Back Hurting? Tips for Getting a Good Night’s Sleep

To put it simply, yes. Research shows a strong association between back pain and sleep problems. Patients with chronic lower back pain report poor sleep duration and low sleep-satisfaction. However, the amount of time people spend asleep doesn’t seem to be clearly impaired by chronic lower back pain (2).

The sleep-and-back-pain relationship goes both ways. Back pain can cause sleep problems, but sleep problems can cause back pain as well. Interestingly, the association between sleep problems and back pain doesn’t seem to be impacted by how long the pain lasts or other factors like anxiety or depression (3).

Scientists don’t fully understand the physiological mechanisms by which back pain causes sleep problems. Studies also show that much of what we assume to be true about the relationship between back pain and sleep may not be. For example, the severity and type of back pain doesn’t correlate to the severity of sleep disruption. The impact seems to be much more binary. If back pain – mild or severe – exists at all, sleep disruption can follow.

Despite the fact that patients with lower back pain self-report significantly poorer sleep when their pain is active, common diagnostic approaches used to study sleep, like measurements of electrical activity, don’t show consistent anomalies in the presence of back pain (4).

Exercise

Far and away, the best treatment approach for back pain and correlated sleep problems is exercise therapy. Exercise therapy is low risk, easy to implement, and shows positive therapeutic effects. Specific exercises useful for improving sleep when dealing with back pain include various kinds of arm lifts and leg lifts (5).

Here are a few exercises you can try that may relieve back pain that’s affecting your sleep.

• Opposite arm and leg lift: Position yourself on your hands and knees. Flatten your back as much as possible. Slowly contract your abdominal muscles – imagine that you’re trying to connect your belly button to your spine. Then raise your left arm and right leg until they make a straight line. Keep your torso straight and don’t let your back dip. Hold this for five seconds then alternate sides. If this exercise is too challenging, simply modify it to outstretch one limb at a time — right leg, then right arm, then left leg, then left arm (6).
• Mid-trap exercise: Lie down on the floor on your stomach. Position a folded pillow beneath your chest. Stretch your arms out straight to your sides. Make sure your elbows are straight and thumbs are pointed toward the ceiling. Then slowly raise your arms toward the ceiling. Your shoulder blades should squeeze together. Lower your arms slowly. Once you can do three sets of fifteen raises, consider attempting the exercise while holding soup cans or small hand weights (7).
• Chair pose: Stand firmly on the floor with your feet close together. Raise your straight arms until they’re parallel to the floor. Slightly squat by slowly bending your knees. Push back through your hips, center your weight on your heels, and keep a straight back. Don’t let your knees extend past your toes. Hold for three seconds. If this is too difficult, you can hold on to a chair during the exercise. If it’s too simple or you’re ready for a deeper stretch, raise your arms above your head (8).
  

Change up Your Sleep Setting

While doctors used to recommend very firm mattresses to people with back problems, studies have shown that people who sleep on firm mattresses actually have the poorest sleep quality. But overly soft mattresses can be a problem too if your joints twist during the night. In order to figure out if a new mattress could help your pain, Harvard Health recommends putting a piece of plywood under your mattress or placing your mattress on the floor for a few nights.

The Cleveland Clinic emphasizes the importance of assessing your body type when selecting a mattress. Softer mattresses may be best if your hips are wider than your waist. If your hips and waist are relatively straight, a firmer mattress will provide the best support. Choose an innerspring or foam mattress, or adding a foam mattress topper to an innerspring mattress (9). You may also want to try out a few styles of mattresses at a mattress store, but keep in mind that what you find comfortable during a few minutes of shopping may not be what you need for long periods of sleep (10).

Your sleep posture may have a direct correlation to back pain and associated sleep disruptions. The Mayo Clinic has some recommendations for the best sleeping positions that you may find helpful as well (11):

• Side sleepers: Draw your legs up slightly toward your chest. Put a pillow between your legs, or use a body pillow. Try to alternate sides.
• Back sleepers: Put a pillow under your knees, which will help you to maintain the natural curve of your lower back during the night. Some people also find relief from placing a rolled towel under the small of their backs. Avoid neck pain by ensuring that your neck is adequately supported with a comfortable pillow.
• Stomach sleepers: Stomach sleeping can be very hard on your back. Consider taking a few nights trying to shift to a side-sleeping position. Sleeping on your side with a body pillow may work well for former stomach sleepers, as the body pillow mimics the feeling of the mattress meeting the torso. If you simply can’t sleep in any position but on your stomach, try placing a pillow beneath your pelvis and lower abdomen. Try sleeping without a pillow under your head if sleeping with your head on a pillow strains your back.

Specially prescribed mattresses can both reduce back pain and improve sleep quality in patients with back pain and related sleep issues (12).‍

Over-The-Counter Remedies

If you spend a great deal of time driving or sitting at a desk, you may struggle with slouching. Take the time to set up your driver’s seat, desk chair, and anywhere else you spend a great deal of time sitting or standing so that they’re ergonomically correct and promote good posture.. Keeping your spine in proper alignment throughout the day can help you prevent back pain in the night that disrupts your sleep.

If your back pain is the result of inflammation, you may find relief from heat and cold therapy combined with rest. You can apply heat by taking a hot bath or shower. A heating pad or hot pack, both of which you can purchase at a pharmacy or online, may also show positive therapeutic effects for your lower back pain. Wrap the hot item in a towel or position it over a cotton t-shirt rather than placing the hot object directly on your skin. This will help you avoid skin irritations, burns, and blisters.

For cold therapy, you can try homemade ice packs, bags of peas, or homemade gel packs that you can buy at a pharmacy or on the internet. Similarly to heat therapy, you’ll want to wrap the cold object in a towel or wear a t-shirt that you press the cold item against. Try alternating hat and cold therapy, each twenty minutes at a time over a period of two hours.

You may also want to try over-the-counter pain relievers like non-steroidal anti-inflammatory drugs (NSAIDs), which have therapeutic effects for some back pain. Ibuprofen (Advil), naproxen (Aleve),  are available at pharmacies as well as online. You can also find acetaminophen (Tylenol), which some patients report has helped their back pain, over-the-counter at pharmacies.‍

Electrotherapy

Some people find back pain relief through the use of an over-the-counter transcutaneous electrical nerve stimulation (TENS) unit. Studies show that electrotherapy delivered by a TENS unit can alleviate back pain and related sleep issues (13). TENS units stimulate the nerves through mild (and painless) stimulation therapy that can be administered personally at home.‍

Muscle Relaxants

For persistent pain, you should consult a doctor. They may prescribe muscle relaxants, which are used for “ordinary” cases of persistent back pain and also happen to show particular efficacy in improving sleep quality. People who  suffer from pain and sleep problems due to back issues originating from myofascial syndrome can, for example, find relief through cyclobenzaprine, a prescription muscle relaxant (14). Other muscle relaxants like diazepam and parachlorophenol gaba can also improve sleep quality (15).

When it comes to muscle relaxants, keep in mind that they aren’t a long-term solution and should primarily be used for temporary relief to improve sleep while you continue an exercise therapy program.

Exercise therapy has extremely limited side effects. As long as you perform the exercises correctly, you should only suffer from some soreness. If you feel uncomfortable starting an exercise regimen on your own, consider seeing a personal trainer, physical therapist, or occupational therapist. They can help you develop a plan for exercise therapy that will address your specific needs.

Electrotherapy also carries few side effects, especially when using an over-the-counter TENS unit as opposed to a prescription-strength unit. You may experience some skin irritation/tingling, but probably not much more. In certain, rare, cases you may encounter muscle spasms. Talk to a doctor about whether or not a TENS unit is right for you if you notice any negative effects.

Heat and cold therapy have few side effects as long as you take care to protect your skin by wrapping the objects in a towel or wearing a cotton t-shirt. NSAIDs may cause gastrointestinal problems (stomach pain) and cardiovascular issues (heart problems). Acetaminophen is linked to liver damage. While over-the-counter pain relievers are generally considered to be safe when taken properly, speak to a healthcare provider about which medication is safest for you if you have any family history or personal clinical history of stomach, heart, or liver problems.

For muscle relaxants, the primary side effects are sedation and fatigue. You might experience some gastrointestinal issues as well (nausea or vomiting). As long as you stick to non-habit-forming relaxants such as cyclobenzaprine, you can consider these drugs to be a safe, temporary option for relieving your back pain and developing better sleep habits.

Back pain and sleep issues are closely linked – each problem can cause the other. Exercise therapy is the best treatment approach for addressing back problems and associated sleep disruptions. In some cases, additional over-the-counter therapies or muscle relaxants may be necessary for relief.