Lower back pain when lying down: causes and treatments

There are many causes of back pain when lying down. Also known as nocturnal back pain, the most common causes include injuries such as strains and diseases such as arthritis or sciatica. The pain can range from mild to debilitating and is often described as dull, sharp, or throbbing.

Lower back (or lumbar) pain when lying down can make a good night’s sleep difficult and affect the way you move your lumbar muscles, ligaments, and vertebrae in your daily movements and activities.

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Possible causes

Back pain at night is not always a sign of serious health, especially if it only occurs occasionally or for a short period of time. But if night back pain is common and bothersome, it may be time to get it checked out.

The most common reasons for back pain when lying down include:

  • Strain or sprain: The most common causes of low back pain are loin strains and sprains when muscles or ligaments are stretched too far.
  • Ankylosing spondylitis (HOW): This rare form of arthritis, characterized by chronic inflammation of the back and neck area, tends to improve with exercise and worsen at night.
  • Spinal osteoarthritis: Pain from wear and tear in the joints of the spine can worsen at night due to inactivity.
  • sciatica: In certain sleeping positions, the vertebrae in the lower back can additionally irritate the sciatic nerve, which leads to pain radiating to the lower body.
  • Spinal tumor: Although rare, pain from a tumor or spinal growth may worsen when you are lying down with direct pressure on the area.

Other causes of back pain when lying down are diseases such as spinal stenosis, a narrowing of the spine.

Nocturnal back pain can also be a symptom of kidney stones, endometriosis, certain types of cancer, pregnancy, and other forms of arthritis. Remember, it’s rare for night back pain to be caused by a tumor, infection, or AS.

When to see a doctor

Back pain at night that wakes you up or prevents you from falling asleep is a sign that it is time to discuss the problem with your doctor. Along with lower back pain, you can also experience muscle stiffness and limited range of motion, especially if the cause is a strain or sprain.

It’s also helpful to know how pain is commonly categorized:

  • Acute pain is short-term pain that lasts for a few days or weeks. It’s usually associated with an injury or a specific event.
  • Chronic pain is a long-term pain that lasts for several months or more. In many cases, it is not initiated by an injury.

Although each individual’s situation and pain threshold is different, there are some general guidelines to help you decide when your nightly low back pain is worth seeing a doctor.

Contact your doctor as soon as possible if your pain:

  • Started with a specific injury
  • Lasts more than a few days or gets worse
  • Feels heavy or radiates to other parts of the body such as your legs
  • Is accompanied by signs of infection such as redness, warmth, swelling, or fever
  • Is accompanied by weakness, numbness, or tingling in the lower body

Consulting your GP or other first-line health care professional is a good place to start. They can treat you if necessary or refer you to another specialist.

For example, if your doctor suspects that your nighttime back pain is related to an inflammatory condition, you may be referred to a rheumatologist (who specializes in arthritis and diseases of the bones, muscles, and joints) for further evaluation.

Consider getting medical attention right away if you have a personal history of cancer, unexplained weight loss, or sudden problems with bladder control, in addition to lower back pain while lying down.


To get to the bottom of your nighttime back pain, your doctor will begin a physical exam and review of your medical history to identify or rule out any serious medical conditions.

Your doctor will ask you the details of your symptoms and ask you to describe your pain. You should be ready to provide information about when the pain started, what made it worse or worse, its quality and intensity, and whether you noticed any additional symptoms such as numbness or tingling.

Aside from the basic exam, there are a few other tests your doctor may order when diagnosing, including:

  • Neurological tests, or movement screenings, can measure muscle strength to determine if the pain is related to the spine or nerves.
  • Imaging testssuch as an MRI or CT scan can help rule out specific causes of pain such as cancer, infection, or fractures.
  • Laboratory tests a complete blood count can help if you have a possible infection or unexplained weight loss, which could suggest cancer or inflammatory arthritis like AS.


Treatment for nighttime back pain may vary depending on the exact diagnosis. In general, for the most common conditions, doctors usually recommend drugs to relieve discomfort before bed, such as:

  • Applying heat or ice
  • Taking an over-the-counter pain reliever
  • Gentle stretching or light (not vigorous) exercise
  • Physiotherapy to strengthen the core muscle groups that support the lower back
  • Spinal injections such as corticosteroid or epidural

Also, since the lower back pain occurs at night, your doctor will likely recommend approaches to improve your sleeping environment, which includes your sleeping position, pillows, and mattress.

Complementary home remedies can also be included in your treatment plan.

These include:

If the pain is severe and cannot be relieved by non-invasive methods, your doctor may recommend surgery to treat certain conditions, such as degenerative disc disease, sciatica, spinal osteoarthritis, and sometimes ankylosing spondylitis.

If you have been diagnosed with cancer, a spinal tumor, or other serious medical condition, your doctor will discuss treatment options, which may include surgery, radiation therapy, or other immediate intervention.


While not all the conditions that cause nighttime back pain can be prevented, there are several strategies you can use to keep your back healthy and pain-free.

Many experts suggest the following to help prevent the pain from progressing:

  • Maintain a healthy weight.
  • Practice good posture.
  • Avoid movements or heavy lifting that can strain your back.
  • Avoid smoking as some studies suggest that it may increase your risk of chronic back pain.
  • Whenever possible, use ergonomically friendly chairs (furniture that minimizes physical discomfort) at home and at work.
  • Change your sitting position and take frequent breaks during the day to walk or stretch.
  • Wear comfortable, supportive, low-heeled shoes.

Keep in mind that there are also some risk factors that can increase the likelihood of lower back pain. These include excessive body weight, a sedentary lifestyle, lifting heavy objects, and repeatedly bending or twisting your lower back.

Get a good night’s sleep

Suffering from back pain at night can make it especially difficult to get a good night’s sleep, which is an important part of recovery for many illnesses. To improve your sleep with back pain at night, experts recommend these tips:

  • Find a sleeping position that supports your specific back condition.
  • Choose a mattress that will keep your spine aligned.
  • Use a pillow support to support certain parts of the body and to relieve pressure and strain on the lower back.

A word from Verywell

Lower back pain when lying down can be especially frustrating, even if you have a diagnosis. When the pain interferes with your ability to get the sleep your body needs to recover, it opens the door to other health problems associated with poor sleep.

Any low back pain that only occurs while lying down or that regularly wakes up in the middle of the night should be evaluated by a doctor as soon as possible so that you can get the restful sleep your body deserves.

frequently asked Questions

  • What conditions include lower back pain radiating into the leg?

    Sciatica is a nerve pain that often radiates from the back through the hip and down the leg. This type of pain usually flares up and goes away on its own in about 80% of people within six weeks.

  • What can i do to relieve back pain?

    There are several forms of complementary therapy you can do at home for back pain, including exercises like yoga or tai chi, stress relief programs, massage therapy, and hydrotherapy. You may also want to see a chiropractor for additional relief.