The common causes of waking up with pain in the middle of the upper back include lumbar dorsal fasciitis, back cold, ankylosing spondylitis and cervical spondylosis. 1. Lumbar fasciitis: long-term chronic strain or sleeping in an inappropriate posture can lead to chronic inflammation of the muscle fascia, resulting in symptoms of pain in the upper middle of the back. 2. Cold back: Sleeping without paying attention to warmth, so that the back is cold, will lead to local muscle spasm contraction of the back, appearing in the middle of the upper back pain performance. 3. Ankylosing spondylitis: Ankylosing spondylitis is a chronic inflammatory disease with no clear cause, mainly affecting the spine and sacroiliac joints, which mainly manifests as pain and stiffness in the lower back, and may cause pain in the middle of the upper back. 4. Cervical spondylosis: Spinal cord cervical spondylosis can cause pain in the middle of the upper back due to stimulation of the spinal cord nerves. There are other causes of waking up with pain in the middle of the upper back, such as dislocation of the joints in the back, vertebral fracture and vertebral tumors, etc. It is recommended to go to the hospital in time for medical treatment, and after completing the examination and clarifying the cause of the disease, targeted treatment or therapy will be given.