This post has been quality checked in line with our Editorial and Research Policy.

How to Sleep With Upper Back Pain (Doctor Reveals 10 Ways)

Dr Albert Stezin Profile Picture
  • Article written and researched by Dr. Albert Stezin (MBBS, Ph.D – clinician and neuroscientist) to ensure maximum factual accuracy and unique content.

I personally suffer badly with upper back pain as a secondary condition related to the arthritis in my shoulders that has developed due to many years of boxing and lifting weights in the gym.

This means that I often find it difficult to get to sleep due to the pain in my upper back and so I have tried many things to help alleviate this discomfort.

So how do you get a better sleep when you have upper back pain?

The best way to get better sleep with upper back pain is to sleep on your back on a medium-firm hybrid memory foam mattress; whilst managing pain with hot and cold therapy, physical therapy, and medication. Home remedies can help aid sleep naturally without drugs.

The rest of this article expands upon these points in more detail and gives you 10 actionable strategies to help you get to sleep with upper back pain.

However, although this article was written by a qualified and practicing doctor, you should always consult with your own doctor for the best advice because back pain is a complex condition.

What’s the best bed for upper back pain? Based on my own experience, I would recommend the DreamCloud mattress (click here for the full review) to help alleviate upper back pain. Pairing this with an adjustable bed frame may be an even better solution for you if your mobility is limited (click here to see the best adjustable beds).

10 Ways to Sleep Better With Upper Back Pain

Here are 10 ways to sleep more comfortably when you have upper back pain:

1: Sleep On Your Back to Keep Your Spine Neutral

BEST Sleeping Position for Back Pain, Neck Pain, & Sciatica

The most effective way to sleep with upper back pain without medication or buying extra equipment is to modify your sleeping position so that your spine is kept in a neutral position as follows:

Sleeping Flat On Your Back is the Best Sleeping Position for Upper Back Pain

The best position to sleep in when you have upper back pain is on your back.

This position allows your back muscles to remain balanced and puts your spine in a neutral alignment.

This position puts only minimal pressure on your upper back compared to other positions and can hasten the healing process in the context of an acute injury. 

If you are not used to sleeping in this pose, use pillows at either side of your hips to help maintain the position. 

Keep a small pillow below your head and neck to maintain the alignment of the cervical spine.

Add another pillow below your knees to align the lower spine to a neutral position while maintaining the normal curve of the spine (watch the video above for a demonstration). 

Do not raise the shoulder by placing pillows or cushions underneath the shoulders.

If maintaining this position using pillows is tedious, invest in a wedge pillow.

The natural incline of a wedge pillow can give you adequate head and neck elevation while keeping the shoulders level on the bed.   

Avoid this sleeping position if you suffer from medical conditions such as obstructive sleep apnea, snoring, or are pregnant. 

Sleep On Your Side With Your Legs Drawn Up if You are a Side Sleeper

If you can’t or don’t want to sleep on your back and you prefer sleeping on your side then the best sleeping position to combat upper back pain is sleeping on your side with your legs drawn upwards.

Because this pose is a modification of sleeping on your side that is not spine-neutral, you should modify this posture to keep the strain off your back as follows:

  • As you lie down on your side, draw your legs up slightly towards your chest and keep a pillow between the legs.
  • The drawn-up leg will realign the spine to its normal curvature and keep it stable.
  • Alternatively, use a full-length body pillow to get the same effect – this sleeping pose is ideal for snorers and people with sleep apnea. 

Sleep in the Fetal Position if You are Pregnant (Avoid Sleeping on Your Back)

If you are pregnant then the best sleeping position when you have upper back pain is the fetal position – where the knees are drawn upwards slightly as you sleep on your side.

This position is not recommended generally for those with upper back pain due to the pressure that it places on your upper spine, lower back, and neck.

However, in pregnant women, trying to sleep on your back puts pressure on the viscera and can be very damaging.

To avoid this, pregnant women are advised to sleep on their side with their knees bent upward and pillows between their knees.

While it is not the perfect pose for upper back pain, the benefits outweigh the risks in this case.

Click here to find out if it’s safe to sleep in a maternity support belt.

Avoid Sleeping On Your Stomach

The worst sleeping position if you have upper back pain is sleeping on your stomach because it flattens the natural curve of the spine; and strains the neck, back, and spinal muscles as well as the surrounding joints.

2: Switch to a Medium-Firm Mattress for Better Spinal Support

DreamCloud Mattress Review (2021 – Get $200 OFF Here) – UK v US Versions

The best type of mattress for upper back pain is one that has a medium-firm level of firmness with a hybrid construction – with pocket coils in the support core and either latex foam or memory foam in the upper comfort layer – because this will provide the right balance of pressure relief and support for your spine and joints.

I personally recommend the DreamCloud mattress for combatting upper back pain because it is medium-firm and provides excellent support and pressure relief.

Watch my video review above then click here to read the full review and save $200 when you buy through the links on that page.

Avoid Mattresses that are Too Soft Because they Can Make Back Pain Worse

Do not sleep on a mattress that’s too soft for you when you have upper back pain because you won’t get enough spinal support – especially if you are a heavier weighted sleeper over 200 lbs.

Softer mattresses are better suited to lighter weighted side sleepers under 150 lbs because the greater ‘give’ of the materials allows you to sink deeper into the mattress for better spinal alignment and postural support.

Click here to learn more about how a soft mattress can cause or help with back pain.

Orthopedic Mattresses Can Help With Back Pain

Orthopedic mattresses are well-suited to patients with back pain.

These mattresses are designed to support your entire body and have a medium-firm to firm feel.

When opting for an orthopedic mattress, buy a hybrid one that is topped with memory foam, latex foam, or bonded foam.

Memory Foam is Best for Upper Back Pain Cause by Pressure Points

Memory foam is highly adaptive and offers good pressure distribution along with adequate musculoskeletal and spinal support. 

Memory foam orthopedic mattresses are made of high-density foam and are at least 2-3 inches thick in the upper comfort layer – greater depths are available and an overall mattress thickness of at least 10 inches is advised for maximum support.  

Click here to see solutions to the 7 ways that a memory foam mattress can cause back pain.

Modern Hybrid Mattresses Provide More Support than Regular Spring Mattresses

Modern innerspring mattresses have a series of spring systems that make them soft yet supportive.

However, newer hybrid models are available which are built for comfort and musculoskeletal support and are generally superior when compared to cheap spring mattresses.

They are also very long-lasting – expect at least 5-8 years of use with the right care.

Latex Foam is Supportive, Breathable, and Responsive

Latex foam doesn’t typically provide as much pressure relief as memory foam, but it is more breathable and bouncy – making it better for warmer sleepers and those that switch positions often during the night.

Latex foam mattresses can also be customized to make them super-dense depending on your needs.

Click here to learn how latex mattresses can keep you cool.

Bonded Foam Mattresses May Be Better for Heavier Weighted Sleepers

Bonded foam mattresses are the most common orthopedic mattresses available in the market. 

They are often regarded as better materials for orthopedic mattresses due to their high density.

They also offer excellent support for your back and can assist people in getting in and out of bed with ease.

They are particularly useful for heavier people and are very affordable.

If your budget cannot accommodate a new mattress, try putting a wooden plank or plywood under the mattress to get additional support.

Click here to discover how an old saggy mattress can cause back pain.

3: Ensure That Your Pillow is Supportive Enough

The best test to determine if your pillow is providing you the necessary support is by assessing if you are waking up with a sore neck or upper back.

If yes, it’s time to change your pillow. 

Here’s how to choose a pillow to combat your upper back and neck pain:

Choose a Pillow Height of 3-6 Inches

The thickness of a pillow determines the alignment of the spine, especially of the neck and upper back. 

In general, thicker pillows are reserved for side sleepers whereas thin pillows are better suited for people who sleep on their back or front. 

4.5 inches is the best pillow thickness overall for back sleepers, whilst broader shouldered side sleepers may need a pillow thickness up to 6 inches or more – front sleepers may be more comfortable with a pillow that is 2 inches thick.

Choose a Memory Foam Pillow for More Comfort

Foam and latex pillows are best for people on a budget.

They provide adequate support and also reduce neck fatigue.

However, a memory foam pillow may be more suitable if you can afford it because it will contour to the shape of your head and neck more precisely for better spinal alignment and comfort.

Click here to find out how to wash a memory foam pillow.

Whole Body Pillows Can Provide Extra Support in All Sleeping Positions

Body pillows are long and elongated pillows designed to contour the shape of the user.

They relieve pressure on the spine, reduces muscle tension, and align the neck and head to promote sleep. 

Due to these qualities, body pillows offer good back support in any sleep position.

4: Consider Buying an Adjustable Bed for Easier Mobility

Not only can an adjustable bed alleviate back pain as you sleep by allowing you to manipulate the angle of the bed to suit your comfort preferences, being able to elevate the different sections of the bed can make it easier to get in and out of bed.

(Click here to see the best adjustable beds and mattresses for back pain).

This is relevant because getting in and out of bed may be challenging when you have upper back pain and stiffness.  

 Avoid bending forward and quick, jerky movements as they can cause you severe pain.  

Follow the sequence below to help you get in and out of bed when you have upper back pain:

  • To get into bed, firstly sit down close to the center of the bed.
  • While keeping your back straight and tightening your abdominal muscles, slowly ease your upper body to lie on your side.
  • Once you are comfortable, raise your legs up and place them on the bed, and carefully roll onto your back.
  • To get out of bed, roll onto your side and then extend your leg off the sides of the bed.
  • Push yourself to a sitting position with the help of your elbow and hand and slowly steady yourself and step down.

The video below shows you how to get in and out of bed properly when you have back pain:

How to Get Out of Bed with Lower Back Pain (Less Pain & Faster Healing)

5: Treat Acute Back Injuries With Bed Rest

Upper back pain caused by an acute injury is usually at its worst in the initial few days after the injury.

During this acute phase, complete rest is recommended. 

Rest nullifies the effect of abnormal posture, muscle imbalance, and gravity which may put further strain on the upper back.

You can rest on a bed or a comfortable sofa.

However, you should ensure to ease the strain on your neck and upper back by placing a pillow to support your head, neck, and upper back.  

Limit Bed Rest to 2-3 Days to Avoid Negative Health Affects

To get the most out of bed rest, limit the time period of rest to two or three days.  

Prolonged bed rest can do more harm than good since unused muscles can quickly lose their tone and bulk.

You may also develop constipation or blood clots in your legs and pelvis if you are immobile for prolonged periods. 

An extended period of bed rest is advised only in specific conditions such as an unstable vertebral fracture or a prolapsed intervertebral disc.

Follow your doctor’s advice strictly.

6: Reduce Load During the Day to Combat Pain at Night

If your hobby or work puts active stress on the upper back, it is better to avoid or modify the activity than work through the pain. 

Here are some points to bear in mind:

Bad Posture

Bad posture can cause and worsen upper back pain.

A sedentary lifestyle or sitting unsupported for long periods of time can cause structural changes in the back muscles that may eventually misalign the spine.

Leaning to one side while driving or working on the computer can also cause muscle imbalance and upper back pain.

A good sitting posture entails sitting with your back straight and shoulders back while ensuring that your body weight is evenly distributed on both hips.

Keep your knees bent at a 90-degree angle and the knees squared with your hips (use a footrest if needed).

Change your position every 30 minutes. 

Inappropriate Lifting Technique

Lifting heavy objects – especially overhead – can cause undue stress on the back muscles. 

The stress is worse if the object is not centered overhead while lifting. 

Try not to lift objects heavier than 20-30 pounds.

Make sure you have a firm footing with a wide stance.

While picking up the object, keep your back straight and stomach muscles tight.

You should bend at your knees and pelvis and straighten up with the help of your leg muscles. 

Walk with short, careful steps.

Overuse or Accidents 

Accidents and overuse of the upper back muscles can cause severe pain and stiffness. 

Take adequate precautions to avoid them.

7: Manage Pain With Non-Pharmacological Therapies

Where possible, you should use non-medicinal methods to manage your upper back pain so that you aren’t reliant upon medication.

Consider the following techniques:

Heat and Cold Therapy

Heat and cold can modulate the inflammatory response and pain. 

Application of ice for two days followed by heat is the recommended regimen for muscle pain.

Do not apply heat or cold directly onto the skin to prevent thermal injury.

Limit application to 20 minutes at a time.

Massage

Massage can provide some relief from back pain. 

Although temporary, a good massage can loosen muscles and increase the blood flow to the target area.  

You can use a foam roller or a ball to perform massage yourself or seek out a professional.

Physical Therapy

Physical therapy for upper back pain predominantly focuses on stretching and strengthening the upper back, neck, and core muscles. 

Treatment has to be customized for each individual and is done by a physiotherapist.

The full program typically progresses over a few weeks to months.

Initially, the program is supervised and later you may switch to an unsupervised maintenance program at home.

Manual Manipulation

Manual manipulation is performed by a chiropractor.

Using hand thrusts and other maneuvers, spinal and upper back adjustments are performed.

Additionally, it can loosen stiff muscles and align joints to decrease upper back pain. 

Electrotherapy

Electrotherapy involves the application of small electrical pulses to the painful area.

This is achieved by the use of a transcutaneous electrical nerve stimulator (TENS).

TENS causes a tingling sensation in the target area and blocks the perception of pain.

Acupuncture

Acupuncture involves placing thin needles in strategic positions or nodes on the body. 

Its ability to decrease tension and pain has been proven by research.

8: Aid Sleep With Home Remedies Rather than Drugs

Most patients do not need sleep medicines since sleeplessness is secondary to pain.

If sleep problems are prominent, give a trial of these sleep-promoting home remedies before considering taking sleeping pills:

Valerian Root

Valerian extract has sedative properties.

It is believed to be a safe supplement with additional anti-anxiety and sleep-promoting properties. 

Clinical trials have demonstrated the sleep-inducing effect of valerian extract.

Regular consumption is known to improve sleep quality by decreasing sleep latency and night awakenings.

Magnesium

Magnesium has a sleep-promoting and relaxing effect due to its ability to regulate melatonin hormone and gamma-aminobutyric acid levels in the brain.

Previous studies have demonstrated a combination of magnesium, melatonin, and vitamin B to be effective in the treatment of insomnia.

Studies on the use of magnesium (taken as 500 mg and 225 mg tablets) compared with a placebo have demonstrated an overall improvement in sleep quality in the group treated with magnesium. 

However, it is uncertain if the sleep-promoting effect would prevail in people without a deficiency of magnesium.

Supplements with magnesium are available in pharmacies as OTC supplements.  

Chamomile

Chamomile has a mild sedative action and can help ease insomnia.

The exact mechanism of chamomile is not clearly understood but is believed to be due to the action on the benzodiazepine receptors (the same receptors that are affected by sleeping pills). 

Drink a strong chamomile tea with 2-3 tea bags to get the sleep-promoting effect before bed.

Glycine

Glycine is an amino acid that can improve sleep quality.

A study successfully demonstrated the use of 3 mg of glycine before sleep time to improve objective measures of sleep quality compared with the placebo group.  

The study reported that the subjects fell asleep faster and performed better during the daytime.

While glycine is available as a supplement powder, its safety in different medical conditions is not established.  

Hence you should try supplementing glycine levels naturally by consuming glycine-rich foods such as bone broth, eggs, poultry, fish, beans, spinach, kale, cabbage, and fruits like bananas and kiwi.

Melatonin

Melatonin is a natural hormone that regulates sleep and wakefulness in humans.

Studies on exogenous melatonin supplementation have shown that it can improve the quality of sleep in people with sleep disorders.

These are available in strengths between 3 to 10 mg in pharmacies and can be obtained without a prescription in some countries.

Click here to find out if you can take melatonin when sick with a fever.

St. John’s Wort

St. John’s Wort has been historically used as a treatment for anxiety, depression, and insomnia by increasing the levels of serotonin in the brain.

Studies show that St John’s wort modulates and increases REM sleep and deep sleep.

However, preparations of St John’s wort interact with many other medicines.

Consult your doctor before using St John’s wort.

If none of these sleep cures works for you, it is time that you consult a doctor.

If you have severe sleep disturbances, your doctor may prescribe a short course of sleeping pills.

9: Talk to Your Doctor About Taking Pain Medications

If you cannot alleviate your upper back pain with natural remedies, then you should talk to your doctor about trying the most appropriate medicinal pain solution from the options below:

Over-the-Counter (OTC) Medications

These medicines work by decreasing the inflammation at the site of injury.

The most common drugs belong to the NSAID (non-steroidal anti-inflammatory drugs) group. 

These include ibuprofen, naproxen, and acetaminophen.  

These medications are also available without a doctor’s prescription.  

Follow the directions on the label to minimize the chance of experiencing any side effects.

Prescription Pain Medications

For severe, debilitating pain and muscle stiffness, short-term prescription medications may be advised.  

Medicines such as opioids and muscle relaxants may be prescribed by your doctor after a physical examination. 

These medicines have the potential for physical and psychological dependence and therefore are to be taken only for the period it is prescribed.

Steroid Injections

For severe spinal abnormalities causing upper back pain, epidural steroid injections may be advised.

Injections can provide short-term relief and is not a long-term solution.

10: Consider Surgery as a Last Resort

In rare cases, the management of upper back pain becomes predominantly surgical. 

This is usually when the integrity of the spinal cord becomes compromised due to severe spinal deformities or fractures and if the pain is very debilitating and unresponsive to conservative treatment. 

There are typically two types of surgical procedures:

Vertebral Augmentation

In this surgery, artificial bone cement is injected into the site of vertebral compression fracture.

This stabilizes the vertebral column and stops the painful movements. 

This is a minimally invasive surgery.

Spinal Decompression

This surgery attempts to relieve the pressure on a nerve root and/or spinal cord.

It prevents the worsening of damage by removing the offending agents such as herniated disc or bony overgrowth. 

Sometimes, the spine is fused after correction to prevent further injury.

These surgeries are complex procedures, especially when performed near the thoracic vertebrae due to their close proximity to several vital organs, and are performed as a last resort in most cases.

Guide to Upper Back Pain and Sleep

Below is a short guide that outlines the condition of back pain and how it can affect sleep:

What Are the Causes of Upper Back Pain?

The most common causes of upper back pain include muscle deconditioning and poor posture, muscle overuse, traumatic injury, herniated disc, pinched nerve, osteoarthritis, scoliosis, fibromyalgia, and myofascial pain.

More serious causes of upper back pain include lung cancer and spinal infections.  

Upper back pain is less common than neck and lower back pain. 

According to surveys, it is estimated that 1 in 10 men and 1 in 5 women suffer from upper back pain.

What Are the Symptoms of Upper Back Pain?

The symptoms of upper back pain are as follows:

General Discomfort

You may feel an achy or throbbing pain in the upper back.

This discomfort may also spread to other nearby areas.

Stiffness

Usually, stiffness is not a problem since the upper back is typically an area that is not built for motion.

However, severe stiffness may cause reduced mobility of the upper back muscles, ligaments, and joints and affect arm movements.

This can make movements such as rotation or lifting difficult.

Radiation of Pain

Pain can often be felt at a distant location when innervated by the same nerve.

This is called the radiation of pain. 

An injury to the thoracic nerve can radiate into the arm, chest, stomach, or further down the body.

It may feel like a dull ache or a sharp, electric shock-like sensation.

Tingling, Numbness, or Weakness

You may feel a pins-and-needles sensation, tingling, or numbness radiating from the site of injury.

It may also feel like a constricting band.

When Should You Consult a Doctor?

Most cases of upper back pain do not have any serious underlying causes.

Rarely, upper back pain is caused by progressive infections and spinal instability that impinges and irritates the root nerve or spinal cord. 

Such conditions should be regarded as a medical emergency and you should seek immediate medical care.

You should consult with a doctor if you have radiating pain, a pins-and-needles tingling sensation in the chest or abdomen, fever, incoordination, walking problems, or a severe headache that accompanies your upper back pain as this may be the result of a serious underlying condition.

Additionally, upper back pain after high-impact accidents or trauma should also be evaluated by a doctor.

What is the Link Between Sleep and Upper Back Pain?

Upper back pain can cause disrupted sleep.

Furthermore, repeated upper trunk movements such as getting in and out of bed, improper posture, and lifting weights can exacerbate pain and also delay healing.

How Do You Prevent Upper Back Pain Long Term?

Try the following strategies to prevent upper back pain long term:

Exercise and Increase Activity

Regular low-impact exercise and an active lifestyle can keep your upper back muscles toned and conditioned. 

You should cultivate habits such as regular walks and engage in non-contact sports and strength training.

Stretching your muscles and yoga may also be beneficial for conditioning the upper back.

If you have had a sedentary lifestyle, transition slowly and steadily into an active one and build up your endurance.

In addition to improving the upper back strength, exercise can also improve the quality of sleep. 

One of the best exercises to build up the back muscles, core stability, and flexibility is doing planks. 

Start by doing the exercise for 15 to 20 seconds while maintaining proper spinal alignment.

As your endurance builds, you can increase the duration as you see fit. 

However, you should not overwork your back muscles nor do the exercise with less than perfect posture. 

Watch the video below to learn how to do a plank exercise correctly and safely:

Bowflex® How-To | Planks for Beginners

Learn to Maintain Better Posture

Keeping your head in a neutral position puts the least amount of strain on the neck and upper back.  

Maintain this posture throughout the day while doing activities such as sitting, walking, or lifting heavy objects to reduce the risk of upper back pain. 

If your work requires long hours behind a computer on a daily basis, set up an ergonomic workstation.

If you lift weights, do so by bending with the knees when lifting.

If you carry a heavy backpack, place both straps over the shoulders instead of just one.

Quit Smoking

Many studies have pointed out that smokers tend to have chronic back pain and accelerated disc degeneration than non-smokers.

This probably happens due to the vasoconstrictive properties of nicotine which decreases the nutrient flow to intervertebral discs.

Decrease the number of cigarettes you smoke.

If you are unable to quit on your own, seek help from an addiction clinic.

Click here to discover how nicotine affects sleep.

Conclusion: Try Multiple Techniques

The most effective way to sleep better with upper back pain is to combine multiple techniques such as sleeping on your back on a medium-firm mattress on an adjustable frame; having the right pillow height; managing pain with natural therapies or medication, and using home remedies like valerian root to induce sleep.

I personally recommend the DreamCloud mattress for upper back pain based on my own experience of sleeping in it with upper back pain.

Click the button below to learn more about this medium-firm hybrid mattress in my first-hand review.


Sources and References

[1] Finley CR, Chan DS, Garrison S, Korownyk C, Kolber MR, Campbell S, Eurich DT, Lindblad AJ, Vandermeer B, Allan GM. “ What are the most common conditions in primary care Systematic review.” Retrieved on 04th July 2021.

[2] Cozen L. “Upper back pain”. Retrieved on 02nd July 2021.

[3] Ortega-Santiago R, Maestre-Lerga M, Fernández-de-Las-Peñas C, Cleland JA, Plaza-Manzano G. “Widespread Pressure Pain Sensitivity and Referred Pain from Trigger Points in Patients with Upper Thoracic Spine Pain”. Retrieved on 04th July 2021.

[4] Chung-Soo K, Jin-Yi H, Seunghwan K, Jin Tae H, Ki-Wan Oh. “Herbs for the Treatment of Insomnia”. Retrieved on 29th June 2021.

Medical Disclaimer

Although this article was written by a qualified and practicing medical doctor, no part of this website offers medical advice. Always seek professional medical guidance for your unique condition.

Image Attribution and Licencing

Main image: ‘Young Woman With Upper Back Pain Holding Spine’ by m-gucci (Getty Images) – used with permission under the terms of Canva’s One Design Use License Agreement.

Leave a comment