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.
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.
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
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.
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
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
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.
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/.
