lower back pain can barely sleep

  • Sleeping on the side with partially bent knees and a thin pillow between the knees may minimize morning back pain(1). The head pillow should only be enough to fill the neck and mattress gaps to maintain natural alignment while sleeping.
  • Research supports using medium-firm mattresses to help maintain low back pain(2-3).
  • Lower back pain (LBP) is either acute or chronic. Acute LBP is short-term yet may develop into long-term chronic back pain if untreated(4).
  • Despite lower back pain, adults must aim for at least seven hours of sleep in a day for general wellness(5). Some lifestyle practices to achieve this include setting and following a sleep-wake schedule.

Older people with lower back pain may struggle with sleeping problems. At the same time, sleeping problems affect a person’s recovery from their lower back pain. 

Health Report Live covers everything older folks with lower back pain can do for better sleep.

This article will outline which sleeping positions are the best for those with chronic back pain and which positions exacerbate the condition.

Health Report Live highlights the best sleeping positions that may help alleviate one’s lower back pain so one can go back to enjoying the simple things for a pain-free and improved quality of life.

The Best Sleeping Positions for People With Lower Back Pain

It is imperative to maintain the body’s alignment while asleep. 

However, a person’s favorite sleeping position could be causing them worsened lower back pain. 

The best and most comfortable sleeping positions for lower back pain are listed below.

Lying Sideways

Studies exploring the relationship between sleep posture and spinal symptoms state that side sleeping generally protects people from spinal concerns(6).

The American Academy of Family Physicians encourages people with back pain to sleep on their side. 

The organization suggests that the best sleeping position for lower back pain is lying sideways with the knees partially bent7).

To get into a comfortable side sleeping position, one should:

  1. Be sure the left shoulder or right shoulder (depending on comfort level) and the rest of that side of the body makes contact with the mattress.
  2. Fill any gaps between the waist and the mattress with small pillows or rolled-up towels.
  3. Place a small or thin pillow between the knees to help maintain spinal alignment.

Sleeping on the side with a thin pillow between the knees helps keep the hips, pelvis, and spine in better alignment for a good night’s sleep.

Another side-lying option is the fetal position. 

To do this, one should:

  1. Lay on the back, and then gently roll over to one side.
  2. Tuck the knees toward the chest, gently curling the torso toward the knees.
  3. Switch sides from time to time to prevent muscle or spinal imbalances.

People with degenerative disc disease, such as a herniated disc, are prone to sciatica and other back problems(8).

Discs are cushions between the spinal vertebrae. When disc degeneration occurs, parts of the disc push out of their regular space, pressing on spinal nerves and causing weakness and nerve pain(9).

Curling into a fetal position, with the knees drawn up, opens the spinal joint and lessens the spine’s curvature. Sleeping in this position on a firm surface may help prevent low back pain(10).

Lying Face Up

Some people may find sleeping on their back the most comfortable position to relieve their lower back pain.

However, a study has noted that sleeping face up increases the risk of developing LBP by 1.9 times(11).

To get a restful sleep while lying face up, one should:

  1. Lay flat on the back.
  2. Place a pillow under the back of the knees. The extra pillow helps keep the spine in a neutral position, maintaining the lower back’s natural curve.
  3. Substitute the small pillow with a rolled-up towel or any comfortable cushion for added support.

Sleeping on the back distributes the body’s entire weight evenly across the widest parts.

This position places less stress on pressure points, allowing for better alignment of the internal organs and the spine.

Adjustable beds can make it easier to raise a person’s mattress to the most comfortable position while lying on their back.

The Worst Sleep Position for Lower Back Pain

Lying face down is perhaps the worst sleeping position for people with lower back pain. Sleeping on the stomach may add stress and cause neck pain.

Still, some people find it difficult to go to sleep unless they are on their stomachs. 

To make stomach sleeping less damaging to the spine, one should:  

  1. Place a pillow under the pelvis and lower abdomen to relieve some pressure off the back.
  2. Use a small pillow for the forehead to allow breathing space between the face and the mattress. 

Meanwhile, some people may find having no head pillow more comfortable when sleeping on their stomach (prone position).

However, sleeping in the prone position inflicts more pressure on the spinal joints and muscles. This position flattens the spine’s natural curvature and puts force on the neck. Stomach sleepers may experience upper back and neck pain(12).

Placing a pillow on the lower abdomen area may relieve stress from the discs’ spaces.

The Relationship Between Sleep and Lower Back Pain

Constant pain may lead to sleep disorders, impairing the pain recovery process(13).

Individuals with lower back pain may experience sudden pain surges, affecting their sleep cycle.

Moreover, people with sleeping problems are prone to pain. Experts suggest that sleep deprivation affects moods and makes people more sensitive to pain(14).

Researchers have collected evidence from animal experiments and human studies linking sleeping problems with lower back pain(15).

Existing evidence has made experts agree that both conditions mutually reinforce each other(16).

What to Look for in a Pillow

Pillows should fill the spaces between the body and mattress to maintain the body’s alignment while sleeping.

People who find more comfort in lying down on their back must fill the space between their neck and the mattress.

Memory foam is a firm pillow material that molds specifically to an individual’s head and neck and provides hip and shoulder support(17). This material may help improve spinal alignment for side sleepers(18).

For side sleepers, firm pillows with an extra-wide gusset may help connect the space between the ear and neck with the mattress.

Placing a pillow between the knees may provide additional relief for lower back pain(19).

Individuals may use a rolled-up towel instead of a pillow between the knees. As long as the body’s alignment is maintained while one sleeps, any comfortable object may suffice.

Body pillows may provide extra support for side sleepers. These large pillows may provide added comfort for people who need to feel something against their stomach while aligning the body during sleep.

Although sleeping on the stomach is considered bad for the back, some people may find this position the most comfortable.

Individuals who need to lay on their stomach to sleep may place a small pillow under the abdomen to help align the back while sleeping.

Overall, one should fill in the spaces between the body and the mattress filled with supporting body alignment while sleeping.

Meanwhile, placing a pillow under the shoulders when sleeping is not a good idea. A pillow under the shoulders puts stress on the neck and affects its alignment with the rest of the body.

What to Look for in a Mattress

An individual’s comfort preferences factor into a person’s ideal mattress. These preferences vary further based on a person’s most comfortable sleeping position, body weight, and body size.

Most people spend almost one-third of their lives lying in bed(20). This fact highlights the necessity of choosing a quality mattress for managing lower back pain.

Existing research suggests medium-firm mattresses to help manage lower back pain(21-22).

However, one survey of 268 people with lower back pain stated no difference in sleep quality between individuals who used a firm mattress and those who slept on a medium-firm mattress(23).

The same survey stated that those who used very firm mattresses had the poorest sleep quality.

Meanwhile, soft mattresses that conform to the body’s natural curves may help align joints and relieve back pain(24).

However, people may sink into extremely soft mattresses, twisting their joints, which may worsen lower back pain(25).

People may try placing a plywood board under their current mattress to gauge whether a firmer mattress is ideal for them.

Conversely, individuals may try using mattress toppers as a new layer above their current mattress without replacing their entire mattress.

Memory foam is a new mattress foam material for people to try without buying a whole mattress. Materials include cotton, latex, polyfoam, polyester, and a mixture of materials.

Studies on the appropriate mattresses that influence sleeping comfort and health are limited. Still, the existing investigations highlight the necessity of proper sleeping support to prevent sleep-related musculoskeletal disorders, such as scoliosis(26).

Sleep Hygiene

Typically, adults need seven to nine hours of sleep in a day(27)

As lower back pain disrupts a person’s sleep cycle, maintaining healthy sleep hygiene becomes imperative.

To improve sleeping habits, one should(28):

  • Set a sleeping schedule by going to bed at a particular time and then waking up at the same time each day. Consider putting the alarm to wake up on time.
  • Exercise and perform lower back stretches for 20 minutes to 30 minutes a day. However, avoid doing heavy physical activities a few hours before going to bed.
  • Avoid caffeine and nicotine products late in the day. Experts have linked nicotine consumption to adverse effects on sleep and mood(29).
  • Avoid consuming alcoholic drinks before bed. Although alcohol has sedative effects, its consumption leads to poor sleep quality and duration(30).
  • Perform relaxing activities before bed. Try some relaxing routines, such as taking a warm bath, reading a book or calming Tai Chi body movements.
  • Try calming scents, such as lavender to promote relaxation. Experts have noted lavender’s purported therapeutic and relaxation-inducing properties(31).
  • Avoid using television or mobile devices to help go to sleep. Continued exposure to blue light from mobile gadgets could disrupt sleep cycles by affecting the sleep hormone melatonin(32).
  • Consult a doctor for medical advice if sleeping problems or unusual tiredness throughout the day persists. Most sleep disorders are reversible and effectively treatable.

Nights tend to become shorter and lighter for the elderly. People over 60 years old may resort to medications to help with sleep interruptions(33).

Standard pharmacological treatments for insomnia in the elderly include(34):

  • Benzodiazepines and nonbenzodiazepine sedatives
  • Antidepressants
  • Melatonin receptor agonists
  • Herbal supplements
  • Orexin receptor agonists

Types of Lower Back Pain

Acute and chronic are the two primary types of lower back pain.

Acute Lower Back Pain(35): This short-term type of lower back pain lasts for a few days or up to a few weeks. Only in a few cases do acute lower back pain symptoms take a few months to disappear.

Acute lower back pain is common with no permanent effects. With healthy lifestyle habits and self-care, this condition may improve in a few days(36).

Chronic Lower Back Pain(37): This long-term type of lower back pain tends to persist for over 12 weeks. Around 20% of acute lower back pain cases develop into chronic pain(38).

Despite the prevalence of lower back pain, its exact cause is unknown. Experts suggest that more than one event causes existing lower back pain. Heavy lifting and arthritis are some causes linked to chronic back pain(39).

When to See a Doctor About Lower Back Pain

A person experiencing any type of lower back pain must watch out for any of the following signs to decide whether they need professional medical attention(40):

  • Back pain after falling hard or getting a severe blow to the back
  • Hematuria or blood in the urine
  • Urinary tract infection (UTI) or burning sensation with urination
  • History of cancer
  • Incontinence or loss of control over urine or stool
  • Pain that travels down the legs below the knee
  • Pain that worsens when lying down
  • Surging pain that wakes a sleeping person
  • Swelling or redness along the back or spine
  • Severe pain that prevents a person from getting comfortable
  • Unexplainable fever with back pain
  • Numbness or weakness in the lower extremities (pelvis, buttocks, thigh, and leg)

Other more alarming conditions include the following signs:

  • Unintentional weight loss
  • Necessary use of steroids or intravenous drugs
  • Different or worse sensation compared to their history of back pain
  • The current back pain episode lasts longer than four weeks

FAQs

Why is lower back pain worse in the mornings?

Some issues that contribute to morning back pain include poor sleeping position, bad mattress quality, disc degeneration, spinal stenosis, and herniated discs(41).

Does lying on a hard floor help with lower back pain?

While there is no proof that sleeping on the floor improves lower back pain, Existing research suggests using medium-firm mattresses to help manage lower back pain(42-43).

How long does lower back pain last?

Acute lower back pain is common with no permanent effects. With healthy lifestyle habits and self-care, this condition may improve in a few days(44).

However, acute LBP that develops into chronic back pain may last over 12 weeks(45).

When should one be worried about lower back pain?

If lower back pain persists for more than four weeks, other underlying causes requiring medical attention may be contributing to the pain(46).

Some alarming signs include worse back pain compared to a past episode and unintentional weight loss.

How long should one rest for lower back pain relief?

People with lower back pain may experience more pain when resting for extended hours(47). Resting for more than 48 hours may increase muscle and spine stiffness(48).

It is suggested to move around at times and find a comfortable position when resting.

References

  1. Low Back Pain. FamilyDoctor.org. American Academy of Family Physicians (AAFP). Retrieved from  https://familydoctor.org/condition/low-back-pain/
  2. Jacobson, B. H., Boolani, A., Dunklee, G., Shepardson, A., & Acharya, H. (2010). Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Applied ergonomics, 42(1), 91–97. https://doi.org/10.1016/j.apergo.2010.05.004
  3. Ancuelle, V., Zamudio, R., Mendiola, A., Guillen, D., Ortiz, P. J., Tello, T., & Vizcarra, D. (2015). Effects of an adapted mattress in musculoskeletal pain and sleep quality in institutionalized elders. Sleep science (Sao Paulo, Brazil), 8(3), 115–120. https://doi.org/10.1016/j.slsci.2015.08.004
  4. Low Back Pain Fact Sheet. National Institute of Neurological Disorders and Stroke. 2020 April 27. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
  5. Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke. 2019 August 13. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep#4
  6. Cary, D., Briffa, K., & McKenna, L. (2019). Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ open, 9(6), e027633. https://doi.org/10.1136/bmjopen-2018-027633
  7. Low Back Pain. FamilyDoctor.org. American Academy of Family Physicians (AAFP). Retrieved from  https://familydoctor.org/condition/low-back-pain/
  8. Michigan Medicine University of Michigan, (n.d.), Lumbar Herniated Disc, retrieved from https://www.uofmhealth.org/health-library/hw226016 
  9. Herniated Disc. American Association of Neurological Surgeons.  Retrieved from https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Herniated-Disc
  10. NIH National Institute of Neurological Disorders and Stroke, (n.d.), Low Back Pain Fact Sheet, retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
  11. Abanobi O, Ayeni G, Ezeugwu C, et al. . Risk-disposing habits of lowback pain amongst welders and panel beaters in Owerri, south-east Nigeria. Indian Journal of Public Health 2015;6:332–7.
  12. University of Southern Carolina, Keck Medicine, (n.d.), The Best — and Worst — Sleep Positions for Back Pain, retrieved from https://www.keckmedicine.org/the-best-and-worst-sleep-positions-for-back-pain/#:~:text=Side%20sleeping%3A%20A%20solid%20runner%2Dup&text=Another%20type%20of%20side%20sleeping,back%20pain%20and%20sore%20joints.
  13. Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. The journal of pain, 14(12), 1539–1552. https://doi.org/10.1016/j.jpain.2013.08.007
  14. Ibid
  15. Marty, M., Rozenberg, S., Duplan, B., Thomas, P., Duquesnoy, B., Allaert, F., & Section Rachis de la Société Française de Rhumatologie (2008). Quality of sleep in patients with chronic low back pain: a case-control study. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 17(6), 839–844. https://doi.org/10.1007/s00586-008-0660-7
  16. Ibid
  17. Sleep.org, (n.d.), What is Memory Foam, retrieved from https://www.sleep.org/what-is-memory-foam/
  18. Ibid.
  19. Low Back Pain. FamilyDoctor.org. American Academy of Family Physicians (AAFP). Retrieved from  https://familydoctor.org/condition/low-back-pain/
  20. What type of mattress is best for people with low back pain? Harvard Health Publishing – Harvard Medical School. 2015 November. Retrieved from https://www.health.harvard.edu/pain/what-type-of-mattress-is-best-for-people-with-low-back-pain
  21. Jacobson, B. H., Boolani, A., Dunklee, G., Shepardson, A., & Acharya, H. (2010). Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Applied ergonomics, 42(1), 91–97. https://doi.org/10.1016/j.apergo.2010.05.004
  22. Ancuelle, V., Zamudio, R., Mendiola, A., Guillen, D., Ortiz, P. J., Tello, T., & Vizcarra, D. (2015). Effects of an adapted mattress in musculoskeletal pain and sleep quality in institutionalized elders. Sleep science (Sao Paulo, Brazil), 8(3), 115–120. https://doi.org/10.1016/j.slsci.2015.08.004
  23. What type of mattress is best for people with low back pain? Harvard Health Publishing – Harvard Medical School. Op cit
  24. ibid
  25. Ibid
  26. Wong, D. W., Wang, Y., Lin, J., Tan, Q., Chen, T. L., & Zhang, M. (2019). Sleeping mattress determinants and evaluation: a biomechanical review and critique. PeerJ, 7, e6364. https://doi.org/10.7717/peerj.6364
  27. Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke. 2019 August 13. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep#4
  28. Ibid
  29. Jaehne, A., Loessl, B., Bárkai, Z., Riemann, D., & Hornyak, M. (2009). Effects of nicotine on sleep during consumption, withdrawal and replacement therapy. Sleep medicine reviews, 13(5), 363–377. https://doi.org/10.1016/j.smrv.2008.12.003
  30. Park, S. Y., Oh, M. K., Lee, B. S., Kim, H. G., Lee, W. J., Lee, J. H., Lim, J. T., & Kim, J. Y. (2015). The Effects of Alcohol on Quality of Sleep. Korean journal of family medicine, 36(6), 294–299. https://doi.org/10.4082/kjfm.2015.36.6.294
  31. Koulivand, P. H., Khaleghi Ghadiri, M., & Gorji, A. (2013). Lavender and the nervous system. Evidence-based complementary and alternative medicine : eCAM, 2013, 681304. https://doi.org/10.1155/2013/681304
  32. Is blue light from your cell phone, TV bad for your health? UC Davis Health. Retrieved from https://health.ucdavis.edu/health-news/newsroom/is-blue-light-from-your-cell-phone-tv-bad-for-your-health/2019/05
  33. Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke. Op cit
  34. Patel, D., Steinberg, J., & Patel, P. (2018). Insomnia in the Elderly: A Review. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(6), 1017–1024. https://doi.org/10.5664/jcsm.7172
  35. Low back pain – acute. A.D.A.M. Medical Encyclopedia. MedlinePlus. 2020 July 8.  Retrieved from https://medlineplus.gov/ency/article/007425.htm
  36. Low Back Pain Fact Sheet. National Institute of Neurological Disorders and Stroke. 2020 April 27. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
  37. Low back pain – chronic. A.D.A.M. Medical Encyclopedia. MedlinePlus. 2019 May 13.  Retrieved from https://medlineplus.gov/ency/article/007422.htm
  38. Low Back Pain Fact Sheet. National Institute of Neurological Disorders and Stroke. Op cit
  39. Low back pain – chronic. A.D.A.M. Medical Encyclopedia. MedlinePlus. Op cit
  40. Low back pain – acute. A.D.A.M. Medical Encyclopedia. MedlinePlus. Op cit
  41. Do You Have Lower Back Pain in the Morning? Orthopedic Associates. 2020 August 21. Retrieved from https://orthopedicassociates.org/do-you-have-lower-back-pain-in-the-morning/
  42. Jacobson, B. H., Boolani, A., Dunklee, G., Shepardson, A., & Acharya, H. (2010). Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Applied ergonomics, 42(1), 91–97. https://doi.org/10.1016/j.apergo.2010.05.004
  43. Ancuelle, V., Zamudio, R., Mendiola, A., Guillen, D., Ortiz, P. J., Tello, T., & Vizcarra, D. (2015). Effects of an adapted mattress in musculoskeletal pain and sleep quality in institutionalized elders. Sleep science (Sao Paulo, Brazil), 8(3), 115–120. https://doi.org/10.1016/j.slsci.2015.08.004
  44. Low Back Pain Fact Sheet. National Institute of Neurological Disorders and Stroke. 2020 April 27. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
  45. Ibid.
  46. Low back pain – acute. A.D.A.M. Medical Encyclopedia. MedlinePlus. Op cit
  47. Choosing Wisely, American Board of Internal Medicine, (n.d.), Treating lower-back pain How much bed rest is too much?, retrieved from https://www.choosingwisely.org/wp-content/uploads/2018/02/Bed-Rest-For-Low-Back-Pain-NASS_2019-Updates091319.pdf
  48. Ibid.