10 Possible Causes Of Back Pain At Night: Should You Be Worried?

back pain at night

As you prepare to hit the sack after a day of hectic work, does a pain in the back nag you? You’re not alone in this. Some people attribute many sleepless nights to acute back pain. If you wonder why this nagging pain strikes only in the night, there are as many as 10 possible reasons, from mild to serious, behind this.

1. Wrong Type Of Mattress

If you find your back aching every time you wake up in the middle of the night, your mattress might be the culprit. Does it have a deep depression in the shape of your body? Or does it feel like a bed of bricks? A mattress that is too soft as well as one that is too firm can prove problematic.


Your long hours of sitting or standing or other activities like lifting or driving through the day affects the spine. When you sleep on a soft mattress, the lack of support to your spine leaves the body at an unnatural angle and prevents the tense muscles from relaxing, which increases the pain.

On the other hand, sleeping on a firm mattress does help your spinal cord assume the right posture at rest. Research has found that a firm mattress reduces pain among patients with chronic non-specific lower back pain (back pain not caused by a disease). However, if the mattress is too hard or uneven, it could result in back pain through the night.1


2. Poor Posture While Sleeping

If you find there’s nothing wrong with the mattress, scrutinize your sleeping posture. These are the ideal positions for sleeping. Are you adopting these when you sleep?

  • Sleeping on your back: Tuck a firm pillow under your knees to maintain the natural curve of your lower back and to support the spine. The natural curve of your neck and the alignment of your shoulders, neck, and head should be supported by the pillow under your head.

  • Sleeping on your stomach: Keep the spine better aligned by placing a flat pillow under the stomach and the pelvic area. Use a flat pillow to support your head or do not use one at all.

  • Sleep on your sides: Tuck a firm pillow between the knees so that your upper leg doesn’t move your spine out of alignment. This way, the stress on the spine is reduced, too. Also, pull your bent knees slightly toward the chest.


If you are already suffering from back pain, fill the gaps between your body and the bed while lying down by inserting small pillows in the gaps. When you turn to a different position in bed, move the entire body as one unit and do not turn or twist from the hips.2

3. Poor Posture Through The Day

Do you slouch while working at your desk? Slouching results in a tilt of your pelvis, which has a direct impact on the curvature of your spine. When you repeat poor posture daily, your body’s structure slowly changes and adapts to it, leading to misalignment and pain. If your pelvis is in a neutral position, it is easy for your spine to hold itself upright. Proper sitting posture relieves the back of any pain.3 Try these postural changes to alleviate back pain and avoid it in the future:4


  • Sit on a chair with a firm back and move it close to the desk to maintain contact between the chair back and your back. This will also relieve pressure on your back and shoulders and maintain the natural, inward curve of the spine.
  • Ensure that the upper back is straight, shoulders are relaxed, and your knees are slightly higher than your hips.
  • Keep your feet flat on the floor.
  • Avoid sitting for a long time at a stretch. Stand up and move around every one hour to stretch tight muscles and give them a chance to relax.

4. Wearing High Heels

Walking on high heels is a common cause for back pain because high heels pull muscles and joints of the body out of alignment. The plantar fascia ligament in the foot connects to the calf muscle, which in turn connects to the hamstring, and the hamstring attaches to the pelvis. Walking on high heels shifts your center of gravity forward, forcing you to arch your back, which eventually leads to back pain later in the day or at night.5


5. Pregnancy

If you are pregnant, you can attribute your back pain at night to the changes happening to your body. In a survey conducted among 200 pregnant women, it was found that 56 percent suffered from low back pain during pregnancy. It is also notable that in one-third of them, the pain increased during the night and disturbed their sleep. Back pain during pregnancy is caused by the enlargement of the pelvic veins and the expansion of uterus, which presses the vena cava, the large vein carrying deoxygenated blood into the heart, particularly at night when the woman is lying down.6 Pregnant women are advised to wear support braces and sleep on the left side. The pain resolves after childbirth.7

6. Kidney Stones

Kidney stones are hard deposits of calcium, minerals, and acid salts formed in concentrated urine in the urinary tract. These cause pain when they lodge in the ureter and obstruct the urine flow. The pain is usually bad at night or in the early morning possibly because of the low urine output during these times.8


7. Endometriosis

Endometriosis is another condition that can cause back pain in women, which often gets worse in the night while sleeping. Endometriosis is a disease in which tissues that normally grow inside the uterus grow outside of it, leading to infertility. Pain occurs in the abdomen, lower back, or pelvic areas, which gets worse at night.9 If you have endometriosis, you may also have a very painful period, heavy bleeding between periods, and pain during intercourse.

[pullquote]Does your pain resolve after rest? This is a critical factor that can help you assess whether the back pain is mechanical (caused by posture or incorrect body movement) or non-mechanical (caused by inflammatory conditions). If you get sufficient rest, a mechanical pain would resolve. A non-mechanical pain will not resolve after rest.[/pullquote]

8. Ankylosing Spondylitis

Ankylosing spondylitis is a type of arthritis that affects the spine and, sometimes, other joints. It causes inflammation between the bones of your spine and in the joints between the spine and the pelvis. The symptoms include pain and stiffness in the lower back and buttocks. The pain can be so severe that it can keep you up all night.10 The symptoms of AS are usually dull and diffuse, with the pain and stiffness worse in the mornings and in the night.11

9. Spinal Tumors

Most cases of back pain are not caused by spinal tumors, but back pain is the presenting symptom in 90 percent of patients with spinal tumors, which can affect any of the structures of the spine or the spinal column. The location of the pain depends on the part of the spine that has the tumor. The common symptoms of spinal cord tumors include pain in the lower or middle back that worsens when you lie down. The pain is often present at night and gets worse with physical activity.12 13 If the tumor is in the middle or the lower part of the spine, along with the pain, you may experience numbness or muscle weakness in the legs as well as loss of or changes in bowel function.

10. Cancer

Low back pain, which cannot be located precisely, can be due to visceral cancer or cancers of the internal organs, such as pancreas, duodenum, colon, uterus, cervix, and ovary. The symptoms include back pain, which is not relieved with rest and can be the most intense at night. This non-mechanical back pain, which progresses persistently in spite of medication and activity modifications, should raise the suspicion of cancer.14 Remember, a back pain that doesn’t get better with postural changes merits a prompt consultation with the doctor.