If you have sleep apnea and back pain, you may wonder whether poor sleep is making your pain worse or your back is keeping you awake. In many cases, both may be affecting how you feel.

Sleep apnea may not directly cause back pain, but poor sleep may increase pain sensitivity. Keep reading to learn how the two conditions may be connected and when to get medical care.

Can Sleep Apnea Cause Back Pain?

Sleep apnea wasn’t associated with back pain in one study, although poor sleep quality was.

🗳️ Do you experience back pain?

Yes, frequently

Yes, sometimes

No

Something else/Other

Thanks! You've successfully submitted your vote.

Sign up to view the results!

Continue with Facebook

Continue with Google

Continue with Email

By joining, you accept our Terms of Use, and acknowledge our collection, sharing, and use of your data in accordance with our Health Data and Privacy policies.

Already a member? Log In

Researchers are still studying this connection, but poor sleep and sleep apnea may affect how the body processes pain in several ways. Obesity is a major shared risk factor for both OSA and back pain.

Less Effective Pain Inhibition

Sleep loss may weaken the nervous system’s ability to control pain signals. In a small study, healthy adults became more sensitive to pressure and cold pain after staying awake for 24 hours.

Central Sensitization

Poor sleep may make the nervous system more sensitive to pain, causing low back pain to feel worse. With central sensitization, the nervous system may overreact to pain signals, making pain feel stronger or last longer.

Inflammation and Oxidative Stress

The repeated low oxygen caused by sleep apnea may increase inflammatory signals and unstable molecules called free radicals. These changes may make the nervous system more sensitive to pain.

Faster Biological Aging

One study found links among a higher risk of sleep apnea, faster biological aging, and more severe chronic low back pain. Researchers suggested that faster aging may affect tissue repair and how the body controls pain.

Can Back Pain Worsen Sleep Apnea?

Back pain may not directly narrow your airway, but it can add another layer of sleep disruption. Pain can wake you, shorten deep sleep, and make it harder to fall back asleep. The next day, added fatigue may make daytime sleepiness, poor focus, or morning discomfort from OSA feel more severe.

Position can complicate the picture. Some people with back pain find sleeping on their backs more comfortable. However, OSA is often worse in that position because the tongue and soft tissues can fall backward and narrow the airway. Side sleeping is often recommended for OSA because sleeping on your back can make apneas more common.

Also, research on chronic low back pain consistently finds a two-way link with sleep problems. Poor sleep may lead to worse pain, while pain can interrupt sleep and reduce sleep quality.

Which Signs May Be Related to Your Spine vs. Sleep Apnea?

The pattern of your symptoms can offer useful clues, but symptoms alone can’t confirm the cause. You may also have more than one condition at the same time.

How Are Sleep Apnea and Back Pain Evaluated?

A healthcare provider may need to assess sleep and back symptoms separately. For possible sleep apnea, an evaluation usually includes questions about snoring, breathing pauses, sleepiness, morning headaches, medications, and sleep position. A sleep specialist may recommend an overnight study in a sleep center or a home sleep apnea test.

For back pain, a provider may check posture, range of motion, strength, reflexes, sensation, and whether certain movements reproduce the pain.

Depending on your symptoms, testing may include:

• X-ray — To look for arthritis or broken bones
• MRI or CT scan — To look for a herniated disc or problems involving bones, muscles, tissues, or nerves
• Blood tests — To check whether an infection or another condition may be causing the pain
• Nerve studies — To check for pressure on nerves caused by a herniated disc or spinal stenosis, which is narrowing of the spinal canal

Keeping a short symptom diary may help. You can track:

• Sleep symptoms — Snoring, gasping, awakenings, morning headaches, and daytime sleepiness
• Pain pattern — Location, severity, movements or positions that trigger it, and whether pain travels
• Nerve symptoms — Numbness, tingling, weakness, or changes in walking
• Current treatments — CPAP use, medications, exercise, and physical therapy

How Are Sleep Apnea and Back Pain Treated?

Treatment depends on what the evaluation finds. Managing both conditions may improve sleep and daily function, even if one isn’t directly causing the other.

Treating Sleep Apnea

Continuous positive airway pressure (CPAP) is a common treatment for OSA. A CPAP machine sends steady air pressure through a mask to help keep the airway open. Effective treatment reduces breathing pauses and may improve daytime sleepiness and sleep quality. If CPAP does not work for you, there are other treatment options.

Other OSA treatments may include:

• Oral appliance — A device worn in the mouth moves the lower jaw or tongue forward to help keep the airway open.
• Weight management — For people with a higher body weight or obesity, losing even a moderate amount of weight may reduce airway narrowing and ease OSA symptoms. Tirzepatide (Zepbound) is FDA-approved to treat moderate to severe OSA in adults with obesity when used with a reduced-calorie diet and increased physical activity.
• Nerve stimulation implant — An implanted device stimulates the nerve that controls the tongue, moving it forward during breathing so it doesn’t block the throat. This option may be used for moderate to severe OSA when CPAP or BiPAP isn’t tolerated.
• Surgery — When other treatments don’t work, surgery may remove or correct tissue or structures that block the airway.

Treating Back Pain

Many cases of lower back pain improve with time, gradual activity, and home care. Heat and over-the-counter pain relievers, such as ibuprofen (Advil), may help.

Long periods of bed rest aren’t recommended. Light activity, such as walking, may help, but stop an activity if it increases your pain.

If at-home care isn’t working, additional back pain treatments may include:

• Exercise or physical therapy — Exercises may improve flexibility, strengthen the back and abdominal muscles, and improve posture. A physical therapist can also show you how to stay active without worsening pain.
• Prescription medication — Depending on the type of pain, a healthcare provider may prescribe anti-inflammatory drugs, muscle relaxants, certain antidepressants, or short-term opioids under close supervision.
• Surgical treatments — Surgery may help create more room around spinal nerves when a herniated disc or narrowed spinal canal causes increasing muscle weakness or pain that travels down a leg.
• Other procedures — Cortisone injections may temporarily reduce inflammation and leg pain. Other procedures may block pain signals by treating or stimulating nearby nerves.

When Is Back Pain Serious?

Most back pain isn’t an emergency, but certain symptoms may signal serious pressure on the nerves at the bottom of the spine. This is called cauda equina syndrome and requires immediate medical care.

Go to an emergency department right away for back pain with:

• New loss of bladder or bowel control
• Trouble starting urination or inability to empty your bladder
• New or quickly worsening weakness in one or both legs
• Numbness around the inner thighs, buttocks, or genital area
• Severe back or leg pain with rapidly changing nerve symptoms

Join the Conversation

On MySleepApneaTeam, people share their experiences with sleep apnea, get advice, and find support from others who understand.

Has back pain affected your sleep apnea? Let others know in the comments below.