Back Pain at Night? Here’s What Your Spine is Telling You

It’s one thing to have back pain after a long day. But what about when the pain wakes you up? Or when lying down—something that’s supposed to bring relief—actually makes your discomfort worse?

If you’re asking, “Why does my back hurt more at night?”, you're not alone. Nighttime back pain is a common concern, and it may point to deeper issues worth understanding.

At MyBackHub, we specialize in nonoperative spine care—and helping you decode what your back is trying to tell you. Let’s take a closer look at why back pain might flare up at night, when to take it seriously, and what you can do to sleep (and feel) better.

Why Nighttime Back Pain Feels Different

During the day, your spine is upright, active, and supported by muscle engagement. At night, when you lie down:

• Your spine settles into a different alignment

• Muscles and joints can stiffen without movement

• Inflammation may build up from the day’s wear and tear

• Pressure points (especially in the lower back and hips) are compressed if your mattress or posture isn’t ideal

This change in load and position can unmask structural imbalances or highlight inflammation that’s less noticeable when you're moving.

Common Causes of Nighttime Back Pain

1. Degenerative Disc Disease or Arthritis

As we age, discs lose hydration and height, and joints develop wear and tear. Lying flat can stress these joints, especially without proper lumbar support.

What it feels like: A deep ache or stiffness in the lower back, worse when first lying down or early in the morning.

2. Spinal Instability

If your spine moves too much between segments (due to disc degeneration or past injuries), certain positions can aggravate it—especially when the core isn’t actively supporting the spine, like during sleep.

What it feels like: Aching or sharp pain when changing positions in bed, or difficulty finding a “comfortable” posture.

3. Sciatica or Nerve Compression

A bulging disc, bone spur, or scoliosis can put pressure on spinal nerves. Certain sleeping positions may worsen this compression.

What it feels like: Burning, numbness, or shooting pain down the leg—especially when lying on your back or affected side.

4. Poor Mattress or Pillow Support

A too-soft mattress can let your spine sag out of alignment. A too-firm one might force your hips and shoulders out of position, especially if you're a side sleeper.

What it feels like: Diffuse discomfort or stiffness in the lower or mid back, often relieved by changing sleeping surfaces.

5. Inflammatory Conditions

In rarer cases, conditions like ankylosing spondylitis or autoimmune arthritis can cause pain that worsens at night and improves with movement in the morning.

What it feels like: Pain that wakes you in the second half of the night, often with morning stiffness lasting more than 30 minutes.

When Nighttime Back Pain Is a Red Flag

If you’re experiencing any of the following, you should speak to a doctor right away:

• Night pain that doesn’t improve with position changes

• Unexplained weight loss, fever, or night sweats

• History of cancer or weakened immune system

• New neurological symptoms (e.g., numbness, weakness, bowel/bladder changes)

These symptoms may signal something more serious, such as infection, fracture, or tumor.

How to Sleep Smarter with Back Pain

Even if your nighttime pain isn’t a red flag, your sleeping setup and habits matter. Here’s how to improve them:

Adjust Your Sleep Surface

• Use a medium-firm mattress that supports the natural curve of your spine

• Consider a memory foam topper if your mattress is too firm

• Use a supportive pillow that keeps your neck aligned with your spine

Try Side-Sleeping with a Pillow Between Your Knees

This position can reduce pressure on your lower spine and hips. If you're a back sleeper, place a pillow under your knees to flatten lumbar strain.

Gentle Stretching Before Bed

Tight hip flexors, hamstrings, and paraspinal muscles can tug on the lower back. A short pre-bed routine can help ease tension.

Manage Inflammation and Stress

Evening pain can sometimes reflect a nervous system on high alert. Meditation, calming breathwork, and a wind-down routine can help reduce central sensitization.

Nonoperative Treatments That Work

If nighttime back pain is becoming a regular part of your life, the right treatment plan can make a huge difference.

At MyBackHub, we use:

• Spine-specific physical therapy to improve alignment and reduce pressure on sensitive structures

• Postural retraining to optimize how you carry your spine during the day and night

• Traction and decompression tools (some usable at home) to relieve disc and nerve compression

• Lifestyle coaching to address inflammatory triggers like diet, stress, and sleep habits

Final Thoughts: Your Spine Is Asking for Attention—Not Necessarily Surgery

Nighttime back pain isn’t just annoying—it’s your spine’s way of saying something’s off. The good news? Most of the time, it’s fixable without surgery.

You don’t have to live with pain that keeps you up at night. You just need a plan that understands how your spine functions—and how to gently guide it back to balance.

At MyBackHub, we specialize in nonoperative spine care for real life. Whether your pain comes in the morning or the middle of the night, we're here to help you feel better, sleep deeper, and move smarter.

About the Author:

Rob Turk, MD, MBA
Chief Medical Advisor, MyBackHub

Rob Turk is the Chief Medical Advisor for MyBackHub, Inc. Dr. Turk has a broad foundation of talent in both medicine and business, previously obtaining his MD at the University of California, San Diego School of Medicine and his MBA at the University of Virginia Darden School of Business. As an entrepreneur and orthopaedic spine surgeon, he has unique and valuable insight on many topics. He is a published author in leading scientific journals such as JBJS and Arthroscopy, has written multiple book chapters, and has been a reviewer for a number of scientific journals. He is passionate about motion preservation and innovation in spine care, health equity, delicious food, and sports.

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