pain (and/or causes irradiation in the leg). An alternative would be to place a pillow under the stomach to minimize hyperextension if it turns out to be painful. Also avoid this position if it ever causes neck pain. 

Consult the products of Cervi-Care if you are looking for a orthopedic, ergonomic or shape memory pillow

Mal back at night: Is it cancer?

When the pain prevents us from sleeping, we sometimes imagine the worst. Unfortunately, internet searches add to our concerns, especially when cancer is mentioned.

Indeed, we can read here and there that back pain at night could be associated with cancer. Is it true ? 

Before worrying, it should be understood that these situations are rare, and that night pain can be associated with several other factors. Awkward positions, changes in position, poor quality mattress and pillow, all of these are common causes of back pain at night. 

You should also know that cancer is often associated with other symptoms. Although rare, here are situations where it is relevant to worry (and consult your doctor urgently!):

  • Constant, progressive, non-mechanical pain: You can't find any resting positions and none  direction of movement does it seem to relieve your symptoms? Go see a doctor to clarify the situation.
  • Chest pain or severe abdominal: It is common for lower back pain to expand, but if you have excessive pain around the lower back area, it is a sign that you need to consult.
  • Constant night pain: If the pain does not change at all during the night, it is relevant to consult (even more so if you have night sweats, chills or associated fever)
  • Weight loss unexplained: You haven't gone on a diet and you haven't started an exercise program, but you seem to be losing weight over the weeks? Speak to your doctor immediately!
  • Saddle anesthesia: If you have any sensory impairment in the region of the perineum (such as strange sensations in the area of ​​the genitals), this should require the intervention of a doctor.
  • Urinary or fecal incontinence of recent onset: I dare to hope that you will consult immediately if you lose control of your sphincters!

To determine if your back pain is potentially serious, see the following article.

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And the mattress in all this?

Another item that can increase your symptoms at night is your mattress. If you wake up in the morning with a lot of pain despite having used an adequate posture, your mattress may contribute to your pain. And even more if the onset of your back pain coincides with a change in your mattress, or a stay away from the comfort of your bed! (Many of my patients come to me with aggravated back pain after a weekend camping trip!).

How to choose the right mattress? Is there one type of mattress that is better than the others? Between soft, semi-soft, firm, semi-firm, hard, it is sometimes difficult to choose!

Of course, each person is different and may prefer a certain type of mattress. It is for this reason that there are "tailor-made" mattresses that are individualized to each person. These mattresses are obviously the best option, but you have to have the means.

Besides “made-to-measure” mattresses, what other type of mattress should we prioritize? Some studies have shown that there is a type of mattress associated with less lower back pain upon waking, and less disability. Contrary to popular belief, it is not the soft mattress, nor the firm, but the semi-firm!

The problem with soft mattresses is that the pelvis can sag and possibly place the spine in awkward positions (like excessive twisting). As for firm mattresses, they prevent the curves of the back from being supported, which can increase stiffness.

I therefore advise you to use a semi-firm mattress to optimize your nights sleep. In a study where individuals with low back pain tested a semi-firm mattress for 28 days, a 48% lower back pain reduction, as well as a 55% improvement in sleep quality! 

“If you wake up in the morning in a lot of pain despite having used proper posture, your mattress may be contributing to your pain. »

The consequences of lack of sleep 

Now that we've explained the relationship between lower back pain and lack of sleep, let's try to explain the inverse relationship: how can lack of sleep during the night make our lower back pain worse?

You are probably already aware that lack of sleep can causeirritability, stress and lead to depression. Guess what? These same factors are also linked to chronic low back pain, as evidenced by several studies. (Marshall et al 2017).

We therefore enter a vicious circle where back pain prevents us from sleeping well, which prevents us from having a good night's restful sleep, which affects our daily life and our stress level, which prevents us from healing well. of our back pain…you get the idea?

9 tips to sleep better at night

It is therefore crucial to find ways to optimize your sleep habits. This will definitely help you heal better from the back, not to mention the benefits in other areas of your life. So, if you ever find you're not getting enough sleep, or if you ever wake up during the night, here's a list of things to consider:

  1. Turn off the television at least an hour before bedtime.
  2. Put your phone in “night” mode.
  3. Avoid looking at your emails right before sleeping.
  4. Don't drink large amounts of water before sleeping, or you'll wake up several times to go to the bathroom.
  5. Write down your last minute thoughts on paper before you go to bed to give your brain a rest and attack the next day…rested!
  6. Keep the bedroom dark and slightly warm to optimize the quality of your sleep.
  7. Light exercise before bed can help reduce stress hormones, allowing you to sleep more peacefully.
  8. If you ever have to take a nap during the day, minimize its duration - no more than 45 minutes - to avoid affecting your sleep cycle later.
  9. Beware of heavy meals before sleep which could affect your digestion, and thus prevent you from sleeping peacefully.
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Conclusion

So! I hope you are now more educated on the relationship between sleep and back pain. If you suffer from low back pain, don't neglect your sleeping habits, or your recovery could be hindered.

If your back pain prevents you from sleeping at night, try the 3 positions suggested, and then re-evaluate their impact on your symptoms. If, on the contrary, your symptoms appear in the form of morning stiffness, your mattress may be at fault. Consider a semi-firm mattress to optimize your nights sleep.

Finally, implement good sleep habits (like the 9 mentioned above) to sleep like a baby, and wake up feeling refreshed and healthy!

Good recovery!

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