Our Sleep Expert Takeaways:

• Pain often wakes you up at night because prolonged pressure and poor spinal alignment increase sensitivity while your body is still. 
• The most effective relief comes from a combination of a proper mattress and sleep support, pain-relieving sleep positions and calming bedtime strategies that help the body relax and stay asleep. 

Does pain leave you tossing and turning at night? You’re not alone. Severe pain affects nearly 25% of adults in the U.S.

That pain has a bidirectional relationship with sleep: Stats show that up to 88% of those people with chronic pain report sleep disturbances. At least half of the people reporting insomnia report experiencing chronic pain.

“Most patients with chronic pain report intermittent sleep disturbances as their most common problem,” says Shamin Ladhani, Psy.D., a pain psychology specialist who has designed pain management programs. “The pain wakes them up, even if they can get to sleep easily.”

What Causes Pain To Wake You Up at Night?

Pain often wakes you up at night because prolonged pressure and tension make the body more sensitive during sleep. Focusing on the frustration of pain can turn into a cyclical series of anxiety and racing thoughts at night. Research notes that pain is not always an indicator that you’ll get bad sleep, but bad sleep can make pain worse. The theory is that sleep deprivation lowers dopamine and opioid receptors and increases negative moods, which makes people more sensitive to pain.

How Do Anxiety and Sleep Pressure Make Your Nighttime Pain Worse?

Knowing that sleep can help mitigate pain can either help or hurt the situation. Some may find that knowledge to be the motivation they need to focus on sleep. But for others, it might increase anxiety about the importance and elusiveness of sleep, causing an even greater challenge to get a good night’s rest. Whichever camp you’re in, we have tips and strategies for breaking up this complicated relationship between pain and sleep.

Anyone with chronic pain can tell you that feeling zingers, aka sudden flashes of pain, in bed while constantly shifting around to avoid pressure on certain spots can certainly make it a struggle to drift off. This tension can create mental barriers that get harder to break down over time. That’s why fully understanding the impact and link between chronic pain and insomnia can help.

“Pain can make someone toss and turn, but it can also become a psychological dysfunction because you know you won’t be able to sleep, so you start to fear it,” says Dr. Jyoti Matta, medical director at the Center for Sleep Disorders at RWJBarnabas Health.

Worrying about how you’ll sleep can also create a type of performance anxiety that leads to bad sleep as well, according to Dr. Chris Winter, president of Charlottesville Neurology and Sleep Medicine, author of “The Sleep Solution” and sleep advisor to Sleep.com.

“The way we feel about our sleep is often reflected in how we perform. You might not even notice a bit of back pain throughout the day, but when it’s time to go to bed, it creates tension and doubt that you’ll be able to go to sleep,” Winter says.

How Are Pain, Insomnia and Mental Health Connected?

There are also other mental health aspects to consider. Pain, insomnia and depression, which often occur together, can feed into each other, making each of the three conditions worse. The same goes for anxiety and substance-use disorders, which people with chronic pain are more likely to experience, hence why a multi-pronged approach might be required to break the cycle.

“Frustration with sleep can be amplified in pain patients. They hear that sleeping better will help with pain, and they feel like they must get eight hours or else, and that makes it hard to sleep,” says Winter. “We don’t want a fear-based model of sleep in anybody’s life.”

As frustrating as fatigue is, remember to be gentle with yourself around your sleeping habits. Winter recommends focusing on the next best thing: rest.

“If you’re in a comfortable position and your mind is in a good place and meditative, that’s quite restorative. If you sleep, that’s awesome, but if not, that’s OK too. You’re still succeeding by resting,” he says.

Common Pain Conditions That Disrupt Sleep

Knowing specifically where your pain comes from—or how much of the pain is physical or emotional—helps you formulate a more effective pain-management plan for short- and long-term pain. Even after healing from acute pain, which lasts up to six months, your sleep schedule may remain disrupted.

Certain conditions and disorders, however, are known culprits for poor sleep and insomnia, such as:

• Lower back pain affects 80% of adults; 59% report sleep disturbances.   
• Neck pain: 54% of people with neck pain report mild to severe insomnia.  
• Arthritis: As many as 8 in 10 people with arthritis face difficulty with sleeping.  
• Restless leg syndrome: 88% of people with restless leg syndrome have at least one negative symptom related to sleep, and most show signs of insomnia.   
• Sleep apnea: Although not classified as a “painful” condition, sleep apnea is associated with chronic pain and fatigue.  
• Shoulder pain: One of the most common types of musculoskeletal pain, this can be difficult to resolve. People who seek care for shoulder pain only have about a 50% chance of resolving it within six months.  
• Hip pain: Chronic hip pain is a common issue among adults ages 60 and up, as well as younger adults who play sports. Some research shows that more than 15% of adults over the age of 40 also experience hip pain. People with hip pain from osteoarthritis often have poorer sleep quality.  
• Sciatica: Caused by the compression of the sciatic nerve, sciatica is a frequent symptom of lower back pain. It’s rare among people under the age of 20, and research shows that it tends to affect men slightly more often than women.   

Remember that completely eliminating pain or achieving full sleep every night isn't a realistic metric for success. Winter advises resetting your expectations, which can go a long way toward reducing sleep anxiety.

“Don’t judge success or failure in bed in terms of consciousness. That’s where a lot of people get hung up,” Winter says.

How Can Mattress and Adjustable Base Technology Reduce Your Nighttime Pain?

Getting better sleep when you have pain often starts with changing what you do with your body—both in bed and out of it.

How Can Updating Your Mattress Help Reduce Nighttime Pain?

The first place to start is with your sleep system. Our bodies change as we age and adapt, and sleep needs can also change. Mattresses that offer contouring support and assist with correct spinal alignment can reduce lower back pain and improve sleep quality as well as sleep efficiency (the amount of time you stay asleep while in bed).

A 2022 study of people with chronic low back pain found that a mattress that supports the neutral spine in side-sleeping reduced pain lying down and improved comfort upon rising.

How Can an Adjustable Base Help Relieve Pressure at Night?

To maximize benefits, add an adjustable base, which can reduce pressure, aid circulation and relieve strain on joints and muscles. Together, these updates can not only reduce pain but also promote deeper, more restorative sleep.

Are There Other Sleep Products That Can Help With Nighttime Pain?

Yes, upgrading some key sleep products could lead to better rest. Slipping a bolster or wedge pillow under your knees, for example, could alleviate back pain that might otherwise disrupt sleep, says Ladhani. Even the pajamas you wear can help with the positions and quality of your sleep.

What Can You Do Before Bed To Reduce Nighttime Pain and Sleep Disruptions?

Once your sleep surface is properly supporting your body, small changes to how you wind down before bed can make a meaningful difference. These strategies focus on reducing tension, easing pressure and helping your body relax so pain is less likely to interrupt your sleep.

• Adjust your sleep position. Depending on where your pain is located, you may find it helpful to train yourself to sleep in a new position. A side sleeper with shoulder pain, for example, might catch more Zzz’s if they learn to sleep on their back instead.  
• Movement and exercise. Winter recommends that people with pain start with an exercise routine that’s “impossibly easy” to set them up for long-term success. That might mean taking a 10-minute walk or raising a 2-pound weight above your head 10 times before gradually increasing the intensity every few weeks or months.   
• Breathing. No, not just regular ‘inhales’ and ‘exhales,’ but carefully controlled, mindfully paced breathing can help with both chronic pain and sleep. Consider trying the 4-7-8 breath relaxation exercise, diaphragmatic breathing or the Papworth method to see which works best for you.  

What Are Some Mindset and Lifestyle Changes That Can Help With Nighttime Pain?

Getting better sleep when you live with pain often requires more than physical support alone. Your mindset and daily habits can influence how pain feels at night and how well you’re able to rest.

What Mindset Changes Can Help With Nighttime Pain?

Your mindset matters when it comes to setting expectations and realistic goals for restorative sleep. Here are some ways you can break out of the thought patterns that exacerbate both your pain and sleep:

Pain acceptance

Acceptance of pain is a psychological flexibility practice to reframe moments of distress. This includes a willingness to experience pain and choosing to continue positive activities despite pain, all through a nonjudgmental mindset. Research shows that pain acceptance helps lower levels of pain and negative emotions.   

Cognitive behavioral therapy for insomnia (CBT-I)

With this program, you’ll meet with a trained therapist or other healthcare professional regularly for 4 to 10 weeks. The sessions are designed to help you “learn what sleep behaviors you have that don’t promote healthy sleep and how to modify those, as well as how to work on underlying processes that might interfere with sleep,” says Ladhani.   

Mind-body movements

Deep and controlled breathing is shown to help with pain processing, so finding a meditative exercise (rather than an intensive one) may be a better choice for sleep and pain improvement. You can get a sense of mind-body movements by trying a yoga, tai chi or qigong class.   

Self-care

Prioritizing feeling good throughout the day (and especially right before bedtime) can help improve your sleep and make predictable pain less dreadful. That might mean soaking in a hot bubble bath, reading a book, tuning into relaxing music or even going through a hair-care ritual.  

Relaxation techniques

Other relaxation techniques, like progressive muscle relaxation, “the wave,” visualization and even sleep hypnosis, might also help take your mind off pain long enough for you to achieve sleep more quickly and consistently.   

What Lifestyle Changes Can Support Pain Relief at Night?

Getting better sleep when you live with pain also depends on practicing a healthy lifestyle. Small, consistent habits can help reduce inflammation, support your sleep‑wake cycle and make nights more manageable.

Avoid inflammatory foods

Certain foods, like sugar, saturated and trans fats, refined carbs and gluten, can trigger inflammation that worsens pain. Explore ways to swap these foods for more anti-inflammatory foods, like brightly colored fruits and veggies. A dietitian might also be able to help.   

Practice sleep hygiene

Incorporate good sleep habits into your routine. This includes getting up when you can’t fall asleep within a half hour and doing something that makes you drowsy (like reading a boring book) before trying to sleep again.  

Develop a daily schedule

Mapping out time to get some sunshine, eat consistent meals, exercise and finish other daily tasks can help keep your circadian rhythm on track, says Winter. Use a sleep diary to help pinpoint what’s working and what isn’t.  

Get a massage

Getting a professional massage has been shown to reduce joint pain and improve sleep for people with arthritis. It may also soothe pain in the lower back, neck and shoulders. Can’t afford to splurge on massages all the time? Try a self-massage at home, using basic tools like tennis balls and a pillow. 

Fine-Tune Your Treatment With Your Doctor

If you’ve tried everything, but pain and insomnia are still disrupting your everyday life, consider connecting with a medical professional for help. Depending on your personal challenge, this professional can be a pain specialist, physical therapist or psychologist. They can help you develop personalized strategies for better sleep and pain relief, including prescribing medications (if necessary) for both conditions.