Back pain in older men may lead to sleep problems years later, according to a study by U.S. researchers. The findings suggest that it is chronic back discomfort—rather than sleep disturbances—that more often initiates a cascade of declining well-being in older age. The study was published in the journal Innovation in Aging.

About half of men over the age of 65 experience either back pain, sleep problems, or both conditions simultaneously. However, until now it was unclear which condition tends to occur first and trigger the other.

The researchers analyzed data from the large Osteoporotic Fractures in Men Study, which included 1,055 older men. All participants underwent clinical sleep assessments twice, with an interval of at least six years between examinations. In the period between these visits, they completed mailed questionnaires every four months, reporting the frequency and intensity of back pain.

Sleep disturbances were assessed using several measures: irregular sleep schedules, insufficient sleep duration, daytime sleepiness, and subjective satisfaction with sleep quality. The researchers then compared sleep parameters at the first assessment with the severity of back pain six years later—and vice versa.

The results were clear: back pain predicted an increase in sleep problems several years later, whereas poor sleep did not increase the risk of future back pain. According to the researchers’ estimates, the presence of back pain was associated with a 12–25% increase in the severity of sleep disturbances six years later.

In addition, men with back pain were more likely to fall asleep either too early or too late and were less satisfied with the quality of their sleep.

The authors emphasized that the study included only men, and further research is needed to determine whether this pattern holds true for women and for other ethnic groups, which were underrepresented in the sample. Nevertheless, the researchers note that regardless of sex or background, people with back pain should discuss treatment options with a physician—from therapeutic exercise to physical therapy.

“Now that it is clear that back pain precedes sleep problems, it becomes evident that effective pain management and maintaining mobility may be key to preserving good sleep quality and overall health in older age,” the researchers concluded.