Oy, my aching back!

May 22, 2007 10:41 PM

How can I learn to sleep better, so I don't constantly wake up with back pain?

I have a history of stress related back pain (which has sometimes been severe.) Since I was a teenager I’ve usually had some degree of back pain, especially from sleeping. Some of this was resolved by getting a better bed. But recently it’s started bothering me more again. I tend to toss and turn a lot and sleep in weird positions, and usually at any point I wake up at night my back is sore, and usually in the morning too. It’s not severe, and I think most of it is just extremely tense muscles.

So my question is, how can I sleep better/keep my muscles from tensing up at night? I think I’m pretty much doing this to myself...my bed now’s not great, but I don’t think that’s the major factor, and this isn’t pain caused from any activities I did during the day. I think it mainly comes from a combination of me moving around a lot, and unconsciously tensing my muscles...so how can I retrain myself, or what other options are there?

(side note: I don’t have health insurance now, or money, so doctors or any other sort of treatment isn’t really an option. Also, I'm only 22, I was looking forward to at least a few more years before the breakdown into old age and constant pain.)

posted by catatethebird to health (23 comments total)

Do some stretching exercises before going to sleep, perhaps.
posted by londongeezer at 10:46 PM on May 22, 2007

Try a body pillow... You can maneuver yourself around the body pillow in whatever way feels most comfortable for you (if you sleep on your side and throw one leg over the body pillow while "cuddling" it to your chest and stomach it relieves stress on your back).
posted by amyms at 10:49 PM on May 22, 2007

A lot of my back pain has gone away since I started doing exercises to strengthen my back and abdomen.

Also, I wouldn't know personally, but I've heard that a decent mattress helps. Curse you, crappy cheap bed.
posted by lekvar at 10:59 PM on May 22, 2007

have a glass of port/sauternes/liqueur/single malt before bedtime. just one will relax you a little, and it's better than going to a doctor.
posted by bruce at 11:41 PM on May 22, 2007

A folded pillow under the knees when on your back, or between the knees when on your side can work wonders.
posted by Manjusri at 11:54 PM on May 22, 2007

seconding the knee support -- it's crucial for me.
posted by scody at 12:02 AM on May 23, 2007

when i went to japan recently, i noticed the beds were pretty hard in comparison to american beds. one hotel we were in even had beds that essentially felt like sleeping on a wood board wrapped in a thin layer of foam, it was so hard. while i initially complained about the hardness of the beds, i noticed that my back and neck pain—which i've had more often than not in the past few years—eventually disappeared when i was there and i felt refreshed when i woke up in the morning.

so my point is: get the hardest bed you can stand; one that is even harder than you think you should have.
posted by violetk at 1:04 AM on May 23, 2007

I just bought "No More Aching Back" by Leon Root. I haven't actually started the exercises yet, but it came recommended. There are other books like this, see Amazon.
posted by davar at 2:19 AM on May 23, 2007

Suffering from similar pains I can tell you:
1. Seconding crazy hard bed.
2. No more coffee (I'm weak on this one, but it has signif. effect.)
3. Simple core strengthening exercises.
4. Acupuncture when things get seriously out of whack.
posted by From Bklyn at 2:37 AM on May 23, 2007

Stretch your back to strenghthen core muscles. Stretch your hamstrings (ie muscles that run down the back of your legs from your buttocks), you'll be surprised how much this helps. I also find walking helps to loosen stuff up quite nicely, though don't go mad if you don't usually take exercise, overdoing it will tire the back muscles and you could be worse off - I do a couple of miles. As a result of my back having a particularly nasty turn in November when I couldn't walk I've started sleeping on my side with my legs bent and brought up a bit (ie what you'd do if you were moving into a foetal position but not pulled all the way up) and this has led to reduced problems. The position was recommended by my doctor.

If you're sitting at a desk all day you need to get up regularly and move around. You might also consider getting an assessment of your desk with regard to seeing how your set-up might be improved, if this is possible where you work. A good work chair can also make a big difference.

I've used osteopathy previously with some positive results, though I wouldn't want to recommend this for all back problems. There's also chiropractors of course. I've not found acupuncture very effective.
posted by biffa at 3:36 AM on May 23, 2007

I used to suffer from back pain -- my orthopedic surgeon suggested sleeping in the fetal position, as there is the least amount of pressure on the back. Worked like a charm. (Except that I tend to drool out of the side of my mouth).
posted by Comrade_robot at 4:55 AM on May 23, 2007

Re: drooling - sweaty bollocks is another potential danger with this position. YMMVW/WOB.
posted by biffa at 5:25 AM on May 23, 2007

Your relatively young age and the fact that your back pain worsens overnight as you sleep makes me wonder whether it's ankylosing spondylitis -- a form of inflammatory arthritis that principally attacks the spine, and which I've had since I was 25 -- rather than, as you believe, extremely tense muscles. Now I'm not a doctor, but you're presenting some symptoms that sound awfully familiar to me as someone with AS; however, you're not a doctor either, and boy are you rationalizing your situation. You don't know. You don't know. You need to find out rather than work it out in your head: there are a lot more possibilities than you are aware of. Or that I'm aware of, for that matter.

Some pages about AS: Arthritis Society, NASS, SAA, WebMD, Wikipedia, Yahoo Health. I need to emphasize that just because your symptoms sound familiar to me, that does not mean you have what I have. But it should illustrate, I think, that this might be more serious than you think.

If you have what I have, the fetal position is the worst way to sleep. Makes it worse. Sleep flat on your back with a neck pillow, thin pillow, or no pillow at all. Do not use knee support. You want your body fully stretched out.

If getting to a doctor is definitely not an option, try taking over-the-counter anti-inflammatories like ibuprofen or naproxen. (Take them carefully.) Before I was diagnosed, I was waking up at three in the morning in pain; better meds and a better sleeping position are the only things that have given me a full night's sleep in the past decade.

And yes, there's a connection between stress and autoimmune disease.
posted by mcwetboy at 5:31 AM on May 23, 2007

How's your weight? I tend to have back pain in the mornings too and I find that if I put on even 10 pounds it makes a big difference in the way I sleep.

Also (unrelated to your weight) are you exercising? When I exercise regularly, my back pain is almost nonexistent. A combination of stretches, weight-bearing exercise, and cardio will help you a lot, or even yoga.
posted by boomchicka at 6:10 AM on May 23, 2007

Yoga will probably help quite a bit if you do it regularly. Also a new mattress? My back was hurting a little in the mornings and even though my mattress looked brand new I realized it was more than ten years old. Stuff wears out. I bought a new mattress and that was it. No more morning back pain.
posted by snowjoe at 7:20 AM on May 23, 2007

I am not a doctor. I'm in my late twenties and I've suffered from moderate-severe pain in my back for the past seven years. It prevents me from sleeping, too. Here is what I've learned from the multitude of internists, chiropractors, physical therapists, orthopedists, and surgeons I've seen.

First, treat this as an injury. You have somehow injured your back and it has to heal. It will continue to get worse if not treated.

Aleve will fix the pain and let you sleep. But know that you have a problem in your back, and Aleve isn't fixing it by itself.

Your back is very complex system. Most persistent injuries like yours will get worse and cause other, more serious injuries (e.g., slipped disc, pinched nerves) if not treated. Many doctors quote the "90% of back problems go away on their own." This is true, but not for you. Recognize your injury has been prevalent for YEARS. Not being able to sleep at night was good motivation for me to get help.

Your back is under constant stress. It generally likes to move around, loosen up and stay nimble. It doesn't like to remain in one position for a long time. This is why sleeping actually aggravates the injury for you.

I know this may be out of bounds, but you need to find health insurance ASAP. It will be your friend. You likely will need some degree of physical therapy or ongoing consultations with experts if you want to sleep regularly again.
To do this, you will need to see different types of doctors since there are very few comprehensive "back doctors" out there. You will also need to get x-rays and an MRI to isolate what the problem is. Take ownership of information they give you. Ask questions. Give increasing amounts of background to each new doctor.

Be cautious of surgery. I met a number of people who had back surgery that did not alleviate the problem.

After years of trial and error, I've found a regiment that works (with the help of a physical therapist who was covered under my insurance and focused specifically on back muscular injuries). For me, I adopted a regimen of bicycling and stretching exercises that seem to do the trick.

I occasionally wake with pain in my back. On those rare nights, I pop an Aleve, go back to sleep and know I've fallen off my training/stretching routines.

You are at the beginning of a lifelong, educational journey. Embrace back research and health as your new hobby.
posted by redarmycomrade at 8:09 AM on May 23, 2007

Talk to your doctor about Elavil, which is frequently prescribed for pain and pretty benign as far as side effects are concerned. A dose before bed will make you drowsy and let you sleep soundly.
posted by wireless at 8:57 AM on May 23, 2007

nth-ing the knee pillow -- between your knees when you're on your side, or under your knees when you're on your back. Also agreeing with the firm mattress -- if you can't afford a new one, you can try putting your mattress directly on the floor instead of on boxsprings. The right kinds of stretching definitely helps as well, but you need to be sure not to push it at first -- stretching muscles that aren't properly warmed up can do more harm than good. I'd do some mild stretching, then some exercising, and then more thorough stretching afterwards. And of course dealing with the stress that seems to underlie these problems couldn't hurt...
posted by svenx at 9:09 AM on May 23, 2007

Most persistent injuries like yours will get worse and cause other, more serious injuries (e.g., slipped disc, pinched nerves) if not treated.

This is hyperbolic nonsense.

In my experience a person with am pain that improves after getting out of bed has mattress issues, period. And you cannot really make yourself stay in a single position all night, although supporting your lower extremities while supine, and/or your upper leg while on your side is a good idea. A good mattress will always wear out faster than you think. A reasonable test for your back would be to put a few layers of quilt or cushion on your floor and try sleeping there for a few nights to see if the pain improves.

I have had back pain since middle school that occurs with awakening if my mattress wears out. The only lasting solution was to sleep on a piece of inflexible fiberboard with a quilt over the top, as the above poster[s] alluded to in Japan. It works great, six years running.

If you have persisting problems, you should consult a physician.
posted by docpops at 10:03 AM on May 23, 2007

Thanks for the answers everyone...and mcwetboy, you have managed to mildly terrify me, as I also have weird random joint pain, especially in my knees. Ah, well, I will try some of these suggestions, and one day when I have health insurance again get it checked out.
posted by catatethebird at 5:21 PM on May 23, 2007

A temporary solution to a soft mattress can be to put a board (nice and strong) between your mattress and spring box. Sleep on it for a week and if you feel better, your mattress needs to go. (If you don't feel any better, then take it out after the week is up.)
posted by anaelith at 7:01 PM on May 23, 2007

Elavil is not a pain drug. It is an anti-depressant. (Tri-cyclic). Wikipedia agrees, I checked. It can aid with sleep (initially) but I doubt pain.

For tension in bed, I wiggle. There is skill to how I wiggle! One leg straight, stretched out. (the stretch goes all the way up your side) The other bent. About 3/4 of the way to being on your stomach. The bent leg provides the motion. You must pay attention to the muscles to learn how to twitch comfortably. You move the muscles to rock your entire body. Your body is in position to be comfortable as you rock. This gets all major muscles except, of course, the leg doing the twitching. Then you switch to the other side and repeat.

Practice makes perfect. I'm a life-long active sleeper. Once I became aware of how much I did this, and needed to do it, I paid attention. I suspect it even lowers blood pressure. When done right, it feels great!
posted by Goofyy at 7:34 AM on May 25, 2007

Amitriptyline, while technically an anti-depressant, is used nowadays to improve and augment deep sleep, thus improving chronic pain, as well as gating pain signals at the spinal level en route to the brain. As an anti-depressant, is was not very helpful, and was used at doses of 100+ mgs/day, with quite a few noxious side effects. At 10-30 mgs at bedtime, it can be a godsend.

The wikipedia link is pretty poor.
posted by docpops at 2:07 PM on May 25, 2007