How Poor Sleep Makes Back Pain Worse — And What You Can Do About It
- Dr Senadheera
- Jun 12
- 6 min read
Updated: Jul 23
And Why Fixing Your Sleep Might Be the Fastest Way to Feel Better
If you live with back pain, you’ve probably learned to prioritise certain things — movement, medication, maybe even mindfulness. But sleep? That often slips down the list. It’s easy to treat rest like a luxury, but the truth is that sleep directly shapes how much pain you feel and how well you function the next day.
Restless nights and heavy mornings can chip away at your resilience. When you wake up stiffer and more exhausted than when you went to bed, it’s not just frustrating — it’s a sign that your body hasn’t had the time it needs to recover.
“Sleep: the answer to muscle healing, immune regulation, and calming of pain pathways.”
It’s a frustrating cycle — but not an unbreakable one. Prioritising sleep isn’t indulgent — it’s a crucial part of recovering from back pain.
The Link Between Poor Sleep and Chronic Back Pain
Poor sleep and chronic back pain often go hand in hand. Research shows that up to 80% of people living with chronic pain experience ongoing sleep difficulties [1].
A landmark study followed over 100 people with chronic low back pain for two weeks. Participants logged their pain, mood, physical function, sleep, and thoughts about their pain throughout the day. The findings were clear:
Poor sleep led to increased pain, worse mood, and lower physical function the next day.
The effects were especially intense in the morning, but even people who’d slept well felt worse by evening unless they were also addressing unhelpful thoughts and stress responses [1].
The takeaway? Good sleep helps — but without mental and physical coping strategies in place, the benefits wear off quickly.
Common Sleep Struggles in Back Pain
Let’s take a step back and name what many people with chronic back pain quietly deal with every night:
Finding it hard to switch off and fall asleep because pain becomes louder in the quiet
Waking up multiple times, shifting endlessly to find a position that doesn’t hurt
Feeling wired and tired at the same time — exhausted, but unable to truly rest
Waking early and still feeling like the night didn’t do much to help
This isn’t just frustrating — it’s a pattern of insomnia, and in the context of chronic pain, it can make everything feel heavier the next day. It affects not just your energy but also your ability to recover, cope, and even your immune system [2].
Does Pain Disrupt Sleep Too?
You might assume a painful day means a sleepless night — but surprisingly, this isn’t always the case. The same study showed that daily pain didn’t consistently predict sleep quality that night [1].
In contrast, a poor night’s sleep was a strong predictor of more pain the following day. This flips our usual thinking. Sleep isn’t just a casualty of pain — it’s a key driver of it.
What’s Going On in the Brain and Body?
When we don’t sleep well — or when sleep is broken into shallow stages — our nervous system becomes hypersensitive. This is known as central sensitisation, and it means our bodies start overreacting to pain signals [2].
Other sleep disruptions common in back pain include:
Frequent micro-awakenings that prevent deep sleep
Lighter sleep stages dominating the night
Feeling unrefreshed despite being “asleep” for hours [3]
These changes make the body more sensitive to pain — even mild discomfort can feel amplified. Your nervous system loses its usual filters, meaning everyday movements can feel more painful. And when sleep is broken or shallow, your body misses out on important overnight processes — like muscle repair, immune support, and natural pain regulation [6]. That’s why you might wake up feeling sore, foggy, and already on the back foot.
The Alcohol Trap: Not the Sleep Aid It Seems
Using alcohol to unwind or help you drift off might seem harmless — even helpful. But over time, it can actually make things worse.
Alcohol:
Reduces deep and REM sleep
Increases night-time wake-ups
Can throw off your posture during sleep, especially if your back is already sensitive
Dehydrates you, which can lead to morning aches and stiffness [4]
It might help you doze off at first, but it disrupts the deeper sleep stages your body needs to truly recover. That quick fix? It often leads to more pain, not less, the next morning.
Just like alcohol, some prescription medications — such as benzodiazepines (like diazepam) — can also interfere with deep, restorative sleep. While they may help with short-term relaxation or sleep onset, regular use can worsen sleep quality and even increase pain sensitivity over time. If you're using them regularly for back pain or sleep, it’s worth having an open conversation with your doctor.
How to Improve Sleep When You Have Chronic Back Pain
Here’s where things get hopeful. You don’t need to rely on sleeping pills to improve your sleep.
These strategies are backed by research and can be game-changers:
1. Sleep Hygiene First
Stick to regular sleep and wake times
Keep your bedroom dark, cool, and quiet
Avoid screens, caffeine, and large meals before bed
Use your bed only for sleep and intimacy
2. Try CBT for Insomnia (CBT-I)
Cognitive Behavioural Therapy for Insomnia is the most effective non-drug treatment. It helps challenge unhelpful thoughts, calm the nervous system, and rebuild healthy sleep habits [3].
3. Use Mind–Body Techniques
Gentle breathwork, guided imagery, and mindfulness before bed can calm the “pain alert system” in your brain. Apps like Calm or Headspace are a great place to start.
4. Move During the Day
Low-impact movement like walking, yoga, or swimming helps regulate both pain and sleep. Studies show that consistent morning exercise can improve sleep quality, support your circadian rhythm, and even boost mood and mental clarity [5].
5. Cut Back on Alcohol
As mentioned, alcohol can sabotage your sleep and recovery. Cutting back can give your body a better shot at deep, uninterrupted sleep — and less inflammation the next day.
6. Talk to Your Doctor
If lifestyle changes aren’t enough, short-term sleep support may be worth exploring. For some people, medications — including those that support better sleep or treat related issues like Restless Legs Syndrome — can be helpful. Clinicians may also consider supplements such as Magnesium or Iron if deficiency is suspected, or recommend targeted therapies based on your full medical picture. Your clinician can help you find safe, evidence-based options tailored to your unique sleep and pain profile.
7. Consider Magnesium
Magnesium plays a quiet yet powerful role in how our bodies settle into rest. For a deeper dive into its role in managing pain and sleep, see our article on Magnesium for Pain Management [internal link coming soon].
Research Spotlight
Sleep as a Core Component of Back Pain Treatment
A pivotal study by Gerhart et al. tracked 105 people with chronic low back pain for 14 days using digital diaries [1]. The key finding? Sleep quality predicted next-day pain, mood, and function far more strongly than daily pain predicted sleep quality.
Sleep isn’t just a symptom of chronic pain — it’s a driver.
Addressing it may unlock faster and longer-lasting improvements in pain and daily life.
Don’t Underestimate Sleep: It’s a Medical Priority
It’s tempting to think of sleep as something we can sort out later, once the pain gets better. But the research says otherwise.
Improving your sleep might be one of the most effective — and overlooked — strategies in chronic back pain recovery. And unlike some interventions, sleep is free, safe, and entirely within your power to improve.
If you’re waking up feeling worse than when you went to bed, it’s time to flip the script. Better rest isn’t a reward for managing pain — it’s the foundation.
Lets hear from you!
We want to hear from you — how does sleep affect your back pain, and what have you tried so far? Share your experience:
What’s the biggest challenge you face when it comes to sleep and back pain?
🔘 Getting comfortable enough to fall asleep
🔘 Waking up through the night due to pain or discomfort
🔘 Feeling unrefreshed, no matter how long I sleep
🔘 Worry or anxiety making it hard to switch off
References
Gerhart JI, Burns JW, Bruehl S, Smith DA, Porter LS. Sleep and pain in patients with chronic low back pain: A daily diary study. Ann Behav Med. 2017;51(3):365–375.
Finan PH, Goodin BR, Smith MT. The association of sleep and pain: An update and a path forward. J Pain. 2013;14(12):1539–1552.
Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trial literatures. Sleep Med Clin. 2004;2(1):57–67.
Roehrs T, Roth T. Sleep, sleepiness, and alcohol use. Alcohol Res Health. 2001;25(2):101–109.
Kline CE. The bidirectional relationship between exercise and sleep: Implications for exercise adherence and sleep improvement. Am J Lifestyle Med. 2014;8(6):375–379.
Haack M, Sanchez E, Mullington JM. Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy adults. Sleep. 2007;30(9):1145–1152.
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