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Lower Back Pain and Insomnia: What’s The Connection? 

SCOFA-Lower-Back-Pain-and-Insomnia-What's-The-Connection-1

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 

What’s The Link Between Pain And Sleep? | Is Lower Back Pain Related to Sleep? | Does Insomnia Cause Lower Back Pain? | How Does Insomnia Cause Lower Back Pain? |
How to Improve Sleep And Avoid Lower Back Pain

 

Overview

Many people have experienced the occasional sleepless night because of lower back pain. Pain can keep you twisting and turning in bed all night, depriving you of the rest you need. 

It doesn’t come as a surprise that chronic lower back pain can cause sleep deprivation or insomnia. However, in some cases, it might be the other way around. Insomnia may be the reason why your lower back hurts. 

Lack of sleep can increase nitric oxide levels, inflammation, and pain sensitivity. It can also make your painkillers less effective. All of which can lead to or amplify your lower back pain. 

Continue reading to learn more about the relationship between insomnia and lower back pain, how one can cause the other, and what you can do to sleep and feel better. 

 

What’s The Link Between Pain And Sleep?

Plenty of scientific evidence points out the bidirectional relationship between sleep and pain. Pain can be both the cause and result of poor sleep.[1]

Experimental studies show that even one bad night’s sleep can make you more sensitive to pain or increase your risk of developing chronic pain conditions.[2]

On the other hand, pain during the night can cause a lack of sleep.[3] The higher the pain intensity, the more likely you’ll toss and turn in bed all night. 

Research shows that up to 88 percent of people with chronic pain disorders report that they don’t sleep well.[4] 

In one study, researchers found that over half of the people with chronic insomnia also suffer from some form of chronic pain, while around 49 percent of people with chronic pain also had trouble falling asleep.[12]

This two-way relationship can lead to a vicious cycle of pain, sleep deficiency, more pain, and worse sleep – a total nightmare!  

 

Is Lower Back Pain Related to Sleep?

The short answer is yes. People with low back pain (LBP) often report having sleeping problems, such as difficulty falling asleep or interrupted sleep.[5]

One systematic review found consistent evidence that chronic low back pain (CLBP) negatively affects the duration and quality of sleep.[13]  Another study showed that 78 percent of patients with CLBP had insomnia, and 64 percent of insomnia cases were due to back pain.[14]   

Constant pain in your lower back makes it difficult to find a comfortable position before going to sleep. You may also take longer to finally get some shut-eye because your brain focuses on the pain signals sent from your lower back. 

Moreover, lower back pain treatment often includes analgesics or opioids, which can lead to sleep deprivation.[1] 

Insomnia might also be the effect of not being able to exercise enough due to lower back pain.[6] Several studies show that exercising helps you sleep better. People who don’t perform enough physical activities tend to lack proper sleep. 

 

Does Insomnia Cause Lower Back Pain? 

Conversely, sleep disorders may cause lower back pain.[7] A large cohort study found that people who don’t get sufficient sleep were twice as likely to develop pain in the lower back.[15] 

Other researchers investigated whether insomnia can make your lower back hurt. Their findings suggest that insomnia significantly increases the risk of lower back pain.[16]

 

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How Does Insomnia Cause Lower Back Pain?

We have yet to fully understand how lack of sleep can cause lower back pain; however, scientists have a few theories.  

1) Insomnia Increases Nitric Oxide (NO) 

Nitric oxide (NO) plays a role in pain regulation and sleep.[8] Animal studies showed that the brain reacts to sleep deprivation by increasing nitric oxide production.  

High nitric oxide levels can make you more sensitive to feeling your lower back pain. It also decreases the pain inhibition activity in your brain, resulting in severe LBP. 

2) Insomnia Increases Inflammation 

Insufficient sleep can trigger the production of inflammatory molecules, such as interleukins.[9] These molecules increase inflammation, which can lead to body aches and fatigue. 

Scientists investigated the effects of short sleep duration on the body’s inflammatory response. Their findings revealed that insomnia could cause low back pain by increasing the production of interleukin 6 (IL-6), an inflammatory molecule.[17]    

3) Insomnia Increases Sensitivity to Pain

Studies on healthy, pain-free individuals show that sleep loss makes them more sensitive to pain and reduces their ability to tolerate pain.[10]

Therefore, insomnia can make mild lower back pain feel more intense and unbearable than it is. 

4) Insomnia Makes Painkillers Less Effective  

Further research suggests that sleep deprivation can block the effects of analgesics (medications that relieve pain).[10]

An experimental study revealed that codeine, a pain medication, was less effective in people who don’t get enough sleep than in those who do. 

Hence, insomnia might make your low back pain feel worse because it counteracts the painkillers you’re using to manage it.[18]

 

How to Improve Sleep And Avoid Lower Back Pain

All this scientific evidence suggests that sleeping well may be a more potent painkiller than any prescribed drug. Getting sufficient sleep can be an effective way to treat and even prevent lower back pain.  

Here are some of the best tips to improve your sleep, reduce your sensitivity to pain, and make your lower back feel better:

 

1) Maintain a Regular Bedtime Schedule: This is probably one of the most effective ways to fall asleep faster and better. Make a sleep schedule that allows you to get around 7-9 hours each night. Make sure you go to bed and wake up at the same hour each day, even on the weekends or holidays. Set an alarm if necessary. Being consistent with your sleep schedule helps regulate your sleep-wake cycle.    

 

2) Create a Comfortable Sleeping Environment: Sleep in a dark, quiet, and cool room (not too hot and not too cold). Keep your curtains closed and don’t use any electronics before bedtime – exposure to artificial light during the evening makes it more difficult to fall asleep. However, leave your curtains 1slightly open so daylight can reach you in the morning and help you wake up at an adequate hour so you wouldn’t oversleep. 

 

3) Exercise: Physical activity helps you de-stress and sleep better through the night. Try to get some exercises done outdoors, such as walking or jogging, to improve your exposure to natural daylight and adjust your circadian rhythms. Leave a two- to three-hour gap between working out and going to bed.  

 

4) Don’t Nap Late in the Day: Avoid taking a nap late in the day unless you work the night shift and need to make up for lost sleep. Later naps make it harder to fall asleep earlier at night. 

 

5) Watch What you Eat and Drink before Sleep: Don’t go to bed too hungry or too full. The discomfort from not eating enough or a heavy meal can keep you up longer. Moreover, when your appetite hormones are off balance, they may affect your sleeping patterns.[11]

Consuming alcohol, caffeine, and nicotine during the late hours of the day can also keep you alert at night or disrupt your sleep.  

Contact a healthcare provider if you have lower back pain and can’t sleep well at night. A sleep medicine doctor might recommend different solutions, such as cognitive behavioral therapy for insomnia (CBT-i), for your insomnia and lower back pain, as an alternative to pain meds and sleeping pills. 

 

References:

  1. Haack, M., Simpson, N., Sethna, N., Kaur, S., & Mullington, J. (2020). Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 45(1), 205–216. https://doi.org/10.1038/s41386-019-0439-z
  2. Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: An update and a path forward. The journal of pain : official journal of the American Pain Society, 14(12), 1539. https://doi.org/10.1016/j.jpain.2013.08.007
  3. Alhalal, E. A., Alhalal, I. A., Alaida, A. M., Alhweity, S. M., Alshojaa, A. Y., & Alfaori, A. T. (2021). Effects of chronic pain on sleep quality and depression: A cross-sectional study. Saudi medical journal, 42(3), 315–323. https://doi.org/10.15537/smj.42.3.20200768
  4. Smith, M. T., & Haythornthwaite, J. A. (2004). How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep medicine reviews, 8(2), 119–132. https://doi.org/10.1016/S1087-0792(03)00044-3
  5. Alsaadi, S. M., McAuley, J. H., Hush, J. M., & Maher, C. G. (2011). Prevalence of sleep disturbance in patients with low back pain. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 20(5), 737–743. https://doi.org/10.1007/s00586-010-1661-x
  6. Dolezal, B. A., Neufeld, E. V., Boland, D. M., Martin, J. L., & Cooper, C. B. (2017). Interrelationship between Sleep and Exercise: A Systematic Review. Advances in preventive medicine, 2017, 1364387. https://doi.org/10.1155/2017/1364387
  7. Ho, E. K., Ferreira, M., Pinheiro, M., Carvalho-E-Silva, A. P., Madrid-Valero, J. J., Zadro, J., Ordoñana, J., & Ferreira, P. (2021). Factors associated with seeking medical care for low back pain in a twin adult sample. European journal of pain (London, England), 25(5), 1091–1106. https://doi.org/10.1002/ejp.1731
  8. Kalinchuk, A. V., Lu, Y., Stenberg, D., Rosenberg, P. A., & Porkka-Heiskanen, T. (2006). Nitric oxide production in the basal forebrain is required for recovery sleep. Journal of neurochemistry, 99(2), 483–498. https://doi.org/10.1111/j.1471-4159.2006.04077.x
  9. Haack, M., Sanchez, E., & Mullington, J. M. (2007). Elevated Inflammatory Markers in Response to Prolonged Sleep Restriction Are Associated With Increased Pain Experience in Healthy Volunteers. Sleep, 30(9), 1145-1152. https://doi.org/10.1093/sleep/30.9.1145
  10. Roehrs, T. A., Harris, E., Randall, S., & Roth, T. (2012). Pain sensitivity and recovery from mild chronic sleep loss. Sleep, 35(12), 1667–1672. https://doi.org/10.5665/sleep.2240
  11. Laposky, A. D., Bradley, M. A., Williams, D. L., Bass, J., & Turek, F. W. (2008). Sleep-wake regulation is altered in leptin-resistant (db/db) genetically obese and diabetic mice. American Journal of Physiology – Regulatory, Integrative and Comparative Physiology, 295(6), R2059. https://doi.org/10.1152/ajpregu.00026.2008
  12. Daniel J. Taylor, PhD, Laurel J. Mallory, BA, Kenneth L. Lichstein, PhD, H. Heith Durrence, PhD, Brant W. Riedel, PhD, Andrew J. Bush, PhD, Comorbidity of Chronic Insomnia With Medical Problems, Sleep, Volume 30, Issue 2, February 2007, Pages 213–218, https://doi.org/10.1093/sleep/30.2.213
  13. Kelly, G. A., Blake, C., Power, C. K., O’keeffe, D., & Fullen, B. M. (2011). The association between chronic low back pain and sleep: a systematic review. The Clinical journal of pain, 27(2), 169–181. https://doi.org/10.1097/AJP.0b013e3181f3bdd5
  14. Bahouq, H., Allali, F., Rkain, H., Hmamouchi, I., & Hajjaj-Hassouni, N. (2013). Prevalence and severity of insomnia in chronic low back pain patients. Rheumatology international, 33(5), 1277–1281. https://doi.org/10.1007/s00296-012-2550-x
  15. Vinstrup, J., Jakobsen, M. D., & Andersen, L. L. (2020). Poor Sleep Is a Risk Factor for Low-Back Pain among Healthcare Workers: Prospective Cohort Study. International Journal of Environmental Research and Public Health, 17(3). https://doi.org/10.3390/ijerph17030996
  16. Luo, G., Yao, Y., Tao, J., Wang, T., & Yan, M. (2022, November 16). Causal association of sleep disturbances and low back pain: A bidirectional two-sample mendelian randomization study. Frontiers. Retrieved January 16, 2023, from https://www.frontiersin.org/articles/10.3389/fnins.2022.1074605/full
  17. Haack, M., Sanchez, E., & Mullington, J. M. (2007). Elevated Inflammatory Markers in Response to Prolonged Sleep Restriction Are Associated With Increased Pain Experience in Healthy Volunteers. Sleep, 30(9), 1145-1152. https://doi.org/10.1093/sleep/30.9.114
  18. Steinmiller, C. L., Roehrs, T. A., Harris, E., Hyde, M., Greenwald, M. K., & Roth, T. (2010). Differential effect of codeine on thermal nociceptive sensitivity in sleepy versus nonsleepy healthy subjects. Experimental and Clinical Psychopharmacology, 18(3), 277–283. https://doi.org/10.1037/a0018899
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