Middle Back Pain While Sleeping: Symptoms, Causes & Tips

Middle Back Pain While Sleeping: Symptoms, Causes & Tips

By Dr. Shoaib Muhammad , published on August 10, 2023
Dr Shoaib Muhammad,MD

Waking up with a stiff and achy middle back isn't a good way start the day.

Because, when your sleep gets disturbed, it affects your whole life. 

The good news is that we have a deep dive on what you're experiencing and how to manage the issue. 

I'll also share some sleeping positions to avoid so you don't make it worse.

To start, if you'd like to know about the anatomy of your middle back, see the section below. If not, use the table of contents links to jump to the section you need. 

What Part Of The Back Is Considered Middle?

The middle back, also known as the thoracic spine, is the area between your neck and your lower back. The part of your back that lines up with your ribcage is the middle back we're talking about [1].

Anatomically speaking, the middle back is made up of twelve vertebrae labelled T1 to T12. These vertebrae are stacked on top of each other and play a crucial role in providing support and protecting your spinal cord.

Here's a quick breakdown of what's in there.

  • Vertebrae: These are the building blocks of your spine. They have a roundish shape and get larger as you move down your back.
  • Discs: These act like cushions between the vertebrae, absorbing shock and allowing flexibility.
  • Spinal Cord: A bundle of nerves that sends messages between your brain and the rest of your body.
  • Muscles and Ligaments: These provide stability and allow movement in different directions.

understanding middle back pain

What Are The Causes Of Middle Back Pain While Sleeping?

According to experts [1][2], there are a number of culprits that might be causing you middle back pain while you're in the Land of Nod. Here are the most common. 

Poor Sleep Posture

Do you ever wake up feeling like a contortionist?

When you sleep in unusual positions, your middle back muscles can get pretty tight and decide to protest. If you maintain good sleep posture, that will help you out a lot. We'll discuss more what that means later. 

Unsupportive Mattress and Pillow

Your mattress and pillow play a big role. If they're not supportive enough, it can cause many problems with your back, especially if you have a pre-existing condition or some kind of weak spot.

Muscle Imbalances

Imagine a seesaw where one side is a little too heavy. That's what happens when your muscles are imbalanced – some are pulling more weight than others. That can lead to middle back pain and discomfort too.

Injury or Overexertion

If you overdid it at the gym or you've been lifting too many pianos, your middle back might be feeling the aftermath.

Straining your muscles or injuring your spine during the day can come back to haunt you at night.

Back Pain Red Flags For Underlying Conditions

Sometimes, there are sneaky underlying issues at play, like herniated discs or arthritis. Most of the time if you have one of these, there will be other symptoms or red flags that would lead you to a doctor's visit.

Stress and Tension

When you're stressed, your muscles can tense up, and guess where that tension loves to express itself? You got it – your middle back.

Age-Related Back Pain

As the years go by, our bodies love to remind us that they're not invincible. With age, the discs between your vertebrae (those bony building blocks in your back) can start to wear down, causing middle back pain.

What Sleep Positions Are Best For Middle Back Pain?

If you want to show your middle back some love and snooze like a pro, let's talk about the best sleep positions and pillow arrangements. Say goodbye to middle back pain and hello to dreamy slumber [1][2][3][4].

Here's the lowdown on the top sleep positions for middle-back bliss.

sleep positions for middle back comfort

Side Sleeping

Side sleeping is great for your middle back. Just remember these tips:

Place a pillow between your knees to keep your hips aligned and reduce stress on your back. Hug another pillow to support your upper arm and shoulder.

Back Sleeping

Spread out on your back, supporting your middle back with these tricks:

Place a pillow under your knees to maintain your spine's natural curve. Consider a small rolled-up towel under your lower back for extra support.

Stomach Sleeping (with a Twist)

If you're a stomach sleeper, you can still make it work: Place a pillow under your pelvis and lower abdomen to ease the strain on your middle back.

Use a thin pillow for your head or opt for no pillow at all to keep your neck aligned. 

Pillow Under the Knees

This magical move supports the natural curve of your spine while sleeping on your back or side. Also consider picking up a custom knee pillow that's especially designed for this sleeping position. 

Body Pillow Hug

Hugging a body pillow can prevent you from rolling onto your stomach and help maintain a side sleeping position. SNUGL plans to make one of these in the future. 

Lumbar Roll

If you're a back sleeper, a small pillow or a rolled-up towel under your lower back can work wonders.

This is a different type of support to our lumbar cushion, although sitting nice and supported during the day will often help your middle back pain while sleeping. §

Adjustable Pillows

Consider pillows that can be customised to your comfort level, especially if you switch between different sleep positions.

Sleeping Positions To Avoid

Some sleeping positions are worth avoiding. The below examples are a little more rare as far sleeping positions go, but worth mentioning still since they will have a negative effect on your lower back.

Starfish Stretch

Sleeping flat on your back with your arms overhead can strain your middle back and shoulders.

Freefall Dive

Stomach sleeping with your head turned to the side can twist your neck and lead to middle back discomfort.

Fetal Position Curl

While the fetal position can be cosy, curling up too tightly can strain your back over time. 

Top 10 Tips For Middle Back Pain While Sleeping

Stretches will always be helpful for back pain. Since there are so many you can choose from, here's a selection that help specifically target your middle back pain and improve sleep [1][2][3][4].

tips for middle back health

Gentle Stretches and Exercises

  • Cat-Cow Stretch: On all fours, arch and round your middle back like a cat stretching.
  • Thoracic Extension: Sit tall and gently arch your upper back while clasping your hands behind your head.
  • Shoulder Blade Squeeze: Sit or stand and squeeze your shoulder blades together to strengthen your middle back muscles.
  • Wall Angels: Stand with your back against a wall and mimic a snow angel motion to improve mobility.

Mind Your Posture

Whether you're standing, sitting, or walking, maintain good posture. Imagine a string pulling you up from the crown of your head.

Ergonomic Support

Adjust your workspace to promote middle back health. Use a chair with good cushions and ensure your computer screen is at eye level. Our coccyx cushion is a good example, and the lumbar support that I mentioned above. 

Stay Active

Engage in activities like swimming, walking, or yoga to keep your middle back muscles strong and flexible.

Hot and Cold Therapy

Apply a warm compress or take a warm bath to relax tense muscles. Use an ice pack wrapped in a cloth for 15-20 minutes to reduce inflammation. Deep heat and other heat rubs can work well too. 

Massage and Foam Rolling

Gently massage your middle back using circular motions or a tennis ball. Roll a foam roller along your middle back to release tension.

Proper Lifting Techniques

When lifting objects, use your legs and keep the object close to your body to avoid straining your middle back.

Mind Your Sleep Environment

Invest in a mattress and pillows that provide proper support for your middle back. Ensure your sleep position and pillow arrangement are in sync with your middle back's comfort [3].

Hydration and Nutrition

Drink plenty of water to keep your muscles and discs hydrated. Consume foods rich in nutrients like calcium and vitamin D to support bone health.

Stress Management

Practice relaxation techniques like deep breathing, meditation, or mindfulness to reduce stress-induced muscle tension [4].

Is Your Side Sleeping Triggering Your Middle Back Pain? A Doctor’s Perspective

Middle back pain while sleeping on your side is a common concern that many people experience. While there might not be an extensive amount of specific research on this exact scenario, I will briefly go through the possible causes based on my medical knowledge and expertise.

When you sleep on your side, particularly if you're not using the right support, a few things can contribute to middle back discomfort.

Spinal Alignment

The position of your spine is crucial. If your mattress is too firm or too soft, it may not provide adequate support to maintain the natural curve of your middle back. This could lead to misalignment and discomfort.

Pillow Height

The height of your pillow matters. If your pillow is too thick or too thin, your head and neck alignment can be off-kilter, affecting the alignment of your entire spine.

Shoulder and Hip Pressure

Side sleeping can sometimes lead to increased pressure on your shoulder and hip, causing your spine to curve excessively. This can result in strain on the muscles and ligaments of your middle back.

Muscle Imbalances

If you consistently sleep on the same side, it can potentially lead to muscle imbalances over time. These imbalances could affect the stability of your spine and contribute to middle back pain.

    The Bottomline: A Doctor's Advice

    As a medical professional, I always emphasise the significance of addressing middle back pain while sleeping to ensure optimal spinal health and overall well-being.

    While specific sleep positions and pillow arrangements may alleviate discomfort for some individuals, it's essential to recognise that individual anatomy and underlying conditions play a pivotal role.

    If middle back pain persists or worsens despite implementing these strategies, seeking medical evaluation is recommended. A thorough assessment can help identify any potential underlying issues that may require targeted interventions or therapies.

    Remember, a restful and pain-free night's sleep is a fundamental aspect of your health, and seeking appropriate medical guidance ensures a comprehensive approach to managing middle back pain and promoting your overall quality of life.


    1. Healthline. Understanding and Treating Middle Back Pain. https://www.healthline.com/health/middle-back-pain

    2. Medical News Today. Middle back pain: Causes and relief. https://www.medicalnewstoday.com/articles/321195

    3. Mayo Clinic. Sleeping positions that reduce back pain. https://www.mayoclinic.org/diseases-conditions/back-pain/in-depth/sleeping-positions/art-20546852

    4. Healthline. The Best Sleeping Positions for Lower Back Pain, Alignment Tips, and More. https://www.healthline.com/health/healthy-sleep/best-sleeping-position-for-lower-back-pain