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What are Common Causes of Back Pain While Sleeping?

By Bethany Keene
Updated Mar 03, 2024
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The most common causes of back pain while sleeping include a mattress that is not the correct firmness or is simply poorly constructed, as well as poor sleeping positions or a pillow that is not properly fitted based on one's sleeping position. The mattress is by far the most common cause of back pain while sleeping, and stiffness upon waking up in the morning. It may be necessary to get a new mattress to address this problem; some stores even allow customers to try mattresses in the home for 30 days before making a purchasing decision to be sure the mattress offers the correct amount of support.

For years, people were told that firmer mattresses were the way to go to prevent back pain, but recent research has shown that this is not actually the case. In fact, medium to soft mattresses can often be much more comfortable as well as being more supportive of the natural curves of the spine. Thus, it is more a matter of personal preference, than a need to choose an extra-firm, orthopedic mattress. Back pain while sleeping is often caused by a mattress that does not offer enough support to certain areas of the spine, such as the lower back; this is why it is important to replace the mattress if it begins to sag or wear out.

Improper sleeping position can also contribute to back pain while sleeping. Sleeping flat on one's back is a good way to prevent back pain, but many people find that uncomfortable and prefer side sleeping or sleeping on the stomach. Sleeping on the stomach can cause back pain because it often forces the spine into a slightly unnatural angle. Side sleeping can be a good choice, especially on a softer mattress; it is best to place a pillow between the knees to avoid collapsing the hips and stretching the lower back.

In addition, a pillow that is the wrong size is another cause of back pain while sleeping. Whether sleeping on the side or the back, the pillow should support the back of the neck and the head without tipping the head to one side or the other, leading to neck strain. Again, the softness or firmness of the pillow is a matter of personal preference, as long as it supports the neck; most experts recommend selecting a flatter pillow just because it keeps the spine more in its natural alignment.

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Discussion Comments

By anon228450 — On Nov 08, 2011

I had problems with lower back pain after I would sleep for about five hours. I would sleep about five hours without issues, then wake up with severe lower back pain. The only way to alleviate this pain was to wake up and go about normal activities, or to elevate the top of my bed at a 40 degree angle or so. By elevating my bed like this, I could sleep more than five hours without the pain. It became a regular routine. Every night, I would wake up after five hours and then elevate the top of my bed.

I had associated my pain with an exercise injury and lived with this pain nightly for over three years. Then I remembered that at the same time as my workout "injury", I had also changed from a polyester to a down/feather pillow.

I then thought about the alignment of my spine when lying on my side and placing my head on the down pillow. Since the down compresses down so far, I found that my neck was badly aligned with the rest of my body when I lay on my side (I am a side sleeper). I even tested my theory by lying on my side without any pillow during the day, and after about 10 minutes, my lower back did begin to feel uncomfortable. I had never associated my head and neck position with my lower back pain.

As a test, I got rid of the down pillow, and bought a quite puffy polyester pillow that supports my head at a much higher level than the down one. The polyester doesn't smoosh down and give way like the down did. After using this new, puffier pillow for about a week, the pain began to lessen. It has now been about seven months since I got rid of the flat down pillow and started using the puffy-type pillow, and I haven't had the lower back pain wake me up any more. Now I can sleep without elevating my bed for a full eight hours easy, and I don't wake up with lower back pain.

I thought my "fix" was going to cost a lot of money, but for me thank heavens, it was actually pretty cheap. I just bought a new very supportive pillow for about $20 bucks, and it fixed the pain. Please, for any of you having this issue, give it a try. It's cheap, it's relatively quick to find out if it will help (about a week or so), and the pain just sucks. Remember, the brand of the pillow doesn't matter. It just needs to support your head and not give too much.

When you put your head on the pillow (while laying on your side), your head and neck should be aligned with the rest of your spine. If, when you lie on your side, your nose falls lower than the middle of your neck vertebrae, that means the pillow is giving way too much. Get a pillow that is more supportive. Good luck. I hope this helps many people. God bless.

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