Can’t Sleep Because of Your Back Pain? Why Back Pain and Sleep Are Connected

How back pain and poor sleep keep each other going, what a 2026 review of older adults found, and the sleeping positions and pillow tips that take pressure off a sore back.

By Dr Naomi Swan, Chiropractor and Co-director ·

18 July 2026

· 6 min read

Older woman sitting on the edge of her bed holding her lower back, showing the link between back pain and sleep

In short

Back pain and poor sleep feed each other. A 2026 systematic review of adults over 60 found that people with more frequent or severe back pain were more likely to develop sleep problems, and sleep quality tended to drop as pain increased. A spine-neutral sleeping position, the right pillow height, a supportive mattress, a consistent routine and having ongoing back pain properly assessed give you the best chance of breaking the cycle.

Back pain and sleep are more closely linked than most people realise. You finally get comfortable. Twenty minutes later you’re wide awake again, shifting position, trying to find the one spot where your lower back will settle down.

If you’re over 60 and dealing with ongoing low back pain, there’s a good chance it’s costing you more than just a comfortable day. It’s costing you sleep too, and that’s not you being soft about it. New research backs up what a lot of our patients have been telling us for years: chronic back pain and poor sleep tend to travel together, and each one seems to make the other worse.

Why do back pain and poor sleep feed each other?

It’s not just that a sore back makes it harder to sleep. Poor sleep can also make your pain feel worse the next day. You wake up tired and stiff, your pain feels more intense than usual, you have a rough day, and that makes it even harder to sleep the following night. Round and round it goes.

A systematic review published in 2026 in the journal Chiropractic & Manual Therapies looked specifically at this pattern in older adults followed over time. People with more frequent or severe back pain were more likely to go on to develop sleep problems, and people whose pain intensity increased tended to see their sleep quality drop alongside it. It runs both ways.

If you’ve ever had a good night’s sleep and noticed your back felt more manageable the next day, or a terrible night and felt like your pain had a field day, you already know this instinctively. The research is just catching up to what your body’s been telling you.

Why does poor sleep hit harder as we get older?

Poor sleep isn’t just an annoyance when you’re in your 60s, 70s, or beyond. It’s connected to bigger things too, including heart health and how sharp your thinking stays. Nearly half of older Australians report their sleep quality isn’t great, and if chronic back pain is part of what’s driving that, it’s worth taking seriously rather than just putting up with it.

This is exactly why we ask about sleep as part of a proper back pain assessment. It’s not a throwaway question. If your pain is disturbing your sleep, or your sleep is making your pain worse, that’s a cycle worth breaking, not something to quietly live with because you assume “that’s just what happens” as you get older.

What’s the best sleeping position for back pain?

There’s no single perfect position, but a few changes help a lot of our patients:

Side sleeping with a pillow between your knees takes pressure off the lower back and hips, and suits many people with disc-related pain.
Back sleeping with a pillow under your knees can ease strain through the lower back.
Stomach sleeping is the position most likely to aggravate a sore neck, because it keeps your head turned for hours at a time.
Pillow height matters. Your pillow should keep your neck roughly level with your spine, not tipped up or dropped down.

The right setup depends on your body and what’s going on with your spine, so we’re always happy to check it with you at your next visit.

What else can you do about back pain that’s ruining your sleep?

The honest answer is that improving your sleep alone probably won’t fix chronic back pain, and treating your back pain isn’t a guaranteed fix for sleep either. But they’re clearly connected, so addressing your back pain properly gives you a real shot at breaking the cycle, rather than managing two separate problems that keep feeding each other.

A few things that genuinely help in the meantime:

Keeping your spine reasonably neutral overnight, rather than twisted or curled up for hours
A mattress that properly supports you, not one that’s sagged in the middle for the last decade
Keeping a consistent sleep routine, since your body responds well to predictability
Not ignoring back pain that’s been hanging around for weeks, hoping it’ll sort itself out

That last one is the big one. If you’re losing sleep over pain that’s been there a while, it’s usually a sign the pain itself needs proper attention, not just a better pillow.

When to call us: back pain that wakes you at night and doesn’t ease when you change position, or that comes with fever, unexplained weight loss, or numbness or weakness in your legs, should be checked promptly rather than waited out.

We offer a free “Clarity Call”, a free 10-minute phone conversation with our chiropractor to talk through what’s going on and whether we can help.

References

Rahbar P, Wong JJ, DeSouza A, et al. The association between low back pain and sleep quality in adults 60 years and older: a systematic review. Chiropractic & Manual Therapies, 2026.

Written by

Dr Naomi Swan

Chiropractor and co-director of Health First Chiropractic in Modbury North, with over 20 years in practice and a Master of Chiropractic. Naomi is also a supervisor and examiner at the Australian Chiropractic College in Adelaide.

Meet Naomi →

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Common questions

Frequently asked questions

Have another question about back pain and sleep? Give us a call and we’ll happily talk it through.

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It can certainly disrupt sleep, whether that’s trouble falling asleep, waking through the night, or not getting deep, restful sleep even when you are asleep. Research following older adults over time has found that back pain often comes before sleep problems develop, so if your sleep has gone downhill around the same time as your back pain, the two are very likely connected.

This is a real, documented pattern, not something in your head. Poor sleep and worsening pain tend to move together, and the evidence suggests the relationship runs in both directions: pain disrupts sleep, and poor sleep can make pain feel more intense. Breaking the cycle usually means addressing the pain itself rather than only chasing better sleep.

The right pillow keeps your neck roughly level with your spine when you lie down. Side sleepers usually need a higher, firmer pillow to fill the gap between the shoulder and head, while back sleepers usually suit a lower one. If you sleep on your side with lower back or hip pain, a second pillow between your knees helps too. Bring your questions to your next visit and we can work out what suits you.

It’s common, but that doesn’t mean it should be left unaddressed. Nearly half of older adults report fair or poor sleep quality, and chronic low back pain becomes more common with age too. When the two show up together, it’s worth having your back pain properly assessed rather than assuming poor sleep is just part of getting older.

Start by having your back pain properly assessed rather than working around it indefinitely. A supportive mattress, a spine-neutral sleeping position and a consistent routine can help in the meantime, but if pain has been disturbing your sleep for weeks or longer, the pain itself needs attention. If sleep problems are significant or ongoing, it’s also worth raising with your GP.