If you or your loved one suffers from low back pain (LBP), you are likely aware that it doesn’t exactly promote quality sleep. In this article, we will discuss the relationship with LBP and sleep. We’ll also hear from medical experts on how you can sleep better while living with this condition. Finally, we’ll take a look at the various reasons why you may be experiencing LBP.
Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t take the place of medical advice and supervision from your healthcare provider. If you feel you may be suffering from any sleep disorder or medical condition, please see a trained medical professional.
How Low Back Pain interferes With Sleep
It is estimated that 50 to 60% of people with LBP report sleep disturbances. (1) One reason is because of the pain associated with LBP. Dr. Shiel Patel, a spine and pain specialist at Thrive Medical Partners, says that recent studies have shown that sleep loss directly increases pain by lowering the pain threshold. (2)
One study found that people with short-term (3 to 6 months), yet persistent back pain had greater sleep disturbance than people who have had long-term (chronic) back pain. (3) That isn’t to say that folks with chronic back pain tend to get quality sleep, as indicated by another study, which found a strong correlation between sleep disturbances and chronic LBP. (4).
Sleep disturbances from LBP are exacerbated by any associated stress, anxiety, and depression. (5) For example, anxiety due to LBP can make falling and staying asleep difficult. (6) So take a chill pill (if prescribed by your doctor) and find ways to reduce your anxiety — your back will thank you.
Tips For Better Sleep With Low Back Pain
Sleep issues related to LBP can be mitigated. Let’s take a look at a few tips for getting better shut-eye in spite of LBP.
1. Consider Alternative Therapy
It is incredibly important that your healthcare provider identify the source of your back pain before you decide on any therapies that might benefit you. (7) With that in mind, you may want to consider alternative therapy if your doctor recommends it. For instance, a 2019 study in the Journal of Pain Research, concluded that transcutaneous electrical nerve stimulation (TENS) therapy helped improve the sleep of about half of their 554 patients with LBP. (8)
2. Practice Good Sleep Hygiene
Dr. Patel recommends the following practices for good sleep hygiene:
- Stick to a sleep schedule
- Get 7 to 8 hours of sleep each night
- Avoid caffeine in the afternoon
- Do not eat a large meal right before bed
- Avoid keeping gadgets such as laptops and mobile devices in your bedroom
- Do not nap after 3pm
- Do not perform stressful activities right before bed
- Check with your doctor to see if any of your medications are contributing to poor sleep. If you take medication such as acetaminophen or ibuprofen, take it 30 minutes before bed
- Apply a heat or cold pack 30 minutes before bed to help relieve pain
3. Use Pillows
If you’re a side sleeper, Patrick Montgomery, a doctor of chiropractic and instructor at Logan University, recommends using pillows to avoid straining your lower back and pelvis. He says side sleepers should have “a pillow under their head to fill the gap between the shoulder and the bed and another pillow between their knees with both knees bent at the same angle.”
Don’t fret, back sleepers — you can use pillows, too! Dr. Tara Salay, a physical therapist, says that back sleepers can try placing a pillow or two under their knees to support their lower back.
Sleeping on your stomach should be approached cautiously. Dr. Gbolahan Okubadejo (AKA Dr. Bo) of the Institute for Comprehensive Spine Care, recommends not sleeping on your stomach since this can stress your spine and extend your neck backward, compressing the spine. If you must sleep on your stomach, Dr. Salay suggests placing a pillow under your stomach and another one under your feet on your shins.
Does the type of pillow matter? Yes! According to Dr. Bo, you should use a memory foam pillow that supports your back. He says that to avoid backaches, you should position your pillow so that your head is lined up with your spine.
4. Choose the Right Mattress for You
Dr. Patel says it’s important to invest in the right mattress for you. He usually recommends his patients use a medium-firm mattress, but he notes that you should ultimately choose the most comfortable mattress for you.
If you’re a back sleeper, Dr. Montgomery recommends using a firm mattress. He says, however, that side sleepers should avoid firm mattresses, since it can cause the middle of the body to sag and put strain on the back. As such, it’s important to choose a mattress for lower back pain that is designed to provide the necessary support you’ll need to relieve some pain at night.
5. Take Vitamin D
If you aren’t getting enough Vitamin D throughout the day, you may want to start. One study suggests that taking Vitamin D supplements can help with all forms of chronic pain, including back pain. (9) You can use this as an excuse to take a break from work to walk outside and get that sweet, sweet Vitamin D from the sun.
6. Stretch Before Bedtime
According to Dr. Patel, stretching before bedtime is effective for relieving stress and reducing pain. Dr. Bo agrees, saying that stretching will relieve discomfort by loosening your muscles in your shoulders and back. Some stretches he suggests are:
- Child’s pose
- Knee to chest stretch
- Seated forward bend stretch
- Pelvic tilt stretches
7. Strengthen Your Muscles
Prepare to feel the burn! Dr. Patel says that strengthening your back and core muscles will help do the following:
- Support your spine
- Alleviate pressure off of nerves that contribute to pain
8. Sit Up Correctly
Dr. Montgomery says that if you sit up straight after lying on your back, you can put immediate strain on your lower back. To avoid this, he says to roll to your side facing the edge of the bed, bend your knees, and push up so that you are sitting sideways.
Causes of Low Back Pain
There can be many culprits behind LBP, and Dr. Bo gave us several reasons why you may be experiencing this condition. But first, let’s look at one of the leading causes of LBP: sciatica.
Sciatica is characterized by radiating leg pain along the sciatic nerve. (10) The sciatic nerve runs from the lower back down to the back of each leg, which is one reason why sciatica can cause LBP.
One study found that 60% of patients with back pain had sciatica. (11) While non-surgical treatments for sciatica are preferable, surgery may be necessary in special cases. (12) But fear not! There are ways to reduce your risk for sciatica. Two of these include not smoking and maintaining a healthy weight. (13)
This can cause nerve damage, weakness in your lower back, and strained muscles, which can lead to LBP. So if you tend to slouch at your desk, remember what you were told as a child and “sit up straight!”
Excess Body Weight
According to Dr. Bo, excessive body weight can “cause the spine to develop an unnatural curvature and become tilted.” So think twice before you stress-eat that entire pizza at 10pm!
Stress can cause tension in your back. Dr. Bo explains this is because stress causes your breathing patterns to change and your shoulders to hunch, which can lead to back pain.
Since kidney stones are located towards the back of your body, Dr. Bo says they can cause severe back pain. When your body attempts to release the stone, this can cause a sharp pain in your back and sides.
He says it isn’t uncommon for folks with osteoporosis to break the bones in their lower back, even if there is not an apparent injury. And it goes without saying that broken back bones and sleep don’t mix well.
Premenstrual syndrome (PMS) also causes back cramps. According to Dr. Bo, “When your uterus cramps, the pain is felt around your sacrum, (the area of your back between your hips), and you can have backaches.”
There are several other potential causes of LBP:
- Skeletal structural abnormalities, such as dislocations or joint impairments. (14)
- Arthritis, which causes spinal joint and bone overgrowth and inflammation
- Disc degeneration, which causes the discs (cushions between the spine’s bones) to get smaller, weaken, or bulge. (15)
Last Word From Sleepopolis
As you can see, LBP isn’t great for sleep, and it can be caused by a variety of reasons, such as sciatica, poor posture, or osteoporosis. Remember that you can mitigate the negative effects LBP has on sleep by practicing good sleep hygiene, sleeping with pillows, and stretching before bedtime. Please remember that we are not medical experts, so be sure to speak with your healthcare provider if you have any medical questions.
- Alsaadi, S et al. Assessing Sleep Disturbance in Low Back Pain: The Validity of Portable Instruments. PLoS One. Apr 24, 2014.
- Staffe, A et al. Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation and facilitates temporal summation of pain in healthy participants. PLoS One. Dec 4, 2019.
- Alsaadi, S et al. Erratum to: Prevalence of sleep disturbance in patients with low back pain. European Spine Journal. Aug 24, 2011.
- Shmagel, A et al. Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009–2010 National Health and Nutrition Examination Survey. Nov 2016.
- Stubbs, B et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. General Hospital Psychiatry. Aug 14, 2016.
- Alvaro, P et al. A Systematic Review Assessing Bidirectionality between Sleep Disturbances, Anxiety, and Depression. Sleep. July 1, 2013.
- Allegri, M et al. Mechanisms of low back pain: a guide for diagnosis and therapy. National Library of Medicine. Oct 11, 2016.
- Gozani, S et al. Impact of transcutaneous electrical nerve stimulation on sleep in chronic low back pain: a real-world retrospective cohort study. Journal of Pain Research. Feb 25, 2019.
- Huang, W et al. Improvement of Pain, Sleep, and Quality of Life in Chronic Pain Patients With Vitamin D Supplementation. Clinical Journal of Pain. 2012.
- “Sciatica.” US National Library of Medicine. https://medlineplus.gov/sciatica.html
- Rikke, J et al. Diagnosis and treatment of sciatica. University of Southern Denmark. 2019.
- Jacobs, W et al. Surgical techniques for sciatica due to herniated disc, a systematic review. European Spine Journal. Jul 20, 2012.
- Cook, C et al. Risk Factors for First Time Incidence Sciatica: A Systematic Review. Physiotherapy Research International. Dec 11, 2013.
- O’Sullivan, P et al. Unraveling the Complexity of Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy. Nov 1, 2016.
- Fernandes, Colin and Mariano, Anthony. “Managing Your Lower Back Pain.” US Department of Veterans Affairs. https://www.myhealth.va.gov/mhv-portal-web/low-back-pain