What causes back pain at night?

Do you find yourself tossing and turning at night because of back pain? Many people experience back pain that either starts or worsens during the night. The pain can disrupt sleep and affect day-to-day life.

“If back pain is waking you up at night or keeping you from restful sleep, it’s time to talk to your provider,” says Jason Schweichler, DO, a primary care physician at Mount Nittany Health. “Sometimes, nighttime back pain can signal an underlying issue that needs attention, like a herniated disc or inflammatory condition.”

Common causes of nighttime back pain

Simple lifestyle issues or medical conditions can cause nighttime back pain. One of the most common causes is poor sleep position. Sleeping in a position that doesn’t support your spine’s natural alignment can strain your back muscles and cause persistent pain.

The mattress you sleep on plays a crucial role in nighttime back pain. An old or unsupportive mattress fails to maintain proper spinal alignment during sleep. Most people only realize they need a new mattress after they start experiencing regular discomfort. A mattress that’s too soft or too firm for your body type can contribute to pain.

Daily activities can significantly impact nighttime pain. The stress and strain from your daily routine often catch up with you at night. Whether you spend hours sitting at a desk, have a physically intensive job or maintain poor posture throughout the day, these can all contribute to nighttime discomfort.

“Conditions like muscle strain, poor posture or degenerative disease often cause nighttime back pain,” explains Dr. Schweichler. “We also see pain linked to arthritis, sciatica or spinal alignment issues.”

Why does my back hurt at night?

During the day, your brain focuses on tasks, conversations and daily responsibilities. At night, as the day settles, you become more aware of physical sensations, including back pain.

“Pain often feels worse at night because your body is at rest and your mind is quieter — there’s less going on to distract you from the discomfort,” explains Dr. Schweichler. “Inflammation can also settle in more when you’re lying still, which makes stiffness and pain more noticeable in the evening or overnight hours.”

Physical factors also influence nighttime pain. Inflammation naturally increases during the night as part of your body’s normal rhythm. Hormone levels fluctuate throughout the day, impacting how you perceive pain. Additionally, lying in one position for an extended period can increase stiffness and reduce blood flow to painful areas.

Medical conditions that cause night back pain

Beyond lifestyle factors, several medical conditions can also trigger or worsen symptoms. Herniated or degenerative discs can cause pain that intensifies when lying down.

Spinal stenosis is a condition that narrows the spinal canal and can cause pain that varies with position and time of day. Many people with spinal stenosis find relief when they bend forward, and an increase in discomfort when they lie down. Pay attention to what makes your pain better or worse — this helps your healthcare provider diagnose and treat any underlying causes.

Arthritis is an inflammatory condition that often follows a daily pattern. Because of your body’s natural inflammatory cycles, symptoms often worsen at night. This explains why some people experience increased stiffness and pain in the morning after a night’s rest.

Tumors or growths, infections, severe nerve compression and inflammatory diseases are more serious conditions that cause nighttime pain. These conditions typically come with additional symptoms and require prompt medical attention.

How to relieve back pain at night

Improve your sleep environment and habits to reduce your nighttime back pain. Start with your sleep position — side sleeping with a pillow between your knees helps maintain proper spine alignment. If you prefer to sleep on your back, place a pillow under your knees to reduce strain on your lower back. Avoid sleeping on your stomach, as it strains your neck and back.

“One of the simplest things you can do is evaluate your mattress and sleeping position,” notes Dr. Schweichler. “Supportive sleep surfaces, proper pillow placement and gentle stretching before bed can all make a big difference.”

Your mattress can significantly improve your nighttime back pain. Look for a mattress that supports your spine’s natural curve while conforming to your body’s shape. You should replace most mattresses every 7-10 years, although the exact timing depends on the mattress’s quality and how often you use it. A mattress topper can provide additional support if replacement isn’t possible.

Gentle stretching before bed can relax tense muscles. Some people find relief with appropriate heat or ice therapy. To help manage nighttime pain patterns, take prescribed medications as directed by your healthcare provider.

Some patients also benefit from osteopathic manipulative treatment (OMT), a hands‑on approach osteopathic physicians use to ease tension, improve mobility and support the body’s natural healing processes. By using gentle stretching, pressure and movement, OMT can help reduce stiffness and muscle tightness that contribute to nighttime back pain.

Lifestyle adjustments throughout the day can impact your nighttime comfort. Maintain good posture during daily activities to reduce the strain on your back. Perform regular, appropriate exercises to strengthen supporting muscles and improve flexibility. Muscle tension can contribute to back pain, and practicing stress management techniques, such as deep breathing and yoga, can help reduce that tension.

If you’re experiencing back pain — whether at night or throughout the day — talk with your primary care doctor. They’ll work with you to understand what’s causing your pain and create a personalized plan to help you feel better. If needed, they can connect you with a specialist for further treatment.