Back pain while sleeping can either be related to many different things. They could be related to how you sleep or the things leading up to your sleep.  While waking up with pain may come from a wide range of things, here are a few tips to manage back pain while sleeping.

Start with sleeping position

Back pain while sleeping in different positions

The easiest to address is sleeping position. When it comes to sleeping position, there are three basic positions: back, stomach, and side sleeping. Although there are a number of combinations, resulting in online debates.  In general, sleeping on your stomach is the worst position, especially for the neck.  Stomach sleeping requires your head to be turned at a 90 degree angle. Overtime, most people only sleep with their head turned to one direction. This puts different stresses on the joints and tissues on either side of the neck. Ultimately, this leads to imbalances in the neck muscles and joint capsules of the spine. And these imbalances will lead to discomfort over time and even some restricted ranges of motion.

In my opinion, back and side sleeping are about even for the overall population, however, individual experiences may vary.  Sleeping on your back or side however does not prevent you from having back pain while sleeping. For side sleepers, you can place a small pillow between your knees to alleviate low back pain.  More frequently, side sleepers have to deal with upper back, shoulder, or shoulder blade pain. This is usually related to forward shoulder positioning from the day. Some patients can find relief by hugging a pillow to your chest while you sleep.  If you are a back sleeper with low back pain, placing a pillow under your knees can alleviate low back pressure while you sleep.  After altering your sleeping position, if you continue to have pain from sleep, the next step is to look at your sleeping equipment, such as pillows and mattress.

Sleeping Accessories

There is no shortage of articles or advertorials on the “BEST” pillow or mattress for back pain.  However, in my opinion, there is no one answer to this question, and trying to approach something as important as pillows and mattresses with this approach is unethical.  Instead, I recommend types of pillows or pillow designs based on how you sleep.  Back sleepers and side sleepers require different pillow thicknesses, with side sleeping being thicker than back sleeping.  As a side and back sleeper, I like pillows that have a bowl in the middle, thicker top and bottom to support the neck when sleeping on your back and thicker sides to support the head when sleeping on your side. 

With regards to mattress selection, it is important to find balance between comfort and support.  Without enough comfort, you won’t be able to get into deep sleep, which will delay healing.  On the other hand, if you don’t have enough support, you may sleep like a baby and wake up with worse pain in the morning.  Therefore, it is important to find the balance between the two to make sure you get the deep healing sleep while having the support to prevent more irritation. 

The perfect firmness balance differs from person to person, and is likely different with people in the same bed. Therefore, I think the best approach to a new mattress is one that changes or adapts with you.  This is why I generally suggest that people invest in adjustable mattresses, which can provide different firmness for each side of the bed, but it can also change with you over the years if something changes.

Back Pain Unrelated to Sleeping

Finally, back pain in the morning may not be related to how you are sleeping at all, and could be related to a micro-injury from the day or day’s before.  A micro-injury is an irritation to tissues that you may not have noticed at the time that it happened.  Micro-injuries usually show up as a combination of multiple different injuries or a repetitive injury.  Micro-injuries could be from physical exercise or something innate as your work or commute.

If these micro-injuries occur to the discs, you will notice increased pain in the morning because your discs have more pressure first thing in the morning.  While we sleep, your discs absorb water and are fullest first thing in the morning. This actually leads people to be slightly taller first thing in the morning.  Then as the day goes on, the compression of the discs squeezes water out, reducing pressure on the disc.  Discs are not the only tissues that can be sore in the morning, micro-injuries can also occur in muscles. You may notice increased pain in those areas due to the tissues tightening up throughout the night, and once you start moving around again or take a warm shower, the pain goes away. 

If this occurs more than a few days in a row, you should seek medical help. For more tips and tricks for your specific back pain while sleeping, schedule an appointment online.