Struggling to Sleep With Low Back Pain? These Expert Tips May Help
At some point, 60% of the population has had or will have lower back pain, says Kin M. Yuen, M.D., a sleep medicine specialist at UCSF Health in San Francisco, California. That means at any one point, about one-fifth of us are pain-stricken in the lumbar area, she adds. In other words, a whole lot of people are going to bed a bit bent out of shape and should learn how to sleep with lower back pain in a way that can help improve their condition over time. (Yes, it is possible!)
Meet the Experts: Kin M. Yun, M.D., a sleep medicine specialist at UCSF Health in San Francisco, California and Owoicho Adogwa, M.D. M.P.H., a neurosurgeon with University of Cincinnati’s Gardner Neuroscience Institute.
Below, Dr. Yuen and other experts share their advice for sleeping with lower back pain. Just read it knowing that everyone’s anatomy, pain tolerance, and injuries are different—so what works for one person may not work for another.
Types of lower back pain
Altering your sleep routine to accommodate your back pain requires you to assess the type of back pain you’re dealing with. According to Dr. Yuen, there are two main types:
Acute low back pain
Acute lower back pain comes on suddenly and can typically be traced back to an incident or injury—it lasts anywhere from a few days to a few weeks.
Chronic low back pain
Contrarily, chronic low back pain is more progressive and long-lasting—it persists more than three months, per the National Library of Medicine. Some common causes are arthritis, a herniated disc, surgery, or heavy use.
Other types of low back pain
Owoicho Adogwa, M.D. M.P.H., a neurosurgeon with the University of Cincinnati’s Gardner Neuroscience Institute breaks it down even further: Axial pain, “also known as mechanical pain,” he says, “is localized to the spine and is often caused by muscle strains, ligament sprains, or degenerative conditions like osteoarthritis.” Secondly, radicular pain “occurs when a spinal nerve is compressed or inflamed, leading to sharp, shooting pain radiating along the path of the affected nerve, commonly seen in conditions like sciatica,” he continues. Lastly, referred pain is “felt in areas distant from its origin, often due to conditions affecting internal organs or structures,” he says. “Differentiating these types is crucial for accurate diagnosis and effective treatment.”
How sleep and lower back pain are related
Not to oversimplify it, but, as aforementioned, most people experience back pain, and hopefully, all of us sleep—so the two are related in that way. Additionally, a lack of sleep has been shown to exacerbate pain of any kind: Studies have found that “anyone who has sleep deprivation will experience pain more acutely the next day,” says Dr. Yuen. Lack of sleep also impairs the body’s ability to heal and recover, Dr. Adogwa adds.
Separately, chronic lower back pain can disrupt sleep by causing discomfort and frequent awakenings, leading to sleep fragmentation and decreased sleep quality, Dr. Adogwa says. Such chronic pain can also take a toll mentally, breeding stress and anxiety, which can further harm sleep, he adds.
Sleep positions for lower back pain
The best sleep position for low back pain depends on the type of pain you have. If your aching is nerve-based, such as a herniated disc, Dr. Yuen says laying on your back with knees bent and cushioned by pillows works best to stabilize the spine.
If there’s no risk of nerve damage, she says people with back pain (say, from arthritis) should be able to comfortably side sleep in the fetal position with knees at a 90-degree angle, a pillow between them for support and cushioning. Dr. Adogwa agrees with this advice. “Sleeping on your back with a pillow under the knees helps maintain the natural curve of the spine, reducing stress on the lower back,” he adds. “Side sleeping with a pillow between the knees keeps the hips, pelvis, and spine in better alignment, minimizing strain on the lumbar region.”
Stomach sleeping isn’t ideal for people with back pain, as it hyperextends the spine. However, if you must, Dr. Adogwa recommends placing a pillow under the abdomen to prevent excessive arching.
Can your mattress cause lower back pain during sleep?
At the very least, your mattress can certainly exacerbate lower back pain for the same reasons poor sleep positions can. “A mattress that is too soft may cause the spine to sag, leading to poor spinal alignment and increased pressure on the lower back,” Dr. Adogwa explains. “Conversely, a mattress that is too firm may fail to support the natural curves of the spine, causing discomfort and stiffness.”
Research suggests that medium-firm mattresses generally provide the best support, comfort, and spinal alignment, he adds.
Tips for sleeping with lower back pain
Sleeping with any type of pain requires adjustment and patience, which is not always easy. But these tips may help.
Try core exercises: A strong core is key to avoiding lower back pain. Dr. Yuen explains that abdominal muscles support the low back, and it’s when the core starts to go (usually with age) that back pain takes over. “I wouldn’t say do crunches, but definitely, you know, planking or any kind of core exercises to work on our abs and all the other muscles that hold out back together,” she says. These exercises may also help with weight control, which can stave off both back pain and poor sleep, she adds.
Prioritize sleep hygiene: If you don’t already have an established nightly routine to help you wind down and optimize sleep, it’s time. Ideally, that includes avoiding caffeine and phone or TV use before bed, Dr. Adogwa says.
Mental health care: If stress or anxiety is keeping you awake, seeking out therapy may help you feel more at ease, and therefore sleep better and have less pain, Dr. Adogwa adds.
Stretch: Engaging in gentle stretches for lower back pain or yoga before bed “can alleviate muscle tension,” says Dr. Adogwa. There is sufficient research that supports yoga as treatment for back pain (when it’s done safely, of course).
When to see a doctor about lower back pain
Put simply, Dr. Yuen says it’s time to see a doctor if the pain doesn’t go away—especially if it’s been a couple of weeks. It’s also important to watch for other symptoms like numbness, tingling, or limb weakness, as they could mean a nerve is being compressed, says Dr. Adogwa.
“Unexplained weight loss, fever, or a history of cancer necessitate immediate consultation, as these could signify underlying serious conditions,” he adds. “Early intervention can prevent further complications and promote effective pain management and sleep restoration.”
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