Back pain is an unfortunate part of life for many people with different kinds of arthritis. On its own back pain is bad enough but when you get it during the middle of the night it can turn into a vicious cycle of pain and insomnia — many patients call this terrible phenomenon “painsomnia.”
Some types of arthritis — like axial spondyloarthritis — list back pain at night as a common symptom. In fact, it is even part of the criteria that doctors use to diagnose the condition. (Read more about the connection with nocturnal back pain and axial spondyloarthritis.)
But even if your arthritis doesn’t target the joints in your spine specifically, it can still contribute to pain along your spine due to muscular imbalances, posture problems, and generalized inflammation, says Chappy Wood, DC, a chiropractor at Marin Spine and Wellness in California. For instance, one in five people with rheumatoid arthritis reported also having chronic back pain in a study published in the journal Rheumatology.
According to the National Sleep Foundation, lower back pain can lead to microarousals while you sleep, causing the body to transition into a lighter sleep stage and briefly awaken. This can happen multiple times an hour throughout the night, which can severely compromise your sleep quality.
So how do you deal with nighttime back pain before it ruins your daytime too? We talked to experts and arthritis patients to get their best tips on coping with back pain at night.
Stretch for Pain Relief
1. Start a nighttime stretching routine
A little stretching before bed can help prevent cramping and muscle spasms once you lie down but while most people with arthritis understand this, many don’t do it because it feels like too much work, especially at the end of a long day, says physical therapist Alan Snyder PT, DPT, at Breakaway Physical Therapy in New York City. “When dealing with nighttime back pain from arthritis, I recommend doing some gentle back stretches to promote better movement and mobility in the lumbar spine,” he says, adding that it doesn’t have to be much. “Your physical therapist can create a bedtime routine that should only take five minutes to complete and will help with pain.”
2. Roll out your spine in bed
If you find yourself lying in bed, unable to sleep due to back pain, try this technique from Nina Geromel, PT, DPT, ATC, a physical therapist and founder of Geromove Physical Therapy: Lie on your back with knees bent and feet on the bed. Slowly rock your knees side to side for a gentle stretch at the low back. “This helps to keep the muscles at the low back relaxed to avoid excess tension and pain overnight,” she explains.
3. Elevate your legs
If you just can’t seem to find a comfortable position for your back in bed, try this trick from Jeff Blanchard, a chiropractor in Morro Bay, California: Lift your legs up, bend your knees at a 90-degree angle, and rest your lower legs on a stack of pillows. Then relax in that position for several minutes. “It’s called ‘static back’ and it relaxes the muscles of the lower back and opens the thoracic spine,” he explains. “This position allows the muscles of the low back to release gradually and passively using your own body weight and gravity.”
Change Your Sleep Position
4. Sleep on your back
The position in which you sleep can be one of the most important factors in managing back pain at night. Sleeping on your back is often the ideal position to reduce back pain, according to the National Sleep Foundation. The key is to preserve the natural curve of your spine which may require placing pillows anywhere there are gaps between your body and the mattress, says physical therapist Joe Tatta, PT, DPT, founder of the Integrative Pain Science Institute. Pillows can also keep you from turning over during the night if you’re used to sleep on your side.
5. Stop sleeping on your stomach
While side sleeping can be okay if you’re properly supported with pillows, you should avoid sleeping on your stomach if you have back pain, according to the National Sleep Foundation. This position puts more strain on your spine, which can increase pain and reduce your sleep quality.
6. Roll over the right way
It happens: You’ve got yourself perfectly positioned and have just drifted off — only to be awoken by a jolt of sharp pain in your back when you roll over. Changing positions quickly or with bad form can cause or exacerbate nighttime back pain, according to the University of Rochester Medical Center. They advise: “When turning in bed, remember not to twist or bend at the waist but to move your entire body as one unit. Keep your belly pulled in and tightened, and bend your knees toward the chest when you roll.”
Get Pillow Smart
7. Tuck a pillow between your knees
When it comes to back pain at night, your sleeping position can make all the difference, Snyder says. One way to keep your hips and spine in proper alignment and make you more comfortable is to tuck a firm pillow between your knees if you sleep on your side or under your knees if you sleep on your back, he says.
8. Get the right pillow under your head
Sleeping on the wrong pillow is a common culprit of nighttime back pain, Tatta says. “Make sure your pillow has enough support and allows your neck and spine to be in neutral alignment, which means that your head isn’t craning backward nor is your chin pushed too far forward,” he explains. Many arthritis patients find the most comfort in a thin, firm pillow. Ditch the giant, fluffy decorative pillows on your bed when it comes time to sleep.
9. Curl up in a pregnancy pillow
You know who else has to deal with a lot of back pain at night? Pregnant women — and you can steal one of their tricks for getting relief. A u-shaped pregnancy pillow can be provide full-body support all night long. This reduces pressure on your low back, hips, and knees, Geromel says.
Look at Your Medication Regimen
10. Talk with your doctor about optimizing your routine
If your back pain at night is interfering with your ability to get a good night’s sleep, your doctor needs to know about it. They may want to adjust your overall arthritis medication regimen to ensure it is adequately lowering inflammation to treat underlying disease activity. They may also recommend other medication to help you sleep better, such as muscle relaxers or anti-epilepsy drugs, often used to treat fibromyalgia, such as gabapentin.
11. Discuss your medication timing
The timing of when you take your medication could play a role in how you experience back pain at night. If you take corticosteroids too close to bedtime, for example, they could cause insomnia. You may be better off taking these medications in the morning with food to avoid affecting your sleep pattern, according to pharmacist Renee Baiano, PharmD, CSP, clinical program manager on the clinical services team at AllianceRx Walgreens Prime.
12. Consider a melatonin supplement
Melatonin is a hormone found naturally in the body that plays a role in circadian rhythm and the sleep-wake cycle. Supplements of melatonin may help some people with insomnia, though they tend to be best used on a short-term basis to overcome jet lag, a few nights of difficulty sleeping, or someone who needs to adjust their sleep schedule, such as a night owl who needs to start getting up earlier for school or work, according to Johns Hopkins Medicine. Always talk to you doctor about taking supplements to make sure they’re safe for you and won’t interact with your medications.
Trick Out Your Bed
13. Get a heated mattress pad
Heat therapy is a go-to treatment for many types of arthritis pain, including nighttime back pain, Snyder says. One way to get even heated coverage throughout the night is to buy a heated mattress pad and put it underneath your fitted sheet, he says. This will prevent it from bunching or slipping during the night. Many models come with automatic timers if you’re worried about sleeping with it on all night or if you only need the heat to help you fall asleep.
14. Tuck yourself in with a heated blanket
Heated blankets come in many sizes, fabrics, patterns, and heating levels so you can find the right one for you. A smaller pad can be tucked under your low back or a larger one can be wrapped all the way around you. “Use a heating pad at the low back for up to 20 minutes before bedtime to allow the body to start to relax,” Geromel recommends.
15. Consider buying a new mattress
The exact mattress that will be most comfortable and supportive for your back will be unique for you but sleeping on a high-quality mattress can make a significant difference in your back pain, multiple studies show. There’s no hard-and-fast rule for how often to replace a mattress, but if you’ve had yours for a decade and you suspect it is contributing to your back pain at night, it’s probably time to start mattress shopping.
16. Use a foam mattress topper
More mattress support is usually better for people with back issues, so consider adding a foam topper, especially if your existing mattress is older or starting to sag, according to the National Sleep Foundation. The memory foam can help you maintain proper spine alignment and support throughout the night.
17. Invest in an adjustable bed
There are beds that can change positions, like raising the head and knee area, at the touch of a button. “It wasn’t cheap but buying an adjustable bed was a gamechanger for me after getting diagnosed with osteoarthritis in my back,” says Steven S., 50, of Toronto, Canada. He used to be able to sleep in only one-hour stretches before becoming so uncomfortable it woke him up. Now? “I can sleep all night because I don’t get those ‘pressure spots’ on my back and it distributes my weight better,” he explains.
Relieve Bedtime Stress
18. Practice relaxation techniques
Many people think of back pain from arthritis as purely a physical issue but emotional stress can definitely play a part, especially if you tend to get anxious at bedtime, says chiropractor Jason Deitch, DC. “It’s not uncommon for stress and worry to show up in our body as back pain,” he explains. “When that happens, I tell people to try and listen to what their body is trying to tell them.” Ignoring it won’t help, nor will obsessively thinking about your worries, so it’s important to find a middle ground with meditation, deep breathing, or other relaxation techniques, he says. Here’s how one patient uses different techniques to listen to her body to help with pain and anxiety.
19. Talk to your partner
If you share a bed with someone then you know how much their sleeping can affect yours. Falling asleep while cuddling, getting pushed when they roll over, listening to obnoxiously intrusive snoring, having your blankets stolen out from under you are just a few of the ways that your bed partner can mess with your sleep and make your back pain seem worse. It’s worth having a talk about what you need to help you sleep with less pain and how you can achieve that — even if the answer is separate beds.
Not Sure What’s Causing Your Back Pain?
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Diagnosis and differential diagnosis of axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis) in adults. UpToDate. https://www.uptodate.com/contents/diagnosis-and-differential-diagnosis-of-axial-spondyloarthritis-ankylosing-spondylitis-and-nonradiographic-axial-spondyloarthritis-in-adults.
Good Sleeping Posture Helps Your Back. University of Rochester Medical Center. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=4460.
How to Sleep with Lower Back Pain: Easy Tricks to Feel Better Fast. National Sleep Foundation. https://www.sleepfoundation.org/articles/right-way-sleep-lower-back-pain.
Interview with Chappy Wood, DC, chiropractor at Marin Spine and Wellness in California
Interview with Alan Snyder PT, DPT, physical therapist at Breakaway Physical Therapy in New York City
Interview with Jason Deitch, DC, chiropractor and founder of the Discover Wellness Center in San Diego, California
Interview with Jeff Blanchard, chiropractor in Morro Bay, California
Interview with Joe Tatta, PT, DPT, physical therapist and founder of the Integrative Pain Science Institute
Interview with Nina Geromel, PT, DPT, ATC, physical therapist and founder of Geromove Physical Therapy in Milwaukee, Wisconsin
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Melatonin for Sleep: Does It Work? Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/melatonin-for-sleep-does-it-work.
Neva MH, et al. Chronic back pain in patients with rheumatoid arthritis and in a control population: prevalence and disability—a 5-year follow-up. Rheumatology. September 2011. https://doi.org/10.1093/rheumatology/ker173.
Radwan A, et al. Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials. Sleep Health. December 2015. doi: http://dx.doi.org/10.1016/j.sleh.2015.08.001.
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