How to Sleep With Lower Back Pain

Let’s face it: a lot has changed in 2020–and for many Americans, that means working from home. A side effect? For many of us, it also may mean an increase in low back pain and sciatica, which impacts everything from our daily lives to how well we sleep at night.

As someone who has not only suffered personally from back pain, but also has a wife whose back pain used to keep her up at night, I know first hand what a big…well, pain, sciatica, back and even neck pain can be. While a healthy sleep environment can help, sometimes it’s just not enough. 

Justin Thottam, D.O. with the Spine Center at Miami Neuroscience Institute has seen a 30 percent increase in patients with back pain, and that’s made worse as people work in uncomfortable environments and put off seeing doctors. 

This week, I’m going to encourage you to stop ignoring your back pain and sciatica, tell you how back pain is killing your sleep, and offer my sleep hacks to sleep better. 

How common are back pain and sciatica?

Trust me when I say that, if you suffer from back pain like I have, you’re in good company. According to the American Chiropractic Association, back pain is the main cause of workplace disability worldwide, costs $50 billion for American healthcare, and will impact as many as 80 percent of us, to some extent, in our lives.

Sciatica, which is described as pain that radiates down the spine and legs, adds to back pain woes. 5 to 10 percent of us with back pain also have sciatica, and while researchers say many recover, as many as 20 to 30 percent have chronic sciatica.

How do back pain and sciatica affect sleep?

If you’ve been following me for a while, you know that I’m all about non habit forming, natural sleep aids–that’s why, when someone complains about tossing and turning from racing thoughts, I recommend a sleep journal or a scientifically proven cooling headband like EBB. 

But just as we have to take care of our mind, our bodies–and chronic pain–can also spell disaster for sleep. 

Night Time Wakening and Poor Pain Control

Lower pain tolerance causes a rise in nerve activation–and that can result in disrupted sleep cycles. Because we may wake up more due to that nerve activation, we’re also less likely to go through all important sleep cycles. That can lead to less deep and REM sleep, leading you to feel groggy the next day. 

Pain Medications

One of the most common treatments for back pain and sciatica comes in the form of medication, whether it’s over the counter or even powerful prescription medications. The use of opioids have been linked to lower sleep quality, less REM sleep, and even disrupted sleep patterns.

A small 2016 study published in Anaesthesia took a look how sleep patterns for chronic back pain sufferers were impacted by opioid use. Participants on the highest dosage of opioids displayed brain activity linked to irregular sleep patterns. While more research needs to be done, it fits into previous research about medication and impact on how we sleep. 

That’s something to keep in mind for medication in general: instead of going straight to prescription or over the counter sleep medications, I recommend clients first try natural alternatives when possible, like a soothing cup of tea or  my Sleep Doctor PM Spray

Depression/ Anxiety Induced Insomnia 

I’ve discussed how mental health issues, especially chronic anxiety and depression can lead to insomnia. It turns out that just having chronic back pain can also lead to increased symptoms of both depression and depression-induced insomnia. 

In the largest study of the pain-mental health connection, 200,000 adults in 43 countries were sampled using a self reporting questionnaire. Those with chronic back pain were two times more likely to exhibit anxiety, depression, psychosis, stress, and subsequent sleep deprivation. 

Sleep Apnea

Of all the connections I’ve looked into between sleep deprivation and back or sciatica pain, this one is perhaps the most surprising. Over the past decade, it’s become clear that many people who have sleep apnea also have some form of back pain. 

There’s not evidence yet that one causes the other, but one thing is clear: sleep apnea, coupled with back or sciatica pain, can spell disaster for sleep and even sleep quality. A study published in 2006 suggests that people with  back pain and sleep apnea, on average, lose 4 hours of sleep per night. It seems, for reasons we don’t yet know, to especially affect REM sleep. 

How do I sleep better if I have chronic back pain and/ or sciatica?

The good news is that there are many ways you can start improving your sleep, no matter where you are on your journey to treating your chronic pain. I find that even subtle changes can make a big difference, both for sleep quality and life quality. 

Manage Your Mental Health

The mind-body connection is real and should never be ignored. Even as you manage your back pain, you also need to keep in mind how depression and anxiety can affect your experience of both pain and sleep. Poor mental health can increase our awareness of pain, while coping and relaxation techniques may help do the opposite. 

TouchPoints is one of my new favorite ways to manage stress quickly. The wearable device has been proven to reduce stress, in fact, in under a minute. 

Ask Your Doctor About Pain Management

If your meds are helping with your back pain but hurting your sleep, consider discussing alternatives with your doctor. While you should never just take yourself off pain medication, lifestyle changes can help with both lower back pain–and even improve sleep quality! Regular aerobic exercise, stretching, and even alternative therapies like reflexology and yoga may improve sleep and help manage moderate pain. 

Invest in a Better Pillow

A better pillow really can make a big difference, especially for back pain. In a 2015 randomized controlled study, patients with low back and lumbar pain were given supportive pillows for their backs. After a twelve week follow up, there were remarkable improvements in pain management, as opposed to improvements made with just physical therapy.

I recommend an ergonomic pillow like Everpillow, which is customized to suit different sleep styles and has been helpful especially for lower back pain. 

Upgrade Your Mattress

While you’re at it, you should take a long look at your mattress–in fact, changing my mattress is what has made the biggest difference for my personal back pain and improving my sleep. If you’ve had your mattress for longer than 8 to 10 years, it’s time to start shopping. Here are my suggestions for the best mattresses for back pain

Consider The Best Sleeping Position For Back Pain

How you sleep matters too. Sleeping on your side is associated with less back pain, and even reduced snoring. Snoring may be a sign of sleep apnea if you snore regularly you should see a sleep specialist to determine if you have sleep apnea.  Not sure if your snoring is an issue? Start with my free snoring quiz). Many people also find relief sleeping in the fetal position.

Other positions that can help with lower back pain relief include sleeping on your back with a pillow under your knees, or sleeping on your stomach with a pillow under your stomach. You may also try sleeping in a reclining position if your bed adjusts or by adding a wedge to your bed to elevate your upper body.

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Michael Breus, Ph.D - The Sleep Doctor is a Diplomate of the American Board of Sleep Medicine and a Fellow of The American Academy of Sleep Medicine and one of only 168 psychologists to pass the Sleep Medical Specialty Board without going to medical school. Dr. Breus is a sought after lecturer and his knowledge is shared daily in major national media worldwide including Today, Dr. Oz, Oprah, and for fourteen years as the sleep expert on WebMD. Dr. Breus is the bestselling author of The Power of When, The Sleep Doctor’s Diet Plan and Good Night!