How Back Pain Affects Sleep

There is a high association between back pain and sleep problems. Studies reveal that back pain interferes with getting to sleep and staying asleep through the night, and conversely, that lack of restorative sleep increases pain. ¹ Alsaadi SM, McAuley JH, Hush JM, Maher CG. Prevalence of sleep disturbance in patients with low back pain. European Spine Journal. 2011; 20: 737–743. This connection has the potential to lead to a downward spiral of both less sleep and increased pain.

How Back Pain Impairs Sleep

Back pain creates several obstacles that get in the way of experiencing adequate sleep:

• Increased awareness of the pain. When trying to fall asleep, there are no distractions. This absence of everyday distractions may increase awareness of the pain, which in turn can make it even harder to fall asleep.
• Back pain makes it difficult to find a comfortable position. A specific back condition may require the individual to try out different sleeping positions in an attempt to lessen the pain at night. A new position may feel awkward or uncomfortable at first, which may delay sleep.

  See Mattresses and Sleep Positions for Each Back Pain Diagnosis

• Medication for back pain may disrupt sleep. A number of medications typically prescribed for pain, such as opioids, have been shown to interfere negatively with sleep. ² Robertson JA, Purple RJ, Cole P, Zaiwalla Z, Wulff K, Pattinson KTS. Sleep disturbance in patients taking opioid medication for chronic back pain. Anaesthesia. 2016; 71 (11): 1296-1307. For example, long-term use of opioids has been linked to sleep apnea. ³ Guilleminault C, Cao M, Yue HJ, Chawla P. Obstructive sleep apnea and chronic opioid use. Lung. 2010; 188: 459-468.

  See Opioid Medication Potential Risks and Complications

• Lack of exercise leads to sleep problems. Back pain usually makes it difficult to engage in vigorous activity during the day. Lack of exercise and activity in turn decreases the chances of acquiring sufficient sleep at night. ⁴ Fotin K, Eaton D, Lowry R, McKnight-Ely L. Sufficient Sleep, Physical Activity, and Sedentary Behaviors. American Journal of Preventive Medicine. 2011; 41(6): 596-602.

  Watch: Video: If My Back or Joints Hurt, Should I Work Through the Pain?

Back pain makes it challenging to experience high-quality sleep. Studies have shown that the relationship between back pain and sleep works in the other direction too.

How Poor Sleep Makes Back Pain Worse

Research indicates that it is probable that inadequate or interrupted sleep may worsen back pain.

• Sleep deprivation shuts down release of growth hormone. The nighttime release of growth hormone is necessary for relieving pain and healing the body. A lack of sleep prevents this process. ⁵ Walker M. Why we sleep: unlocking the power of sleep and dreams. Scribner; 2017: 168.
• Poor sleep may intensify sensitivity to pain. Sleep disturbance may reduce the body’s pain tolerance by making the central nervous system overly sensitive to pain signals. ⁶ Burton E, Campbell C, Robinson M, et al. Sleep mediates the relationship between central sensitization and clinical pain. The journal of pain. 2016; 17(4): S56. Pain from back conditions may feel even more painful because of sleep deprivation.
• Inadequate sleep aggravates inflammation. Studies show a link between sleep disturbances and increased inflammation. ⁷ Irwin MR, Olmstead R, Carroll JE. Sleep disturbance, sleep duration, and inflammation: A Systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol Psychiatry. 2016; 80(1): 40-52. Inflammation is almost always present with painful back conditions, and increased inflammation typically leads to increased pain.

  See Causes of Lower Back Pain

• Lack of sleep contributes to depression. There is a strong association between the lack of sleep and increased risk of depression. Depression may be a contributor to the onset of back pain. ⁸ Linton, SJ. A review of psychological risk factors in back and neck pain. Spine. 2000 May; 25(9):1148-56.

Studies to further clarify the relationship between sleep and pain are ongoing; there is enough research to suggest that the two are linked. ⁹ Finan PH, Goodin BR, Smith MT. The association of sleep and pain: An update and a path forward. The journal of pain. 2013; 14 (12): 1539-1552.