Nighttime lower back pain

How to Relieve Nighttime Back Pain

2. Use a bed pillow properly. “Pillows should be supporting the neck, not the shoulders, so no shoulders should be on the pillow,” says Schexneider. “Shoulders should be on the mattress.” He also recommends using a water pillow, which fills with about 5 quarts of water, instead of a traditional foam or feather-filled pillow.

3. Take a mattress for a test ride. Schexneider recommends that people try out mattresses before buying. If they find a mattress they like, he recommends trying it for 30 to 45 days. “There are a number of stores that allow this now, unlike several years ago,” he says. Call around until you find a store that will work with you on this.

Discover What Works for You

Diane Penna of Pollack Pines, California, has been living with back pain for many years. She says that part of her problem at night is the location of the pain.

“My pain is mostly on the left side, my preferred side to sleep on, so when I naturally roll over to that side in the middle of the night, I’ll wake up from the pain and have to move to another position,” she explains. She often uses a heating pad, which helps relax the back muscle spasms and helps her fall asleep. However, remember to turn off your heating pad before falling asleep to reduce the risk of burns.

If you’re like Penna and find yourself turning over onto your painful side, you can try putting a pillow behind your back to keep you from rolling over. This is a trick used by nurses in the hospital when they want a patient to stay in one position.

Practice Good “Sleep Hygiene”

Michael Rack, MD, a sleep medicine expert in at the medical clinic Sleep Unlimited in Southaven, Mississippi, suggests that people with back pain remember the rules of what sleep experts call good “sleep hygiene.” Some of Rack’s suggestions include:

  • Avoid alcohol, especially near bedtime.
  • Create a sleep-friendly environment that’s cool, quiet, and comfortable.
  • Talk to your doctor about medications for insomnia.

Additionally, the National Sleep Foundation recommends a number of other good sleep hygiene practices, including avoiding daytime naps, maintaining a healthy sleep-wake cycle by getting adequate exposure to natural light during the day, and avoiding heavy meals before bedtime. The foundation also suggests avoiding caffeine close to bedtime, though a study published in November 2013 in the Journal of Clinical Sleep Medicine found that even caffeine taken six hours before bed can disrupt sleep.

If sleep is still elusive, you should talk with your primary care doctor about other approaches to back pain relief.

Back Pain at Night: When It’s a Sign of Ankylosing Spondylitis

If you’re reading this article, chances are your back pain is bad — so bad that it’s disrupting your ability to sleep well, which generally makes everything in life worse. Poor sleep can exacerbate pain symptoms, affect daytime fatigue, and contribute to a host of other health problems, from heart disease to weight gain to diabetes.

It’s an important first step that you’re taking your back pain at night seriously and looking for answers as to what is causing it.

Back pain at night could be due a number of different health concerns (more on that below), but one that often goes overlooked is inflammatory back pain from conditions like ankylosing spondylitis or axial spondyloarthritis (AS). These are types of arthritis that affect your spine and other parts of the body, causing inflammation, chronic pain, and, over time, joint damage that can cause the bones in your spine to fuse together.

In a study presented at the 2018 annual meeting of the American College of Rheumatology, morning stiffness and pain that wakes people up from sleep were the two most common symptoms in people with back pain from inflammatory arthritis like AS.

Back Pain at Night and Ankylosing Spondylitis

There are two main categories of back pain: mechanical and inflammatory. Mechanical back pain results from problems with the way the different components of your spine (joints, discs, muscles, tendons and ligaments, etc.) work together. Mechanical back pain, such as from overuse injuries, poor posture, or a herniated disc, is the reason for the vast, vast majority of back pain cases.

On the other hand, inflammatory back pain occurs because there’s a problem with your immune system attacking the joints in your spine, sacroiliac joints (where the spine connects with the pelvis), and the entheses (the connective tissue between ligaments, tendons, and bones).

Back pain that wakes you up in the second half of the night is one of a few key signs that your back pain could be inflammatory and due to a disease like ankylosing spondylitis.

“Patients often experience stiffness and pain that awakens them in the early morning, a distinctive symptom not generally found in patients with mechanical back pain,” reports Medscape.

“It’s not common to have back pain so bad in the middle of the night that you can’t go back to sleep,” says Fardina Malik, MD, a rheumatologist at NYU Langone in New York City who frequently treats patients with ankylosing spondylitis.

Mechanical back pain generally feels better when you rest or sleep. You might have discomfort, but you should be able to sleep through the night.

If you have inflammatory back pain, however, rest makes it worse. While you sit still for too long, such as during sleep, inflammatory chemicals accumulate in your joints, exacerbating pain and stiffness. That’s why people with inflammatory back pain can wake up in agony in the middle of night and feel stiff and achy first thing in the morning.

Other Signs of Inflammatory Back Pain

Back pain at night is one of the more obvious clues for inflammatory back pain, but there are other key signs to keep in mind as well. There are slightly different sets of criteria for inflammatory back pain, but generally speaking they include the following:

  • Back pain at night
  • Back pain improves with exercise or activity
  • Back pain gets worse with rest
  • Back pain in the morning that lasts more than 30 minutes
  • Gradual, not sudden, onset
  • Lasts more than three months
  • Symptoms first occur before age 40-45
  • Alternating buttock pain
  • Anti-inflammatory meds (NSAIDs) help you feel better

Here’s how a New England Journal of Medicine article describes inflammatory back pain: “Such pain is usually dull and insidious in onset and is felt deep in the lower back or buttocks. Another prominent feature is morning back stiffness that lasts for 30 minutes or more, diminishes with activity, and returns after inactivity. Although initially the back pain is intermittent, over time it becomes more persistent. Nocturnal exacerbation of pain is common, particularly during the second half of the night, forcing the patient to rise and move around.”

If you have back pain at night but don’t recognize many of these other signs of inflammatory back pain, your symptoms may not be from ankylosing spondylitis, but rather because of different reasons for nocturnal back pain.

Do Doctors Recognize Nighttime Back Pain as an AS Symptom?

Unfortunately, not as much as we’d like. According to a study of 300 British primary care doctors, only 5 percent could identify all of the common features associated with inflammatory back pain. Only about two-thirds of doctors in the study knew that back pain at night was associated with inflammatory back pain.

“I started to develop back pain in my twenties at night and I always thought that it was from a workout,” says Hillary Norton, MD, a Santa Fe-based rheumatologist who was diagnosed with ankylosing spondylitis during her medical training.

“I’d have trouble moving at night and when it got scary enough that I finally sought answers I saw a sports medicine doc, who misdiagnosed me with an SI joint sprain,” she says. “I’m not sure if such a thing exists actually, but every time I went on the internet, like many patients do when you can’t stay in bed at night, I never found information that was really helpful in leading me to the correct diagnosis.” (Watch more of Dr. Norton discussing ankylosing spondylitis in this video.)

Other Causes of Nighttime Back Pain

Nighttime back pain isn’t always a sign of a serious disease, especially if it happens infrequently or for a short period of time. It’s when nighttime back pain becomes a chronic problem that you need to get it checked out and properly diagnosed. Possible reasons for nighttime back pain aside from inflammatory arthritis like AS include:

  • Injuries to the spine, such as a sprain or fracture
  • Spinal bone infection
  • Neurological conditions
  • Spinal tumors (keep in mind that while most people with spinal tumors have back pain, most people with back pain do NOT have spinal tumors)

What to Do Next

Nighttime back pain that wakes you up from sleep or prevents you from getting a good night’s sleep is a red flag you need to discuss with your doctor. Seeing your primary care doctor is a good place to start.

Make sure to familiarize yourself with the symptoms of mechanical vs. inflammatory back pain, as well as other symptoms of ankylosing spondylitis, so you can be sure to have a proactive discussion about whether your back pain at night could be inflammatory.

If your primary care doctor suspects it could be, you should be referred to a rheumatologist for more testing.

Keep Reading

  • The 10 Worst Side Effects of Ankylosing Spondylitis, and How to Cope with Them
  • 6 Daily Stretches for Ankylosing Spondylitis that Can Help Ease Pain
  • How Doctors Diagnose Ankylosing Spondylitis: What to Expect at the Rheumatologist

Is your back pain getting worse at night?

What causes back pain at night?

Do you feel as though your back pain is worsening at night but can’t understand why? Well surprisingly there are a number of reasons why your back pain can spike suddenly during the night, either disturbing your sleep or causing you to wake up feeling stiff, sore and in need of another nap.

  • Circadian rhythm: Your circadian rhythm simply refers to your internal 24 hour clock that governs your sleep/wake cycle. It can stimulate the release of certain hormones, such as cortisol and melatonin, but it can also slow down certain bodily processes, such as your digestion, circulation and breathing. This can sometimes be problematic though, especially when it comes to pain and inflammation. If your digestion is slowed down, it means that excess fluid and toxins can linger inside your body, triggering an inflammatory reaction that may upset your back pain. You also have to consider that if your breathing is being slowed, more carbon dioxide is also present within your system, which can make your nerves more sensitive and susceptible to pain!
  • Sleep deprivation: Now this may seem extremely unfair – after-all, it’s likely the back pain itself is interrupting your sleep but hear me out. Sleep is vital for the healing process – if your back pain is due to a sporting injury or overstretching your muscles then you will need plenty of rest to recuperate. However, if you are not getting enough sleep it can interrupt the healing process and cause your symptoms to dawdle. It’s even suggested that sleep deprivation can “negatively impact perception of pain1” making you more aware or sensitive to pain than you ordinarily would have been
  • Posture and sleep position: It’s a pretty obvious factor to consider but how you sleep does matter. Certain sleeping positions can place a strain on your hips and lower back, inflaming your symptoms and making your back pain worse. This is especially true if you have bad posture – how many of us spend our time slouched over our computers or in an office? This can come into play later on in the day when our muscles start to complain and ache
  • Mattress: Another seemingly evident option that can affect how you sleep, the comfort of your mattress can certainly contribute towards back problems. Naturally, the type of mattress you prefer is a personal choice, however if your mattress does not support your back adequately, it can trigger back pain. A medium firm mattress is preferable if you have a bad back – it should be firm enough to support you but soft enough to contour your body.2



Can sleeping on my stomach cause back pain?

The simple answer is yes. Stomach sleeping is infamous for causing back pain problems, which makes sense when you think about it.

Most of your body weight will be dispersed around your middle so the natural curve of your spine will be flattened and placed under unnecessary strain in an awkward position. Since the spine is a hub for your nerves this pain can spread throughout your entire body, not just your lower back!

Then there’s your neck to consider. Unless you’ve miraculously developed the ability to breath with a pillow stuffed in your face, the chances are that you have to turn your neck to the side in order to breathe peacefully through the night.

This can cause problems because it’s not a natural angle for your neck to be twisted at – imagine sitting all day with your head turned to the side! It puts your head out of alignment with your spine which eventually will cause you some discomfort and in a worst case scenario it can cause some real health problems such as a herniated disk!

How should I sleep with back pain?

Okay, so stomach sleeping is clearly off the agenda – how are you supposed to sleep then? Well hold your horses; stomach sleeping doesn’t have to be off the agenda entirely.

I understand that it can be difficult to adjust to a new sleeping position so I’ve provided some tips on how to optimise your stomach sleeping experience to minimise any back pain problems.

1. Ditch the extra pillow – Well all enjoy lying back and taking in the comfort of a nice soft pillow but if you prefer stomach sleeping you may need to prepare yourself to part with at least one of your pillows. The more elevated your neck is, the more it is angled which can cause a lot of pain and discomfort. Instead use that extra pillow to prop up your pelvis while you sleep – this should take some of the pressure off your back!

2. Stretch in the mornings – Try to stretch properly in the mornings – it can help to diminish any lingering aches or pains and help to wake up the muscles in your back properly. Why not give yoga a go? It’s great for promoting flexibility and balance and can help you to relax and focus, preparing your mind and body for the day ahead.

3. Train your body – On the other hand, if you really want to curb that bad habit, you could try training your body for a new sleep position. Most stomach sleepers find it easier to adjust to sleeping on their sides so why not try using some of your pillows to train your body? Position a few pillows at either side of your body, close to the ribs – this should prevent you from rolling on to your stomach!

What if I don’t sleep on my stomach? Well if you don’t sleep on your stomach there are still a number of things you can do to improve the quality of your sleep, especially if you suffer from back pain. Check out my article on the topic here to get an idea about the best sleeping positions for your back!

How do you prevent back pain?

Apart from correcting your sleeping position, you are probably wondering what else you can do to diminish your chances of developing back pain, particularly at night. Fortunately there are a number of easy steps you can take to relieve and prevent back pain, although it may involve making a few simple lifestyle changes!

Change your posture: I have already touched upon how posture can affect your back so it’s important that you do everything possible to amend your own posture. I know it’s tempting to slouch, particularly when you’re tired, but it really can upset your back. If you need a little extra support, simply roll up a towel so it forms a long tube. Position it between your chair and the small of your back. Hopefully this should discourage you from slouching without compromising on your comfort!

Consider your footwear: Your feet are important but most of us are guilty of mistreating them at some point or another, whether it’s imprisoning them in stiletto heels or going for a jog in inappropriate trainers. Instead of punishing your feet, try to focus on comfort first. Wear shoes that fit properly and if you are going for a jog, make sure you have the right trainers!

Look at your diet: Believe it or not, your diet can affect your chances of getting back pain, especially if you’re fond of sweet, sugary foods. This is because many foods can stimulate an inflammatory reaction – think alcohol, caffeine, salt and processed fats! Eating too much of these foods can also lead to obesity, which will really place a lot of unnecessary strain on your poor back. Instead focus on wholesome healthy foods – fruit, veg and plenty of wholegrains. Really try to increase your intake of vitamin D and calcium – both of these nutrients are critical when it comes to supporting your bones!

Gentle exercise: Exercise can be a great way to strengthen your back muscles and increase your flexibility. Knowing how much and what types of exercises to do is crucial though – the last thing you want is to over-exercise and end up pulling a muscle! I’d personally recommend swimming because it’s a gentle, low impact exercise that should help to ease any pain or discomfort. If you want to read more about back pain and exercise though, make sure you check out my article on the subject for more details!

Try Atrogel® Arnica Gel to ease your pain

If you are currently suffering from back pain at night and looking for a natural way to relieve your discomfort without having to resort to painkillers, I would really recommend trying our Atrogel®Arnica Gel.

This natural herbal remedy is prepared using extracts of fresh arnica flowers formulated into a lovely cooling non-greasy gel that’s quick and simple to apply directly to the source of your pain.

Perfect for adults, children and pregnant women, you can use this wonderful product for bruises, joint pain or muscle aches alongside your usual pain relief medication. It’s a must-have in my opinion and once you’ve tried it, I’m sure you’ll agree!

“Excellent gel, better than the other available in the market.”

Originally written on 06/07/2017, updated on 14/08/2018.

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