There are lots of reasons why you might toss and turn at night, but one of the most annoying is back pain. When your back aches or twinges, it can make it impossibly hard to fall asleep. Back pain can also wake you up later on in the night, especially if you tend to sleep on your back.
First things first: It helps to pinpoint the cause behind your backaches, especially if you experience them often. “Common causes of back pain can include disc problems, nerve irritation, and muscle strains,” physical therapist Dr. Jasmine Marcus, PT, DPT, CSCS, tells Bustle. Sitting for long periods of time or hunching over a desk all day can lead to pesky tension, too. These are culprits that can often be addressed during the day with subtle lifestyle changes.
Still, any type of pain can sabotage a peaceful night of sleep. The nighttime is when you’re most likely to notice aches that have been lurking all day. “We naturally move around during our sleep, and bouts of back pain can make that uncomfortable and wake you up,” Dr. Thanu Jey, a chiropractor and clinical director of Yorkville Sports Medicine Clinic, tells Bustle. And your sleeping position can either help or exacerbate back pain. “Lying on your back with your legs straight is actually not neutral for the spine,” says Dr. Theresa Marko, a physical therapist and board-certified orthopedic clinical specialist. It puts your back into extension, she explains, which can cause pain and pinching.
While it can be tough to find the perfect combination of things that relieve back pain at night, one of these pro tips may be able to help.
1. Put A Pillow Under Your Knees
If you’re a back sleeper, try putting a pillow under your knees. “This tilts your pelvis forward, which helps keep your spine from being over-extended or curved backwards,” Jey says. Once you wedge a pillow to elevate your knees and support your back, you’ll feel your muscles relax. If you’re a side sleeper, it may help to place a pillow between your knees in a curled position. You can also hug the pillow for proper spine alignment, says Jey. And if your neck is the source of agony, he recommends rolling up a towel or blanket and placing it inside the base of your pillowcase. “This will prop up the curve of your neck and help with pain,” he says.
2. Get A Soft Foam Topper For Your Bed
Sleeping on a mattress that’s either too soft or too hard can make back pain even worse, says Marko, which is why backaches might tempt you buy a whole new bed. Before you drop the bucks, try experimenting with a foam topper and see if that helps. “A foam gel topper for your mattress will help your back sink a little into the mattress,” she tells Bustle. If you’re a side sleeper, Marko says the squishy foam will give your pelvis room to settle into your bed just a bit, relieving points of pain.
3. Experiment With Different Sleeping Positions
According to Marcus, back pain tends to favor certain positions. “For example, someone may have pain standing and relief with sitting, or vice versa,” she explains. “If you have pain sitting, you may also have pain lying in a curled up position, whereas someone with pain standing may have pain lying flat.”
If you’re a big fan of side sleeping, the thought of turning onto your stomach or back might not be appealing. But Marcus says it’s definitely worth experimenting. “You may have to adjust the number of pillows you use, or you can experiment with using a body pillow or pillow between the knees,” she says. “There is no one perfect way to sleep, so you have to find what works for you.”
4. Try A Guided Meditation
It might not occur to you to meditate while in the throes of back pain, but it could help. “Listening to a meditation can actually be really powerful, especially if you are having a hard time relaxing because of pain,” says Dr. Alyssa Kuhn, a doctor of physical therapy. Look for an app that guides you through a visualization or simply close your eyes and try to let your thoughts float by. “It can help distract you from your pain and help you to find periods of relaxation so you can doze off,” she says.
5. Grab A Knee
Still can’t fall asleep? Try pulling one or both knees to your chest and rocking side to side. As Kuhn says, “Many times movement can help your muscles to relax while decreasing pain levels.” So this stretch might do the trick.
The cat-cow yoga stretch can be a big help, too, says physical therapist Dr. Whitney Fitzpatrick PT, DPT. So if you can’t sleep, pop down onto the floor and try to work out your knots. “Stretching exercises should relieve the painful area of some stress and improve flexibility,” Fitzpatrick tells Bustle.
For an extra dose of relief, she says you can follow up your stretch by placing a heating pad or ice pack on your back, depending on which one feels better.
6. Be Active During The Day
A stiff back is often caused by sitting in the same position all day long. To help prevent spasms and tension, try getting up more frequently and doing some movements. Whether it’s walking, jogging, or doing yoga, movement can help keep your back loose and flexible, says physical therapist Noah Arenson, PT, MPT.
You can even do little exercises while under the covers. “It could be lying on the bed and making gentle movements with the hips or arching your back before you lie down,” Arenson says. “If your back is more mobile it is less likely to be irritated in the middle of the night when you switch positions."
7. Do Something To De-Stress
If you’ve been under a lot of stress, you might sleep a lot better if you find ways to cope. “The large superficial muscles of the neck along the spine and in the low back react and tighten when the sympathetic nervous system is activated in fight-or-flight,” says physical therapist Stephanie Carter Kelley, PT, Ph.D. “When these muscles stay turned on, you experience a sense of tightness and eventually pain.”
Consider incorporating a chill nighttime routine. The goal is to calm your nervous system before bed, Kelley says, because if your body is relaxed, it’ll be easier to get good, restorative sleep. “If you have difficulty turning your brain off, journal before bed,” she suggests. “Just write down anything and everything that comes to mind and then rip the paper to shreds. The idea is to get the ruminating thoughts out of your head and onto paper.”
It might also help to follow the same routine every night so that once you take an evening shower or pour a cup of tea, your body knows it’s time to relax and get ready for sleep. Kelley says a calming routine is often the one thing that works best, especially if it feels like you’ve tried literally everything to sleep with back pain.
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Jacobson BH, Boolani A, Dunklee G, Shepardson A, Acharya H. Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Appl Ergon. 2010 Dec;42(1):91-7. doi: 10.1016/j.apergo.2010.05.004. Epub 2010 Jun 26. PMID: 20579971.
Merkle, S. (2020). The interaction between pain and movement. J Hand Ther. doi: 10.1016/j.jht.2018.05.001
Schell, E. (2008). Stress biomarkers' associations to pain in the neck, shoulder and back in healthy media workers: 12-month prospective follow-up. European Spine Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2270377/
Dr. Theresa Marko, physical therapist
Dr. Thanu Jey, physical therapist
Dr. Jasmine Marcus, PT, DPT, CSCS, physical therapist
Dr. Alyssa Kuhn, physical therapist
Dr. Whitney Fitzpatrick PT, DPT, CIDN, ITPT, physical therapist
Noah Arenson, PT, MPT, ATC, physical therapist
Stephanie Carter Kelley, PT, PhD, OCS, physical therapist