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

Those who experience back pain at night know how the pain can be more problematic than one might imagine.

Interesting statistic: Did you know that 80% of people suffering from chronic lower back pain also have sleep problems? Now, is it back pain during the night that causes insomnia, or rather poor quality of sleep that makes the pain worse? Both !

In this article written by a physiotherapist, we will share positions and tips to relieve back pain at night. We will also discuss situations where pain could prevent a serious condition (such as cancer).

Sleep postures to consider for relief

Let's start by discussing the connection between pain and lack of sleep. It is easy to imagine that if our backs hurt 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 at the same time reduce stress on your spine.

Contrary to popular belief, there is not necessarily a “best” sleeping posture per se. Likewise, there is no contraindicated posture that would automatically be “bad” for the back (sleeping on your stomach is not as serious as some may claim!).

On the other hand, certain postures further reduce stress on the lumbar vertebrae. When experiencing back pain, I often recommend that my patients adopt one of the following postures to relieve their symptoms.

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

Essentially, keeping your knees slightly bent will prevent your back from arching excessively. This will reduce stress on your vertebrae.

In technical terms, it is said that this position will reduce lumbar hyperlordosis by inducing posteriorization of the pelvis, which will reduce stress on the vertebral joints.

For people whose symptoms worsen with lumbar extension (prolonged walking, static standing position, etc.), 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 helps reduce lumbar twisting.

If you ever have pain in one leg, it is best to sleep on your side so that the symptomatic leg is on top.

For example, if the pain radiates down your left leg, try sleeping on your right side to keep your left leg elevated.

This reduces the load on the symptomatic leg, and sometimes even reduces numbness when present.

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

3. Lying on your stomach

This may go against what you have heard in the past.

In fact, it is sometimes said that sleeping in this position will hyperextend your spine and damage it in the long term. Not necessarily.

Moreover, the prone position (and the famous cobra position) can potentially relieve symptoms, and is often used in McKenzie method.

On the other hand, make sure to avoid lying on your stomach if it aggravates your pain (even more so if it causes radiating pain in the leg).

An alternative would be to place a pillow under the stomach to minimize hyperextension if it proves painful. Also avoid this position if it ever creates neck tension.

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

Back pain 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 seems to relieve your symptoms? Go see a doctor to clarify the situation.
• Severe chest or abdominal pain: It is common for lower back pain to increase, but if you have excessive pain around the abdominal 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 appropriate to consult (even more so if you have associated night sweats, chills or fever).
• Unexplained weight loss: You haven't gone on a diet or started an exercise program, but you seem to be losing weight over the weeks? Talk to your doctor right away.
• 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 faecal 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.

And the mattress in all this?

Another thing 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 be contributing to your pain. And even more so if the appearance of your back pain coincides with a change in your mattress, or a stay away from the comfort of your bed!

For example, many of my patients come to see me with back pain that is worse after a weekend camping!

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

Of course, everyone is different, and may prefer a certain type of mattress. This is also why there are “custom” mattresses that are individualized to each person. These mattresses are obviously the best option, but you have to have the means.

Besides “custom” 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 up, and less disability. Contrary to popular belief, it is not a question of the soft mattress, nor the firm one, but of the semi-firm!

The problem with soft mattresses is that the pelvis can sag and possibly place the spine in uncomfortable positions (such as excessive twisting). As for firm mattresses, they do not support the spine enough, 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 an improvement in sleep quality by 55%. 

The consequences of lack of sleep

Now that we have 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 worsen our lower back pain?

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 lower back pain, as shown by several studies.

We therefore enter a vicious circle where back pain prevents us from sleeping well, which prevents us from having a good, restorative night's sleep, which affects our daily life and our stress level, which prevents us from healing well. of our back pain…do 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 your back better, not to mention the benefits on other areas of your life.

So, if you ever find that you are not getting enough sleep, or if you ever wake up during the night, here is 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 checking your emails right before bed.
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 let your brain rest and tackle the next day.
6. Keep the room dark, and avoid cold temperatures which can decrease pain tolerance.
7. Light exercise before bed can help reduce stress hormones, allowing you to sleep more peacefully.
8. If you ever need to take a nap during the day, minimize its duration to avoid affecting your sleep cycle.
9. Beware of heavy meals before sleep which could affect your digestion, and thus prevent you from sleeping peacefully.

Conclusion (the take-home message)

I hope you are now more educated about the relationship between sleep and back pain. If you suffer from back pain, don't neglect your sleep habits, otherwise your recovery could be slowed down.

If your back pain keeps you from sleeping at night, try the suggested positions, and then reassess their impact on your symptoms. If, on the contrary, your symptoms appear in the form of morning stiffness, your mattress may be to blame. Consider a semi-firm mattress to optimize your night's sleep.

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

Good recovery !

Resources