Sleep and pain are closely linked, and many people notice their symptoms feel worse in the evening or at night. This often relates to how the nervous system, muscles and joints respond to tiredness, reduced distractions and long periods in one position.
Why pain can feel worse at night
- When the day quiets down, there are fewer distractions, so the brain pays more attention to pain signals that were easier to ignore when you were busy.
- Fatigue, stress and low mood later in the day can increase pain sensitivity, so the same level of tissue irritation can feel more intense.
- Being still for a long time allows joints and muscles to stiffen slightly, so when you wake or turn in bed, movements can feel sharper or more uncomfortable.
How sleep position affects your spine
- Lying on your stomach often forces the neck into rotation and extension, and can increase load on the lower back, especially if the mattress is very soft.
- Side‑lying can work well for many people, but if the pillow is too low or high, the neck may be bent all night; if the top knee drops forward without support, the lumbar spine and pelvis can twist.
- On your back, a very flat pillow can let the head fall backwards, irritating the neck, while a very hard mattress may increase pressure on the sacrum and heels.
Small changes that can ease sleep
- For side sleepers: use a pillow that keeps the neck in line with the rest of the spine and place a cushion between the knees to reduce twisting through the pelvis and lower back.
- For back sleepers: try a slightly higher pillow to keep the neck neutral and, if the lower back feels tight, place a small pillow or folded towel under the knees to reduce lumbar arching.
- If you must sleep on your front, use a very thin pillow or none under the head and consider a small pillow under one hip to reduce strain on the lower back and neck rotation.
Routines that support better nights
- A consistent wind‑down routine (lower light, screens off, gentle stretching or breathing exercises) can calm the nervous system and lower pain sensitivity at bedtime.
- Gentle mobility or short walks during the day help prevent stiffness from building up, so the body is less reactive when you finally rest.
- If pain wakes you, changing position, getting up briefly for a slow walk, or doing a few gentle movements is often more helpful than lying still and tensing against the discomfort.
