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Lifestyle Foundations for Back Pain (Part 1): Sleep and Stress

By Dr. Mitch Whittal

Apr 17, 2026

Last week, we covered mindset and beliefs. This week, I want to zoom out to the daily habits that shape how your back feels. This is part one of a two-part series on lifestyle and general health. Today: sleep and stress. Next week: activity, bodyweight, and smoking.

Lifestyle Foundations

We could talk all day about the specifics of spine biomechanics, but the truth is that much of our ability to prevent and recover from back pain depends on our overall health and lifestyle choices. Getting enough sleep? Staying active? Maintaining a healthy body weight? Our lifestyle choices and habits are the foundations of our health. Addressing the following domains is equally important to your back health as any program or treatment approach. If there are two things that you take away from this two-part series, I'd like them to be:

  1. You can improve your quality of life with back pain, and
  2. You cannot ignore your general health in the process.

That being said, here are some additional domains of health worth focusing on:

Sleep

Sleep is so important that I have it first on my list. The downstream effects of chronic poor sleep are no joke. Rather than scaring you by listing the negative effects, we're going to take a more practical approach to this section.

Sleep is when all of our systems perform maintenance to prepare us for the next day. On a personal note, my wife and I recently became parents, and prioritizing sleep allows us to keep our sanity…well, kind of. Here are some sleep tips:

Routine

  • Go to bed and wake up at the same time. This sets your circadian rhythm – a kind of internal clock – that orchestrates your bodily processes.
    • An hour or so deviation here and there is not a big deal, so don't beat yourself up. A consistent sleep schedule is the goal. Your body will thank you.
  • Aim for about 7-9 hours of sleep per night.
    • You know when you have to be up, so do the math and hit the mattress then.
  • Avoid developing a monstrous 'bedtime routine.'
    • Reading for 20 minutes, meditating, stretching, a 20-step skincare routine, and gratitude journaling all sound nice but the inconvenience of requiring these tasks can act as a barrier to getting to sleep
    • Keep it simple and repeatable

Environment

  • Make your room cool and as dark as possible
    • Without covers, you should be cold, and just warm enough underneath thembattery-operated
    • We set our thermostat at 67°F
  • If you struggle to fall asleep:
    • No TV or phones in bed
    • Reduce your bright light exposure before bed
      • Turn the lights down in your house and use soft lighting from lamps or dimmers
      • My wife makes fun of me, but I swear by using minimal lighting in the bathroom with battery operated candles or night lights. Try it out yourself!
      • Turn your phone brightness down and switch on 'night mode.'

Position

  • Find a comfortable position for you and your back.
    • I personally like sleeping on my side with a pillow between my legs/knees
    • You may also like sleeping on your back with a pillow under your knees

Stress and Anxiety

When I was in school, my nervous system didn't seem to know the difference between taking an exam and having a near-death experience. Dramatic, I know. Chronic stress disrupts our systemic balance between anabolism (repair and growth) and catabolism (breakdown). This limits our resilience and manifests as weakened immunity, physical fatigue, and irritability, among others.

If you find that you're consistently in fight-or-flight mode, here are a few things to consider:

  • "Sigh breathing"
    • Inhale deeply, filling your belly and chest, then take another quick inhale to fully fill your lungs. Pause briefly
    • Then release your breath and let yourself deflate as if letting air out of a balloon.
      • Bonus tip - after trying this a few times, begin to exhale slower so that your exhales are longer than your inhales. This activates your parasympathetic nervous system, switching you out of panic mode
    • A few of these breaths can work wonders. Seriously, try it.
  • Adequate sleep and regular exercise increase our ability to tolerate stress!
  • Remain positive and interrupt negative thoughts
    • Catastrophizing or getting yourself worked up about traffic or something ridiculous you saw online just isn't worth your peace.

Next week, I'll be back with Part 2 — activity, bodyweight, and smoking. Until then, start with sleep. Pick one thing from the list above and give it a week.

As always, have a great weekend.

Best,

Mitch