Sleep disorders associated with back pain

Insomnia due to chronic back pain? In our centre in Vilnius we apply a complex method of treatment of sleep disorders caused by vertebrogenic pain. The combination of kinesiotherapy, myofascial release and functional correction of the spine eliminates not only the symptoms but also the causes: muscle spasms, protrusions, functional blocks.

Treatment of sleep disorders for back pain at the Paupio Kinezioteka Clinic Centre¶

Why back pain destroys sleep quality¶

Vertebrogenic Insomnia.

a persistent sleep disorder caused by chronic spinal pain characterised by difficulty falling asleep, frequent awakenings and non-restorative sleep. It is accompanied in 78% of cases by muscle spasms, restricted mobility and morning stiffness.

Main causes of painful insomnia:¶

Patients often try to solve the problem with sleeping pills, ignoring the root cause - structural abnormalities of the spine.

The key provoking factors are:

Muscle-Tonic Syndrome.
- Paravertebral muscle strain.
- Spasm of the iliopsoas muscle (nocturnal ‘shooting’).
- Trigger points in the trapezius muscle.
Functional blocks.
- Limitation of mobility of the thoracolumbar junction (Th12-L1)
- Rotational displacements of vertebrae
- Nerve root impingement with changes in body position.
Postural imbalance
- Lumbar hyperlordosis
- Uncomfortable pillow syndrome in cervical osteochondrosis.
- Nocturnal calf muscle spasms.

Important!

Prolonged use of sleeping pills without eliminating the cause leads to:
- Increased muscular hypotonia.
- Progression of degenerative changes
- Formation of persistent insomnia

Pathogenesis of Painful Insomnia: How Spinal Problems Destroy Sleep¶

1. Nocturnal hypoxia and muscle spasms.¶

Or "why shortness of breath with back pain" and the occurrence of "shortness of breath in sleep with osteochondrosis".

Mechanism of development:¶

Spasm of respiratory muscles (intercostal, ladder muscles) - restriction of chest mobility
Explanation: In chronic pain, a ‘guarding’ hypertonus is formed, reducing the depth of inspiration by 30-40%.
Diaphragmatic blockade - decrease in amplitude of diaphragm movements to 1-2 cm (norm 4-6 cm)
Example: Patient with L4-L5 hernia subconsciously restricts abdominal breathing to reduce pain.
Metabolic vicious cycle:
Lactic acid accumulation - increased spasm - new pain impulses - awakenings at 3-4 am.

2. Proprioceptive chaos: when the body ‘lies’ to the brain.¶

Or ‘restless sleep with back pain’ and ‘why can't I find a comfortable position?’

Signal transduction disorders:¶

Distorted afferentation (signals coming from the joints of the spine).
Explanation:Facet joint protrusions and arthrosis produce false signals of ‘wrong’ body position.
Disorientation of the reticular formation (the brain structure responsible for sleep cycles).
Example: Pain impulses from a twisted pelvis are perceived as a danger signal, interrupting the deep sleep phase.
Phenomenon of ‘phantom discomfort ’ - patient constantly tosses and turns, although objectively the posture is physiological.

3. Circadian disasters: broken biorhythms.¶

Or ‘sleep disturbance in chronic pain’ and ‘how pain affects melatonin production.’

Hormonal and neurological shifts:¶

Melatonin deficiency
Mechanism: Constant pain impulses depress the epiphysis, the gland that produces the ‘sleep hormone’. Melatonin levels can drop up to 60% of normal.
Hypersympathicotonia at night
Effects: Instead of the proper nighttime ‘inhibition’, the nervous system remains alert. Blood pressure and HR do not decrease as in healthy individuals.
An imbalance of IL-6.
Fact: In back pain, its levels are 45% higher than normal at night, which directly disrupts sleep patterns.

Clinical markers of pathology (what the doctor sees):¶

Parameter	Normal	In pain insomnia
Night saturation	≥95%	88-92%
Number of turns	10-15/night	25-40
Sleep latency	10-20 min	60+ min
Deep sleep phase	20-25%	<10%

For patients: These abnormalities explain why common sleeping pills don't work for back pain - they don't affect the mechanisms listed.

Vertebrogenic Pain Sleep Rating Scale (SVS-6):¶

Parameter	Score (0-3)
Time to fall asleep	>30 min = 3
Number of awakenings	>4 = 3
Morning stiffness	>60 min = 3
Sleep posture	Sleep posture forced = 2
Sleep efficiency	<65% = 3
Daytime sleepiness	Severe = 3

Interpretation

15 points - severe insomnia requiring complex treatment

Treatment history of a patient with painful insomnia¶

We were approached by a 52-year-old man with a 3-year history of sleep disturbances against a background of chronic low back pain.

‘I forgot what it was like to sleep through the night...’¶

‘After an episode of heavy lifting, I developed constant aching pain in my lower back. Painkillers helped at first, but eventually the pain started waking me up 5-6 times a night. I woke up from every movement, could not find a comfortable position. In the morning I felt broken, as if I had not slept at all.

Consultations with neurologists, blockades, massages gave only temporary relief. MRI showed L4-L5 protrusion, but surgery was not recommended. When I came to Paupio Kinezioteka Clinic, my condition was rated as:

SVS-6: 19 points
Limitation of lumbar flexion: 45° (normal 70-90°)
Spasm of the quadratus lumborum muscle on the right side (soreness 8/10 on VAS)
Nocturnal saturation: 92% (episodes of hypoxia up to 85%)

Saturation

Saturation (SpO₂) is a measure of the percentage of oxygen in the blood relative to its maximum possible saturation.

Physiological norm:

95-100% is the norm for a healthy person.
90-94% - possible sign of hypoxia (requires observation).
<90% - critical level (requires medical attention).

Diagnostic algorithm¶

Functional analysis of sleep posture.
- IR camera video recording
- Identification of abnormal motor patterns
Myofascial mapping
- Trigger points in the iliopsoas muscle
- Asymmetry in tone of the multifascial muscles.
Breath monitoring
- Decreased amplitude of diaphragmatic movements (40% of normal)
- Apnoea pattern when turning to the right side.
Stabilometry
- 65% anterior displacement of CD
- Violation of postural reflexes

position apnoea

The pattern of ‘apnoea of position’ when turning on the right side is a specific breathing disorder characterised by brief respiratory arrest (apnoea) or a significant decrease in respiratory amplitude, occurring exclusively or predominantly when the body is positioned on the right side.

Strategy for the treatment of sleep disorders in vertebrogenic pain¶

After studying our patient's medical history, a personalised strategy was developed using a comprehensive approach.

Three stages of restoring healthy sleep¶

1. Pain management (first 4 weeks)¶

Eliminate muscle spasms that interfere with sleep posture change.
Restore physiological mobility of the spine
Normalise diaphragmatic breathing at night.
Relieve compression of nerve roots

2. Correction of postural disorders (6-8 weeks)¶

Form new motor stereotypes for sleep
Restore muscle balance of paravertebral muscles
Eliminate positional dependence of apnoea
Stabilise the lumbo-pelvic region

3. Consolidation of results (4-6 weeks)¶

Automatise correct positional shifts during sleep
Teach self-help techniques for night awakenings.
Develop an individualised support programme
Conduct a polysomnography check-up.

Three-module programme for the treatment of painful insomnia at Paupio Kinezioteka Clinic¶

Our centre uses a three-module recovery programme for comprehensive treatment. (Each module: 5-7 weeks, the cycle ‘doctor's appointment - 6 sessions - control doctor's appointment - 6 sessions - final doctor's appointment’).

For our patient we adjusted the programme taking into account his individual characteristics and symptoms. As a result, the patient followed the following programme:

Module 1: Overnight Decompression (4 weeks)¶

Goal

To suppress pain syndrome, to restore physiological sleep postures

Main procedures:¶

Position therapy on Speedience:
- Anti-gravity hangs (25% of body weight)
- Lumbar traction in physiological sleep positions
- Correction of rib and spine articulations
Breathing Rehabilitation:
- Diaphragmatic activation in supine positions
- Sleep Breathing exercises
- Myofascial release of intercostal muscles
Antispastic Protocol:
- Cryotherapy of paravertebral areas before bedtime
- Postisometric relaxation of the iliopsoas muscle
- Lumbar Kinesiotaping at bedtime

Clinical control parameters

Reduction of night awakenings by 50%
Increase in the amplitude of diaphragmatic movements up to 60% of the norm
Reduction of VAS pain syndrome to 3/10.

Module 2. Positional Correction (6 weeks)¶

Goal

To eliminate the dependence of apnoea on body position, to restore muscular balance.

Key methods:¶

Biomechanical correction:
- Asymmetrical loading for pelvic alignment
- Lumbar stabilisation on unstable platforms
- Virtual reality to practise turning in sleep.
Breathing adaptation:
- Paradoxical breathing training in problematic postures
- Exercises with a load waistcoat (2-3% of body weight)
- Overnight saturation monitoring with feedback
Neuromuscular realignment:
- EMG training of deep neck flexors.
- Proprioceptive stimulation in dark conditions
- Method of ‘controlled awakening’

Effectiveness Criteria

Disappearance of positional apnoea in 80% of cases
Restoration of physiological turning pattern
Increase in sleep efficiency up to 75%

Module 3. Sleep Stabilisation (4 weeks)¶

Goal

To consolidate results, to create stable sleep reflexes.

Stabilisation Programme:¶

Functional Training:
- Sleep-wake exercises according to circadian rhythms.
- Multi-sensory vestibular stimulation.
- Heart rate variability training.
Home Monitoring:
- Smart mattress with position correction
- Mobile app to analyse micro-awakenings
- Real-time muscle tone sensors
Preventive Complex:
- 15-minute evening ritual
- Emergency wake-up self-correction techniques
- Personalised scheme of supportive exercises

Important

The programme requires strict adherence to the steps: - Skipping module 1 reduces effectiveness by 60% - Violation of the sequence leads to relapses

Unique technologies of the centre¶

Video analysis of sleep movements:
- IR-illuminated video analysis of sleep movements.
- Reconstruction of breathing patterns
- Prediction of micro-awakenings
Biocontrolled decompression:
- Adaptive loading on Speedience simulators
- Real-time muscle response sensors
- Automatic programme correction
Circadian Synchroniser:
- Individualised light programmes
- Thermoregulatory stimulation
- Melatonin-centred training

Improvement Trends¶

Parameter	Before treatment	After treatment
SVS-6	19	7
Number of awakenings	5.8 ± 1.2	1.2 ± 0.4
Overnight saturation	92%	96%
Lumbar flexibility	45°	68°
Pain syndrome (VAS)	7.5/10	2.1/10

Unique aspects of our approach¶

Positional Sleep Coaching.
- Training of ‘sleepy’ movement patterns
- Virtual reality for practicing turns
Nighttime biomechanics
- 3D sleep kinematics analysis
- Precision correction of micromovements
Circadian synchronisation
- Light therapy for individual chronotype
- Melatonin-oriented exercises

Result

89% of our patients report:
- Increase in sleep duration by 2-3 hours
- Reduction of pain syndrome by 67%
- Recovery of performance during the day

Why develop chronic insomnia with back pain?¶

Many patients with vertebrogenic insomnia make the fatal mistake of trying to solve the sleep problem in isolation, using only sleeping pills or folk remedies. They don't realise that nighttime low back pain and frequent awakenings are links in the same chain. Without addressing the root cause - muscle spasms, pelvic misalignment, or blocks in the spine - insomnia will return again. Key search terms: "how to sleep with back pain “, ”waking up with lower back pain ’.

The main mistakes in self-treatment of chronic insomnia¶

Agnoring positional dependence.
Patients do not attribute deterioration in sleep quality to body position, even though it is the night turning that triggers muscle spasms. Queries: "why my back hurts when I lie on my side", "how to sleep with a lumbar hernia".
Underestimation of respiratory distress
Spasm of the diaphragm and intercostal muscles causes nighttime hypoxia, but people write it off as ‘bad pillow’. Popularly searched for: *‘choking in my sleep with osteochondrosis’.

Why is kinesiotherapy overlooked in the treatment of chronic insomnia?¶

Most people perceive treatment of insomnia as the domain of neurologists and somnologists, unaware of the potential for functional spinal recovery. Fear of exercise for pain and myths about the ‘harm of exercise for herniated discs’ discourage the right solution.

Breakthrough in the treatment of chronic insomnia: a kinesiological approach¶

When patients learn about personalised sleep programmes combining:

Spinal Decompression
Breath training
Sleep posture correction.

they get resilient results where traditional methods have failed. Testimonials confirm: "after kinesiotherapy I sleep through the night “, ”no more night pains without pills ’. The key benefit is treating the cause, not the symptoms.

Get your healthy sleep back today¶

Don't put it off!¶

Every sleepless night increases
- Muscle imbalances
- Degenerative changes.
- Chronic pain syndrome.

Sign up for a comprehensive sleep and musculoskeletal diagnosis at Paupio Kinezioteka Clinic!

✅ Individualised protocol
✅ Biofeedback technology
✅ Proven effectiveness

Patient Testimonial

‘After 3 months of treatment I was finally able to sleep for 6 hours without waking up. It's a fantastic feeling to wake up feeling rested!’