Back Pain That Wakes You Up at Night: What It Can Mean

If your back pain wakes you up at night, it can be unsettling. You might wonder, “Is this serious?” Sometimes the answer is no — but nighttime pain is one of those symptoms you shouldn’t ignore, especially if it’s new, worsening, or coming with other changes in your health.

Let’s walk through what nighttime back pain can mean and what you should do next.

The Most Common (and Less Concerning) Reasons

A lot of nighttime pain comes down to mechanical issues — meaning your spine, muscles, or joints are irritated and your sleeping position keeps poking the problem.

This can happen with:

• Muscle strain that gets stiff when you’re still
• Arthritis in the spine that aches more at rest
• A herniated disc that flares in certain positions
• Mattress or pillow problems (too soft, too firm, poor support)

If your pain improves once you change positions, get up and walk around, or feels better during the day, that often points to a mechanical cause.

When Night Pain Can Be a Red Flag

Here’s where you want to pay closer attention: back pain that is persistent at night and doesn’t improve when you shift positions.

Call a medical professional promptly if nighttime back pain comes with:

• Fever, chills, or feeling ill
• Unexplained weight loss
• History of cancer
• New numbness, tingling, or weakness
• Pain that keeps getting worse week by week
• Loss of bladder or bowel control

Night pain can be associated with inflammation, infection, fractures, or tumors — not commonly, but enough that it’s worth checking if red flags are present.

A Simple Self-Check Tonight

Before you spiral (understandable), quickly ask yourself:

• Does the pain ease when I change positions?
• Is it worse after physical activity or better?
• Do I have any other symptoms like fever or weakness?

What You Can Do Right Now

Try these steps for the next few nights:

• Sleep with a pillow under your knees (back sleepers) or between knees (side sleepers)
• Use heat 15–20 minutes before bed
• Avoid late-evening heavy lifting or bending
• Keep short walks in your day to reduce stiffness

If this keeps happening for more than a week, or you have any red flags, a spine specialist can evaluate the cause and get you a plan that actually addresses it 

Virginia Spine Specialists is an award-winning, minimally invasive spinal care practice with locations in Fredericksburg, VA and Manassas, VA. We also serve these Northern and Central Virginia locations: Haymarket, Gainesville, Culpepper, Front Royal, Spotsylvania, Stafford, Colonial Beach, Tappahannock and Lake Anna.