Combatting Back Pain and Sciatica During Sleep: A Comprehensive Guide to Nighttime Relief

Issue 45

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When the sun sets and you’re ready for a peaceful night’s sleep, the last thing you want is the agony of back pain or sciatica waking you up. Unfortunately, for many, this is a nightly reality. The torment of back pain at night or sciatica pain at night can make it nearly impossible to get a good night’s rest, leading to a cycle of discomfort and fatigue that can significantly affect your quality of life. 

In the stillness of the night, many factors can make your back pain or sciatica flare up, turning your bedtime into a nightly dread. But it doesn’t have to be this way. Understanding the triggers and implementing the right strategies can turn your nights from a battle against pain into a sanctuary of restful sleep. Healing and regeneration take place most efficiently when we are sleeping, it’s the natural window in our day when the body can turn its focus to repair, making good sleep all the more important when recovering from back pain or sciatica.

In this comprehensive guide, we will navigate through the intricacies of nighttime back pain and sciatica. We’ll explore the causes and impacts of different sleeping positions, provide valuable tips for sleeping with back pain and sciatica, and discuss lifestyle changes that will lead to a significant reduction in your symptoms at night. Additionally, we’ll highlight the role of exercise in fixing your back or sciatic pain for good.

Whether you’ve been wrestling with this issue for a while or you’re new to the world of back pain and sciatica, this guide is tailored to equip you with the knowledge and tools you need to reclaim your nights and wake up feeling rested and rejuvenated. It’s time to put an end to your struggle with sleeping with back pain and break free from the shackles of discomfort.

Let’s dive in and turn your pain-filled nights into a soothing sleep experience!

Understanding the nighttime back pain and sciatica

The main reason that your back pain or sciatica flares up at night is down to two important factors. Firstly, it is a period in the day where you’re often nice and warm, resting and your body views this as an opportunity to start to heal. This involves the build up of inflammation in the area to drive new resources to the cells such as oxygen, white blood cells to remove cellular debris, as well as remove waste products such as metabolites from the tissues. Inflammation is a process that increases the vascular supply to the area for obvious reasons. The challenge is that the lower back, compared to other areas like the wrist or knee, has a number of bony tubes that are limited in their size and do not stretch. Compared with the capsules and other soft tissues that surround an injury in the knee, the back consists of a series of bony tubes which will not stretch. Through these tubes run nerves and blood vessels. A build up of inflammation here in the low back will therefore create pressure in these areas. When they build to a point of significance, the pain begins to set in.

Secondarily is the stillness, think about a time in the day where you were still perfectly for 3-6 hours. It is very common that the back pain or sciatica will kick in in the middle of the night after just enough time to put you in a deep sleep, but not enough time for you to be rested! Being still for this length of time allows the inflammation to build up. Your lower back would ordinarily be moving, even in small ways during the day. These small posture changes and movements – even if barely perceptible visually, during the day, are enough to change pressure in the low back and help aid the moving of fluid around the lower back, preventing the inflammation from pooling too much in your low back tunnels mentioned earlier. 

Ultimately this is why back pain or sciatica flares up at night, or similarly is particularly bad first thing in the morning. There is only so much inflammation that can build up in the region overnight before symptoms trigger. Often we will find that the pain at night will transform into pain first thing in the morning, as recovery occurs and the speed at which the inflammation builds lessens. From here, you often find the severity of the morning soreness turns to stiffness, then an “inconvenience” and finally is absent as more and more healing takes place.

The reality is that we cannot change these facts of sleeping. The processes will occur and we are simply falling prey to the certainty that they will occur, every night. Instead we then need to look to the other factors that we can influence to improve the status quo. As we will find out, there are a plethora of areas where we can (but often don’t) make changes to reduce the likelihood of our back pain or sciatica waking us up at night. 

Causes of back pain and sciatica at night

We have discussed the reason that the pain will build up at night, perhaps bothering you midway through the night, or if you are a little more lucky, only first thing in the morning.  But let us drill into the cause of this pain as the inflammation is caused by something! It will come as no surprise that there will be an “injury” in the lower back. Back pain will often flare mid way through the night as mentioned, and this is common with all manner of diagnoses. Be it a disc injury, a herniation or degenerative disc disease, or something more severe such as a spondylolisthesis, the presence of inflammation in response to the injury is a feature of all injuries. In some circumstances, you will notice that the pain flares as soon as you get into bed, and prevents you from falling asleep in the first place. Here there are two main reasons for this as well as a number of other factors which just exacerbate one or both of these reasons. 

You went to bed 3 hours before you got into bed

This sounds a little tongue in cheek but it is true. Think about your nighttime routine honestly. For many adults the nighttime routine will involve dinner, then perhaps some menial tasks, washing up etc, then you collapse in front of the television to unwind before bed. You might well be there for an hour or even more, before you make your way to the bedroom. At this time, your back is still, you’re sitting up, or reclined, with your back nice and warm against the sofa seat. 

What is different here from being in bed? 

Practically nothing.

If we consider that our back might have a “timer” that starts the moment you go to bed, we could compare this to a bucket placed under a leaking tap. If the bucket is placed fresh at 7pm when you sit in front of the television, it might even be close to full at 11pm when you make your way into bed. This is no different to if a fresh bucket was placed there at 11pm when you went to bed, waking you at 3am. A little reflection here often leads to the “ah ha” moment. Granted it doesn’t fix the issue, we’ll discuss strategies for that later on, but it at least identifies an important factor in those sleepless nights. A factor that can be addressed immediately.

Instability in the injured site of your lower back pain

For some, there is a large degree of instability associated with their back issue. When we think about a lower back injury, whether or not there is sciatica present too. There will always be some degree of instability as by definition you have injured the structures that provide stability and so they are less able to completely do their job. 

During the day when your muscles are engaged and perhaps compensating for this weakness, everything is managed a little better, but the moment you lie down and those muscles finally relax, the unstable, injured region moves creating local irritation, almost like a mini re-injury. Now this won’t be significant in terms of tissue damage, but it will create that immediate degree of pain. This might be made worse by certain muscles remaining a little tight as others relax. 

For example, if you had an injury like this to the last joint in your low back, the lumbosacral segment (L5, S1). You lie down onto your back and relax, as you do this your hip flexors are still tight from sitting all day, which is a problem for another time, they pull your pelvis forwards creating a shift or shear at the lumbosacral joint and creating that sharp local pain, or often, the sciatica symptoms down the leg. 

Additional factors that can impact your back pain or sciatica at night

Other simple factors include the position you’re lying in, as well as the bed more generally. We never advocate people go out and buy a mattress when they’re in pain. However, if your mattress is 20 years old and sagging in multiple places, it’s about time you did. There are lots of options these days for a good mattress, but speaking from personal experience, spend the money on a good mattress because sleep matters. Understanding the position that you’re in when  you’re sleeping and how it can be affecting the spine can help you make wiser decisions about the use of pillows and the position in which you fall asleep. For example, sleeping on your side, especially for ladies with wider hips than men, will lead to a bend in the spine. This has always been the case, but when you have the injury, it becomes a problem. Sleeping on your back has the effect of opening out the spaces where the nerves come out for some, but for others like mentioned in the example on instability, it could be pulling your back. Finally we have sleeping on your front, that itself could be good for your lower back, or it could not, it certainly isn’t optimal for your neck, but could play a role in your getting a better nights rest in some circumstances. 

Finally, your routine in the morning can have a big impact on the degree of pain you experience first thing, as well as the healing process itself. Some of the actions that people gravitate too often undo the very healing that could have taken place overnight, such as deciding to round the lower back with a knee hug while still in bed..

The most ignored factor in back pain at night: It’s too late when you get into bed

This will come across as a little anticlimactic, but it is true. Worrying about your back pain at night when you’re in bed is too late. It is a sign that your day was putting significant strain on your lower back and that you have exceeded what was manageable for your current back health. This is one of the reasons in the Back In Shape Program we go to great lengths to educate our members on their backs, and how they should be using them during the day. Make modifications to what you’re doing on a daily basis so you are exposing your back to less strain during the day that will compromise the healing that takes place.

For example, if you have a low back disc injury, say a herniated L4, L5 disc, and you’ve spent 6 hours sat at the desk, followed by a 1 hour drive home, and 3 hours in various chairs in the evening, is it any wonder that you’re in pain at night when you finally go to bed. Your whole day has been an assault on the poor disc that’s trying to heal. Trying to look for things to help at 11pm or 3am when you cannot sleep because of the pain is futile. It started at 7am that morning. 

Unfortunately, back pain does take some time to resolve as it is an injury that needs to heal, we will discuss other tips and pieces of advice in the rest of the article, but make no mistake, those strategies work, but they’re not magic. You must be more aware of how you are using your body on a daily basis and make necessary modifications, for any nighttime practice to work. 

Sleeping positions to improve your back pain and sciatica at night

We have already discussed the old mattress, however, chances are, if you have a mattress under 10 years old and you’ve taken good care of it, the mattress is not an issue. Here are some strategies that you can employ to provide a little more support at night and reduce pressure on certain areas of your back. Fundamentally here, we have a neutral lumbar spine in mind. This is what we are looking to support through the use of position and props (pillows). Some will work for some of you, and for others they will not help, it is down to you to test these out to find out which setup works best for you right now, and know that that might change as you recover from your back pain. We’ll also offer some critique for these positions, trying to point out the areas that might be disadvantageous too.

Sleeping on your back to ease back pain at night

This is the most popular option for many, sleeping on the back with a pillow underneath the legs to elevate the thigh. One of the reasons this position works for many is because it makes the holes we mentioned in the earlier part of the article larger. By supporting the thighs, we pull the pelvis into a mild posterior tuck, flattening out the lumbar spine and creating a greater degree of space in the lower back. This greater amount of space means that the process of filling the space takes longer. For many this really does work. However, if you’re aware of our teachings on back pain you’ll know that this comes at a cost. 

Flattening your lumbar spine in this way does not offer the usual disadvantage, for example, in the case of the child’s pose stretch, a terrible low back stretch. It doesn’t have the same compression on the discs but it does allow more inflammation to build in the area. This could well mean that when you try to stand up in the morning you experience more pain. Secondarily, it will have a mild stretching effect on the ligaments and muscles of the lower back. This is not ideal for the healing process that is taking place overnight. 

With a back injury the ligaments will be trying to knit back together overnight, it would be better if they were to knit back together tightly, and you not to round your lower back in the short term. By encouraging the ligaments to heal with a flat spine as opposed to a lordotic spine they are not providing the same degree of tension that they are designed to have. This is fundamentally why we go to great lengths to eliminate the flattening of the lower back in the early stages of recovery.

As a complete counter to this, the towel under the lower back for some offers a relief when sleeping and a question that we commonly get when it comes to the towel stretch for lower back pain relief is if this can be done in bed. For some with the instability example we mentioned before, the presence of the towel in bed might offer the support to prevent the spine being pulled in a peculiar fashion. Often you will find that it is a pleasant way to sleep on your back, however it comes with a risk and something we would caution you on. If you roll over suddenly or twist in your sleep it is more likely that you could irritate your lower back if you’ve been on the towel for a long period of time. It is for this reason we would not ordinarily recommend sleeping with the towel. 

We could however make the case that it is sinking into the bed a little and therefore less pronounced compared to being on the floor and so providing just enough to offset other factors and so a viable option. 

The safest use of the towel in bed would be to get into bed with the towel and then remove it after a short period of time and switch over to a side lying position which seems to be one of the best sleeping positions if you have lower back pain, and we will now see why.

Getting a better night’s sleep on your side with sciatica

Side lying offers the ideal solution for those with back pain for a couple of reasons. Firstly it gives us the opportunity, with pillows to support the spine in the most neutral position, whilst not having anything in the way of trade offs like sleeping on your back. It also is the easiest position to get into when getting into and out of bed. 

Firstly, think of supporting a neutral spine. When sleeping on your side a small pillow or even rolled towel can be placed in the waist to prevent the pelvis rocking and bending the spine to the side. You can also straighten the top or bottom leg to see how this affects the side-bending of your spine. Secondarily, tension on the gluteals can lead to some discomfort in the lower back and exacerbation, so a large pillow can be placed between the knees to open the legs and alleviate the tension there too. Finally a pillow behind the back can offer support, just to make it more comfortable so you don’t feel like you’re having to “balance” actively. 

This side lying position can then easily be transitioned into getting up with minimal spinal movement by shimmying closer to the edge of the bed and using the pendulum swing to get up to sitting without bending your spine.

Sleeping on your font for back pain relief

This is a little controversial but there is logic behind the move, perhaps this will even be the one that you find most helpful. This is likely to be most relieving in the case of a recovering disc bulge, perhaps not in the very fresh, acute and severed disc bulge, but shortly after this you might want to give it a go. 

Before we explain why, make no mistake, sleeping on your front is not good for your neck, as invariably you’ll find you have to twist your neck in order to breathe – quite an important activity as it turns out. 

The reason sleeping on your front might be a great option, providing you have a good mattress, is because it allows your lordosis to more effortlessly be supported, allowing the curve to drop into your low back, as opposed to being on your back, when the curve drops out. As this happens, your disc spaces are opened and there could be a good argument made for this being a good position to adopt sleeping for a good number of hours as that directional movement is fundamentally what your low back disc herniation is trying to do to heal.

Change your bedtime routine to incorporate movement for your back pain

We discussed earlier the pervasive nature of sitting and the likelihood that your bedtime build up of inflammation could well have started long before bed time. The best way to have an impact here is to break up your evening. Some of our members find it great to do their Phase One routine mid evening, others right before bed, but something should be done, even walking about the house to aid in the reduction in build up of excess inflammation. Calming down the low back and resetting the clock before you go to bed can be a great strategy to help raise the odds of a good night’s sleep.

Remember that if you have a degree of degenerative change in your lower back or a raging disc bulge, the spaces we mentioned in the spine will be smaller, so you have a shorter time clock before things reach a critical, symptomatic level. Therefore taking a 15-20 minute break in the evening to move around and do something to reduce the excess inflammation and heating of your lower back can make a big difference. It might mean the difference between waking at 3am and waking at 7am. You might still be in pain, but at least you can get up and get on with your day at 7 having had a good night’s sleep!

Lifestyle changes to alleviate back pain and sciatica at night

Back pain is a “you problem”. The way you use your body on a daily basis contributes enormously to the health, or disease of your lower back. By taking steps to start to become more conscientious about how you use your back every day you will begin to have immediate impacts on the recovery process, and the pain that wakes you every night. We teach these principles to members in the program, they are important and unique to each one of us. You need to take the time to evaluate what you’re doing every day. Are you spending hours at a desk? If so, make changes to how you do your work. For example, you can use a sit-stand desk or take calls walking around. It could be that you’re a keen gardener. Strategies such as reducing the time you’re spending in one go in the garden, as well as using a kneeling cushion so you do not compromise your low back when working on the ground can work. Perhaps it is activities like doing the ironing or other house chores, like cooking. Reducing the volume in one go can make a difference, and seeking out more ergonomic methods can also work.

These modifications might be annoying, especially breaking up tasks when it is so much more efficient to do them in one go. The reality is that this is an important step in the short term to help your back heal.

The role of exercise in eliminating nighttime back pain and sciatica.

Ultimately you have a bad back. It’s injured and it needs to heal. We can make all the changes above to our sleeping routine but if we do not make this next part a feature, we will never be able to move on properly. Proper rehabilitative exercise must make a feature, this means doing the right strengthening exercises and learning to move correctly. 

This is important because it means that all those activities we mentioned on a daily basis become easier for your body to manage, while your back is healing. It reduces the likelihood that the day’s activities were too much and re-aggravated the injury, creating a cycle of relapses. It is important because resistance training guides the healing and remodeling process, strengthening not only the injured tissues, but also the supporting structures around the injury. Doing the right resistance program, to build stability for your lower back and strength in the back, core and hips, you will find that your back injury goes through a more complete healing process and this is what will make those sleepless nights a thing of the past. 

We discuss the concept of resistance training to fix your back pain in other episodes and have the full program to help you achieve this with support. You can use the link at the end of this article if you need help with this. But make no mistake, back pain or sciatica disturbing your sleep is a problem that can be fixed if we take the strategies in this article into account and start to make changes from today.

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    1. Hey Sara, good comment, we can cover this a little more in detail this Wednesday on the live coaching call to flesh things out a little more, the short answer is, shower will be better and depending on where you are in the recovery process a little ice post can be handy, even if just a few minutes.

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