A recent U.S. study published in Innovation in Aging1 has found a long-term association between back pain and subsequent sleep disturbances in older men aged 65 years and above. The research, based on longitudinal data from the Osteoporotic Fractures in Men Study (MrOS), suggests that back pain may be a risk factor for worsening sleep health later in life. Importantly, the study also found no evidence that early sleep problems predicted later back pain, clarifying the direction of this relationship.
MedBound Times reached out to Dr. Krishna Subramanyam, MS (Ortho), PDCR, Ph.D, Lead Surgeon and Senior Consultant in the Arthroscopy and Joint Replacement Unit, Department of Orthopedics and Sports Medicine at Yashoda Hospitals, Malakpet, Hyderabad, Telangana, for his insights on back pain and poor sleep. He notes that back pain after the age of 60 is “one of the most common problems we see in both men and women, and it is rarely due to a single cause.”
Researchers analyzed data from more than 1,000 community-dwelling older men who completed two clinical sleep assessments approximately six years apart.
Sleep health was measured as a composite of multiple domains, including sleep duration, regularity, daytime alertness, efficiency, timing, and satisfaction, collectively referred to as a multidimensional sleep health score.
Back pain reports were collected by mail every four months and categorized into measures including any pain, frequent pain, severe pain, and pain that limited everyday activity.
The analysis showed that older men who reported back pain, whether occasional or severe had a 12% to 25% higher likelihood of experiencing greater sleep problems six years later compared with those without back pain.
In contrast, measures of sleep difficulties at earlier timepoints did not predict subsequent back pain. This finding indicates a unidirectional relationship in which back pain precedes and potentially contributes to later sleep disturbances, rather than sleep problems leading to back pain.1
The sleep issues associated with earlier back pain were most evident in problems such as poor sleep satisfaction and irregular sleep timing, rather than classic sleep disorders like sleep apnea.
According to Dr. Subramanyam, this progression is frequently observed in clinical practice. “As the day progresses, pain in degenerative back conditions tends to increase because the muscles and joints fatigue over time. By evening or nighttime, this pain interferes with relaxation and sleep.” he explains.
Why does back pain tend to affect sleep more as people age?
Dr. Krishna Subramanyam: After the age of 60, back pain is usually not caused by a single issue. Bone density reduces, spinal joints degenerate, discs lose their cushioning effect, and muscles fatigue easily. By nighttime, this combination makes it difficult for the body to relax, leading to frequent awakenings and poor-quality sleep.
Are there warning signs older adults should not ignore?
Dr. Krishna Subramanyam: Pain that worsens by evening, stiffness after getting out of bed, difficulty turning in bed, or leg pain while walking that improves with sitting should not be dismissed as normal aging. These symptoms often indicate degenerative or nerve-related spinal problems that need evaluation.
Can early treatment really improve sleep?
Dr. Krishna Subramanyam: Yes. When we identify the cause early and treat it appropriately, whether through physiotherapy, bone strengthening, or managing nerve compression, patients often report significant improvement in both pain and sleep quality.
Back pain is one of the most common causes of disability in older adults, with prevalence increasing with age. Pain can interfere with multiple facets of sleep, from difficulty initiating sleep to frequent nighttime awakenings and may also contribute to daytime fatigue and reduced overall sleep quality.4
Dr. Krishna Subramanyam explains that age-related back pain often arises from multiple overlapping factors, including muscle fatigue, degeneration of spinal joints called facet joints, weakening of vertebral bones due to osteopenia or osteoporosis, and disc degeneration leading to nerve compression.
Our spine is not a single bone. It is a complex structure of vertebrae, joints, muscles, and nerves. With aging, each of these components can deteriorate, and together they produce persistent pain.Dr. Krishna Subramanyam, MS (Ortho), PDCR, Ph.D, Lead Surgeon and Senior Consultant in the Arthroscopy and Joint Replacement Unit, Department of Orthopedics and Sports Medicine at Yashoda Hospitals, Malakpet, Hyderabad
He adds that prolonged inactivity during sleep can worsen symptoms. “After six to seven hours of lying down, the anti-gravity muscles of the back are not immediately ready to bear body weight.” Dr. Subramanyam notes.
While this study focused on men, other research has indicated that sleep problems are widespread among older adults overall, 3and that sleep quality tends to decline with age as part of normal aging processes.
Taken together, these findings suggest that sleep disruption linked to pain may have consequences that extend beyond physical discomfort, influencing broader aspects of aging health.
A growing body of scientific evidence links poor sleep with accelerated cognitive decline in older adults. Research shows that both short and long sleep durations can be associated with reduced cognitive performance, possibly affecting memory, attention, and executive function.6
Longitudinal studies suggest that chronic sleep problems such as insomnia may increase the risk of cognitive impairment and dementia by altering brain processes linked to memory and neural repair. In one study tracking older adults’ brain health over several years, those with chronic insomnia had a 40% higher risk of developing mild cognitive impairment or dementia compared to those without chronic insomnia.6
Other research indicates that disrupted sleep may interact with biological mechanisms implicated in age-related neurodegenerative changes, such as impaired clearance of amyloid proteins, a hallmark of Alzheimer’s disease though the precise pathways are still being studied.5
Dr. Krishna Subramanyam emphasizes that untreated back pain can indirectly contribute to these risks. He says,
“Disturbed sleep, repeated nighttime awakenings, and chronic discomfort create a cycle of fatigue and frustration. Over time, this lack of restorative sleep affects not just physical health but mental clarity and overall well-being.”
The finding that back pain precedes sleep problems in older men emphasizes the importance of:
Early assessment of back pain in routine care for adults over 65
Integrating pain and sleep evaluations in clinical practice
Considering multifaceted interventions that address both pain and sleep health
Dr. Subramanyam stresses that management must be cause-specific rather than symptom-driven.
“We must first identify whether the pain is muscle-related, bone-related, joint-related, or nerve-related. Treatment then ranges from physiotherapy and muscle strengthening to bone-strengthening medications, braces for fractures, or neurological treatment when nerves are involved.”
He also highlights the importance of appropriate investigations, including blood tests to rule out inflammatory or metabolic causes, X-rays for structural assessment, MRI for nerve compression, and DEXA scans in women or men suspected of osteoporosis.
Because sleep disruptions are linked with other adverse aging outcomes, including declines in cognitive function, identifying and managing modifiable risk factors like pain may help support healthier aging trajectories.
Back pain in adults over 65 may predict poorer sleep health years later
Sleep problems do not appear to cause later back pain in this age group
Early identification and management of back pain may help preserve sleep quality
Addressing pain may support broader healthy aging outcomes, including cognition
Can back pain cause sleep problems in older adults?
Can back pain cause sleep problems in older adults?
Yes. Long-term research suggests that back pain in adults over 65 often precedes later sleep disturbances, likely due to nighttime discomfort, fatigue, and reduced ability to relax.
Does treating back pain improve sleep quality?
Clinical experience indicates that addressing the underlying causes of back pain through physiotherapy, pain management, or treatment of nerve or bone conditions can lead to better sleep quality in many older adults.
Should older adults seek evaluation for back pain even if sleep problems are mild?
Yes. Early assessment of persistent or worsening back pain may help prevent later sleep disruption and reduce the risk of broader health consequences linked to poor sleep.
References
Lee, Soomi, T. Muhammad, Eric J. Roseen, David T. McNaughton, Christina X. Mu, Cecilie Krage Øverås, Hazel J. Jenkins, Casper Nim, James J. Young, Howard A. Fink, Kristine E. Ensrud, David M. Almeida, Brent J. Small, Peggy M. Cawthon, and Katie L. Stone. 2025. “Back Pain Precedes Sleep Problems in Older Men.” Innovation in Aging 9, no. 11 (October 11): igaf113. https://doi.org/10.1093/geroni/igaf113.
Roseen, Eric J., David T. McNaughton, Stephanie Harrison, Aron S. Downie, Cecilie K. Øverås, Casper G. Nim, Hazel J. Jenkins, James J. Young, Jan Hartvigsen, and Katie L. Stone, for the Osteoporotic Fractures in Men (MrOS) Research Group. 2024. “Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Men: A Cohort Study.” Pain Medicine 25, no. 8 (May 13): 505–513. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11292054/.
Welsh, Travis P., Ailing E. Yang, and Una E. Makris. 2020. “Musculoskeletal Pain in Older Adults: A Clinical Review.” Medical Clinics of North America 104, no. 5 (July 15): 855–872. doi:10.1016/j.mcna.2020.05.002. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034863/.
Tatineny, Prathyusha, Farheen Shafi, Asma Gohar, and Adil Bhat. 2020. “Sleep in the Elderly.” Missouri Medicine 117, no. 5 (September–October): 490–495. PMCID: PMC7723148. PMID: 33311760.
Souza Ângela Maria Natal de, Dalila Pinto de Souza Fernandes, Isabella Silva Castro, Fernanda Gaspar Gróla, and Andréia Queiroz Ribeiro. 2025. “Sleep Quality and Duration and Frailty in Older Adults: A Systematic Review.” Frontiers in Public Health 13 (February 26, 2025). https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1539849/full.
Hyndych, Alexander, Rasha El-Abassi, and Edward C. Mader Jr. 2025. “The Role of Sleep and the Effects of Sleep Loss on Cognitive, Affective, and Behavioral Processes.” Cureus 17, no. 5 (May 16): e84232. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12168795/.