This article has been written and medically reviewed by Darshan Shingala (M.D, MPH) – a qualified and practicing medical doctor – for maximum factual accuracy and reliability.
I have personally suffered badly with upper back and neck pain for many years due to my sporting injuries and I’ve lost countless hours of sleep in the process.
This means that I’ve tried many different ways to try and alleviate this discomfort at night.
So what are the best ways to sleep better with upper back and neck pain at night?
The most effective way to permanently stop upper back and neck pain at night is to fix your bad posture by sleeping on your back on a supportive mattress – ideally with an adjustable bed frame – and choosing a pillow that’s the right type and size.
The rest of this article expands upon these recommendations to provide you with 10 actionable ways to fix your upper back and neck pain at night now.
Although this article was written by a qualified and practicing medical doctor, you should always see your own doctor for the best guidance for you.
10 Ways to Sleep With Upper Back and Neck Pain
Try these 10 ways to help you sleep better with your upper back and neck pain now:
1: Buy a Mattress With Adaptive Support and Pressure Relief
Sleeping on a high-quality hybrid mattress with an adaptive coil core and memory foam or latex foam in the upper comfort layer is one of the most effective ways to prevent upper back and neck pain by helping you sleep in good posture.
For side sleepers with upper back and neck pain, I personally recommend the Puffy Lux Hybrid mattress because it has more ‘give’ around the shoulders to allow for better posture.
I personally recommend the DreamCloud hybrid mattress for back and front sleepers with upper back and neck pain because it is medium-firm, has adaptive support, good pressure relief, and helped to reduce my back pain.
1.1: Orthopedic Mattress Can Prevent Upper Back and Neck Pain
I usually tell my patients who suffer from severe back pain to switch to an orthopedic mattress as they are specially designed to provide targeted support to the joints of your musculoskeletal system.
Several studies have shown significant improvements in back pain relief, back discomfort, back stiffness, and overall sleep quality among volunteers who used orthopedic bedding for 28 days (5), (6), (7).
An orthopedic mattress offers a firm surface that helps the sleeper obtain the correct sleep posture.
The unique design of an orthopedic mattress evenly distributes the body weight to prevent the build-up of tension and pressure on the neck, back, and hip joints.
Hence, switching to an orthopedic mattress is worth consideration for back pain and neck pain patients.
2: Pair Your Mattress With an Adjustable Bed Frame
Pairing your mattress with an adjustable bed frame is an excellent way to reduce the chance of experiencing upper back and neck pain because you can adjust the angle of the bed to shift the weight away from your pain hot spots.
For example, increasing the angle of the upper portion of the bed can reduce the pressure on your upper neck and back whilst also helping to guard against snoring and acid reflux.
I recommend buying an adjustable frame with your mattress from the same manufacturer to prevent compatibility issues.
Both Puffy and DreamCloud offer compatible adjustable frames that you can bundle in at the point of purchase.
3: Sleep On Your Back if You Are Not Pregnant
Sleeping flat on your back is one of the best ways to prevent upper back and neck pain at night because it keeps you in good posture and reduces strain on your neck and back.
However, you shouldn’t sleep on your back if you are pregnant because this can harm the fetus.
Poor sleeping positions are among the most common causes of sleep-related problems and your sleep posture can potentially cause or relieve your upper back and neck pain (12).
Sleep therapists’ best and most widely recommended sleeping position is the supine position – which means lying flat on your back – to achieve optimal spinal alignment and relief from upper back and neck pain (11).
I suggest placing one pillow under your head and another under your knees for added support while sleeping on your back.
However, if you are pregnant, avoid sleeping on your back in the second and third trimesters of your pregnancy (4).
The reason is that sleeping on your back during the late stages of pregnancy shifts the entire weight of the growing uterus and the baby onto the veins of your lower body, which reduces the blood flow and oxygen circulation to your heart and unborn baby.
Research suggests that falling asleep on your back after 28 weeks of gestation can double the risk of stillbirth.
Hence, I advise my pregnant patients to sleep on their side and protect their bumps with pillows for extra support and comfort (4).
To my non-pregnant patients, I generally recommend the supine position for getting a good night’s sleep when they have upper back and neck pain.
4: Choose the Correct Pillow Type
Choosing the right pillow type can potentially prevent upper back and neck pain – whilst choosing the wrong type of pillow can be the root cause of the pain.
Use the pillow buying tips below to help you choose a pillow that will enhance your sleep if you suffer from upper back and neck pain:
4.1: Orthopedic Pillows
Consider an orthopedic pillow if you suffer from chronic upper back pain or neck pain.
Research suggests that an orthopedic pillow offers optimal support for promoting high-quality sleep due to the effects of its shape on the curvature of the cervical spine (2).
An orthopedic pillow’s overall comfort, temperature, and breathability deem it safe and adequate for supporting quality sleep (2).
Moreover, experts regard the orthopedic pillow as a therapeutic aid because it’s specially designed to orthopedic guidelines to maintain good posture as you sleep.
4.2: Memory Foam Pillows
Memory foam is another excellent option when looking for comfortable pillows, offering optimum support and comfort for your head, neck, and spine during sleep (14).
Research suggests that memory foam may also help align your spine, which improves posture and sleep quality (15).
4.3: Feather Pillows
Natural feather pillows are soft and can easily conform to the shape of your neck and the contour of the occipital area of your head (14).
However, feather pillows tend to collapse over time with extended use, which is why manufacturers suggest you replace them every year or so.
If you want a more sustainable alternative to replacing your pillows, consider re-fluffing the ones you have about once a year.
5: Choose the Correct Pillow Loft (Height)
To prevent upper back and neck pain at night, the pillow must be the correct height (loft) to ensure that your spine is kept in the correct posture.
The spinal position is important because an overly thick pillow can incline your neck and chin, which can cause neck pain.
In contrast, if your pillow is too thin, then your head falls backward, leaving your neck unsupported.
For these reasons, I suggest that back sleepers use a 4-5-inch-thick pillow (a mid-loft pillow) and for side sleepers, I recommend a 5-7-inch-thick pillow (a high-loft pillow) to give you optimal spinal support during sleep (13).
6: Try Physical Therapy to Reduce Pain
In my professional experience, physical therapy – when used in conjunction with appropriate medical management – can be highly effective at reducing upper back and neck pain by correcting muscle imbalances.
There are two primary forms of physical therapy used to relieve upper back and neck pain:
6.1. Passive Physical Therapy
Passive physical therapy treatments include methods applied by the therapist and do not require any physical input from the patient.
A broad range of treatments is available under the umbrella of passive physical therapy, such as applying ice packs to those areas of concern, heat therapy, massaging the affected area, and using ultrasound and electrotherapy (9).
A systematic review was conducted in 2009 within the Cochrane Back Review Group framework to assess the actual effects of massage therapy for nonspecific back pain.
Researchers concluded that massage therapy might benefit patients struggling with subacute and chronic nonspecific pain when used with targeted physical exercises and patient education (27).
Consequently, we can say that passive forms of physical therapy may be beneficial to a certain extent for chronic back pain sufferers.
6.2. Active Physical Therapy
The other component of physical therapy is “active,” which requires patient participation by moving their own body through a combination of various exercises and stretches.
Active physical therapy can reduce spinal stress by strengthening your back and neck muscles, increasing flexibility, and improving posture (8).
Physical therapists can educate you by helping you understand which postures may exacerbate your back pain and how to prevent them.
A good therapist can suggest techniques to help you manage back pain flare-ups.
For example, you can learn to modify your movements in a way that helps to avoid severe and frequent episodes, and prolong the remission period of back pain while continuing to be active (9).
So, a good physical therapist can guide and assist you in managing your pain better.
7: Manage Upper Back and Neck Pain with Medications
Some medications may help to manage your upper back and neck pain effectively, but the choice of drugs depends on the type and severity of your pain (16), (17), (18).
You may consume medications orally or apply them topically over the area of concern.
Depending on the regulations, medications may be prescribed by a board-certified medical doctor or purchased over the counter (OTC) in any pharmacy.
7.1: Oral Medications for Upper Back and Neck Pain
Oral pain medications can be manufactured and marketed in pill form, capsules, and liquid formulations, available either by prescription or over the counter, depending on the type and strength of the medication.
Below is a list of oral pain medications that may be effective for upper back and neck pain:
Non-Steroidal Anti-Inflammatory Drugs
Non-steroidal anti-inflammatory drugs like Advil (ibuprofen) can help reduce inflammation and pain and are available over the counter.
Muscle relaxants such as cyclobenzaprine can help relax your tight, tense back muscles, but they’re prescription-only drugs in most countries.
Anticonvulsants – also known as anti-seizure or anti-epileptic drugs such as gabapentin – are especially helpful for managing neuropathic pain.
Disk herniation, spinal stenosis, diabetic neuropathy, and post-herpetic neuralgia are common causes of neuropathic back pain.
Note that these are regulated medications and are available by prescription only.
To be diagnosed with neuropathic back pain, you need to be evaluated by a physician and a neurologist.
Opioids such as tramadol are potent pain-relieving drugs available by prescription only because the risk of misuse and abuse associated with opioids is very high, so their prescription is strictly regulated and supervised by health care providers.
7.2: Topical Medications for Upper Back and Neck Pain
Drug companies manufacture and market topical pain medications in ointments, creams, gels, sprays, and patches that you apply directly to the skin.
When choosing topical medications for pain management, you must perform a patch test on a small area of skin to check for sensitivity, allergies, irritants, and other adverse skin reactions.
Below are some examples of topical pain medications that may be effective for upper back and neck pain:
Topical diclofenac is a non-steroidal anti-inflammatory drug that can reduce pain, swelling, stiffness, and inflammation.
Lidocaine is a local anesthetic that induces temporary numbness to the application area, minimizing pain, and is therefore commonly used for several musculoskeletal conditions, including upper back and neck pain.
Please note that only a qualified medical expert can accurately diagnose upper back and neck pain and treat your medical condition.
I suggest you discuss your diagnosis, management, and treatment plan with your doctor at length and strongly urge you to be safe with medications.
You need to be aware and cautious of any potential side effects caused by the medications you use, either over-the-counter or prescribed.
Always talk to your physician before deciding on any drugs and follow the prescribed medicinal dosage and times precisely as suggested.
Furthermore, always report to your doctor if you experience any adverse side effects.
8: Implement Good Postural Habits in Your Daily Routine
It is vital to understand how your posture can substantially impact your long-term health.
Try to implement good postural habits in your daily routine to help maintain the health of your spine and minimize the severity of your back and neck pain.
Poor posture not only causes neck, shoulder, and back pain, but it can also severely misalign your musculoskeletal system, make your spine fragile by causing unnecessary wear and tear, and make it awkward for you to digest food.
To improve your posture while standing, make sure you stand up straight and tall by keeping your shoulders well back and pushing your chest forward and out, and put most of your weight on the soles of your feet by keeping them shoulder-width apart.
Lastly, keep your head central, and your chin parallel to the ground for the ideal posture (10).
To improve your posture while seated, make sure you change your sitting positions often and avoid sitting down for long periods.
Aim to take breaks from sitting and do brief activities such as short walks or gentle body stretches to relieve muscle tension.
Avoid crossing your legs in the sitting position and keep your feet on the floor with the ankles in front of your knees, and if your feet do not reach the floor, use a footrest for added support.
Relax your shoulders when sitting and keep your elbows close to your body.
Lastly, use a back pillow for added comfort and to support your spine when sitting for extended periods (10).
9: Apply Sleep Hygiene to Aid Muscle and Mind Relaxation
Following a good sleep hygiene routine can help to relax your mind and body which may in turn help to alleviate your upper back and neck pain.
One of the best practices for good sleep hygiene is to minimize all types of distractions near bedtime, so you can fall asleep quickly and get an uninterrupted and sound night’s slumber.
9.1: Maintain a Silent and Calm Environment in the Bedroom
For most of us, it’s difficult to fall asleep in a noisy environment, so my advice is to create a quiet bedroom atmosphere to help you relax and fall asleep easily (22).
A calm sleeping space helps you unwind and destress, which, in turn, boost your overall health and well-being (22).
9.2: Avoid Bright, Flashy, and Flickering Lights in the Bedroom
Sleep disruptions are common in the presence of excessively bright lights, and overly bright or flashy lights in the bedroom can harm your sleep-wake cycle (20).
Thus, I suggest you try to dim your bedroom lights at least a few hours before bedtime and switch them off before you go to sleep.
Also, ensure that your bedroom lights do not flicker, as flickering lights tend to trigger headaches in some people and make it harder to fall asleep (20).
9.3: Avoid Electronic Devices for 2-3 Hours Before Bed
We now know that the blue light emitted from screens and electronic devices can disturb the sleep-wake cycle, so it is better to limit the use of electronic devices, such as smartphones, laptops, and TVs in general, but especially before bedtime (19).
I recommend you try to observe a period of no screen time in the evening hours.
It is best to remove yourself from all screens 2-3 hours before bedtime to improve sleep quality and reduce the frequency of nightmares (19).
10: Visit Your Doctor for the Best Care
If you continue to struggle sleeping with upper back and neck pain after adopting the above tips, then you should schedule a visit to your doctor’s office.
It is also vital to be attentive to your body and note any symptoms that may have severe consequences if ignored.
For instance, if you experience excruciating shooting pains, numbness, a limited range of motion, or muscle spasms in your neck, arms, or shoulders, then visit your health care provider without further delay.
Guide to Sleeping with Upper Back and Neck Pain
Below is a short guide that explains the relationship between upper back pain, neck pain, and sleep at night.
What Causes Upper Back and Neck Pain at Night?
The causes of nocturnal upper back and neck pain are multifactorial and quite complex.
Some common causes of nocturnal upper back and neck pain are poor body posture during the day, incorrect sleeping position at night, and poor quality sleep.
Research suggests that poor sleep quality among people with chronic upper back and neck pain may intensify the severity of that pain (24).
In addition to these causes, inadequate sleeping arrangements like low-quality bedding, sagging mattresses, and the wrong type of pillows account for various musculoskeletal pains as they fail to conform to the body’s contours.
How Can Upper Back and Neck Pain at Night Be Treated?
Upper back and neck pain can often prove quite complex to treat, but there are a few tips that you can implement to manage your pain more effectively.
For instance, try switching to orthopedically designed mattresses and pillows, and if orthopedic products are out of budget or unavailable, opt for memory foam or feather pillows instead.
Also, pay attention to the loft size of your pillow.
I suggest back sleepers use a 4–5-inch-thick pillow, also known as a mid-loft pillow, and for side sleepers, go for a 5–7-inch-thick pillow, known as a high-loft pillow.
In addition to making changes to your sleeping arrangement, I also suggest you try passive and active forms of physical therapy in conjunction with appropriate medical management prescribed by a licensed doctor.
Active forms of physical therapy – like medically recommended exercises – and passive forms of physical therapy – such as applying ice packs to the area of concern, heat therapy, ultrasound therapy, electrotherapy, and massaging the upper back and neck – can all be effective for pain relief.
The importance of medical management of upper back and neck pain cannot be underestimated.
What Is the Best Sleeping Position for Upper Back and Neck Pain?
If you are not pregnant, lying on your back is the best sleeping position for upper back and neck pain because it maintains good posture and reduces pressure on your spine.
Sleep therapists recognize the supine position as best and the most effective as it aligns your spine, promoting faster recovery for your upper back and neck pain.
However, sleep experts do not recommend sleeping in a supine position during pregnancy as it shifts the weight of your uterus onto the veins of the legs, decreasing blood and oxygen circulation to the fetus.
How Does Upper Back and Neck Pain Affect Sleep?
Chronic pain – including upper back and neck pain – can lead to shorter sleep times, fragmented sleep, sleep deprivation, and generally poor overall sleep quality.
Research demonstrates that people with chronic back and neck pain have a markedly lower quality of life (physically and mentally), poorer sleep quality, and a disrupted sleep cycle (23), (24).
Scientific literature also shows that people with chronic pain may suffer from a self-perpetuating cycle of suffering, insomnia, and depression or anxiety (25).
Patients dealing with chronic pain may become anxious over time and eventually end up with a perpetual cycle of disrupted sleep.
Furthermore, the sufferer may wake up feeling depressed due to constant sleep deprivation, which substantially increases their sensitivity toward pain.
This endless loop and vicious cycle of pain, sleep deprivation, and anxiety can be impossible to break without professional help.
Indeed, studies show that a history of poor sleep quality can lead to the development of several sleep-related disorders such as insomnia, obstructive sleep apnea, and nightmares (26).
Hence, untreated upper back and neck pain can undoubtedly have adverse effects on your sleep when ignored.
Conclusion: Fix Your Posture
The most effective way to reduce upper back and neck pain at night is fixing your bad posture.
This can be done by sleeping on your back, choosing the right pillow loft, sleeping on a supportive mattress, and maintaining good posture throughout the day.
If this doesn’t work then you should see your doctor for more precise treatment.
Click the button below to see the best mattresses and beds for back and neck pain.
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No part of this article or website offers medical advice – always consult with a qualified medical professional for such guidance.
Image Attribution and Licencing
Main image: ‘Pain in Neck After Sleeping’ by Photodjo (Getty Images) – used with permission under the terms of Canva’s One Design Use License Agreement.
Dan is the founder and head content creator at Bedroom Style Reviews.
He has been working as a professional online product reviewer since 2015 and was inspired to start this website when he ended up sleeping on a memory foam mattress that was too soft and gave him backache.
Through in-depth research and analysis, Dan’s goal with this website is to help others avoid such pitfalls by creating the best online resource for helping you find your ideal mattress, bedding, and bedroom furniture.
Dan is a qualified NVQ Level 2 Fitness Instructor with 6 years’ experience helping clients improve their health through diet, exercise, and proper sleep hygiene.
He also holds several college and university-level qualifications in health sciences, psychology, mathematics, art, and digital media creation – which helps him to publish well researched and informative product reviews as well as articles on sleep, health, wellbeing, and home decor.
Dan also has direct personal experience with insomnia, anxiety, misophonia (hypersensitivity to sounds), and pain from both acute and long-standing sporting injuries – he enjoys writing insightful articles around these subjects to help fellow sufferers of such conditions.
Learn more about Dan here.