How should you sleep if you have lower back pain?

Article feature on MedicalNewsToday, Medically reviewed by Deborah Weatherspoon, Ph.D., R.N., CRNA

Lower back pain can affect a person’s sleep as well as their daily activities, and sleeping in certain positions can cause or worsen the issue.

Below, learn about some appropriate sleeping positions for people with lower back pain. Then, find advice about choosing the right pillows and mattresses.

We also explore what having good sleep hygiene entails and when to see a doctor.

The best sleeping positions

Certain positions can place unnecessary strain on the neck, hips, and back, worsening, or even causing, back pain.

It is important to maintain the natural curve of the spine when lying in bed. To do this, make sure that the head, shoulders, and hips are aligned and that the back is properly supported. Sleeping on the back may help achieve this.

However, many people find that sleeping on their backs is uncomfortable or leads to snoring. Luckily, several other positions may also help improve the quality of sleep and reduce back pain.

Anyone with lower back pain might try the following sleeping positions:

On the back with knee support

Lying on the back evenly distributes the body’s weight, helping to minimize pressure and ensure a good alignment of the head, neck, and spine.

Placing a small pillow under the knees may provide additional support and help maintain the natural curve of the spine.

To get comfortable in this position:

  1. Lie flat on the back facing the ceiling. Avoid tilting the head sideways.
  2. Position a pillow to support the head and neck.
  3. Place a small pillow under the knees.
  4. For extra support, fill any other gaps between the body and mattress with additional pillows. Try placing one beneath the lower back.

On the side with a pillow between the knees

Lying on the side can be comfortable, but it can pull the spine out of alignment, straining the lower back.

It can be easy to correct this issue by placing a firm pillow between the knees. This raises the upper leg, restoring the natural alignment of the hips, pelvis, and spine.

To get comfortable in this position:

  1. Get into bed and carefully roll to one side.
  2. Use one pillow to support the head and neck.
  3. Pull the knees up slightly, and place another pillow between them.
  4. For extra support, fill any gaps between the body and mattress with more pillows, especially at the waist.

Anyone who usually moves from their side to their front may also want to try hugging a large pillow against their chest and stomach to help keep their back aligned.

In the fetal position

For anyone with a herniated disk, sleeping in the fetal position may help. This is because lying on the side with the knees tucked into the chest reduces bending of the spine and helps open up the joints.

To get comfortable in this position:

  1. Get into bed and carefully roll to one side.
  2. Position a pillow to support the head and neck.
  3. Draw the knees up toward the chest until the back is relatively straight.

On the front with a pillow under the stomach

This is generally considered the least healthy sleeping position — but for people who struggle to sleep any other way, placing a slim pillow beneath the stomach and hips can help improve spinal alignment.

Also, sleeping on the front may actually benefit anyone with a herniated disk or degenerative disk disease.

To get comfortable in this position:

  1. Get into bed and carefully roll onto the stomach.
  2. Place a slim pillow beneath the abdomen and hips.
  3. Use a flat pillow for the head, or consider sleeping without one.

On the front with the face down

Sleeping on the front is generally unhealthy when a person turns their head to the side, twisting the spine and placing additional stress on the neck, shoulders, and back.

To avoid this, try lying face down. To do so comfortably:

  1. Get into bed and carefully roll onto the stomach.
  2. Place a slim pillow beneath the abdomen and hips.
  3. Position a pillow or a rolled-up towel under the forehead to create enough breathing space between the mouth and mattress.

On the back in a reclined chair or bed

This might help people with lower back pain, particularly those with isthmic spondylolisthesis, a condition in which one spinal vertebra slips over the vertebra right below.

If a person gets significant relief from resting in a reclined chair, it may be worth investing in an adjustable bed that can be positioned in the same way.

Choosing a pillow

A pillow should maintain the natural position of the neck and help support the spine. Ideally, it should be comfortable and adaptable to different positions, and it should keep its overall shape.

Someone who sleeps on their back may be better suited to a thinner pillow because raising the head too much can strain the neck and back. Some thin pillows are specifically designed to support the neck.

Thin pillows are also ideal for placing under the hips, for people who sleep on their stomachs. Overall, memory foam may be a good option because it conforms to the shape of the head and neck.

People who sleep on their sides may be suited to thicker pillows. These should fill the space between the neck and mattress completely. A gusseted pillow might be an excellent choice.

People who sleep on their stomachs should use thin pillows or none at all because pushing the head backward places pressure on the neck.

Or, a person might try sleeping face down with a small, firm pillow propping up only their forehead. This leaves enough room to breathe but helps ensure that the neck stays straight.

Choosing a mattress

A mattress should be well made, supportive, and comfortable. Some people believe that a firm mattress is better for the back, but some evidence suggests that a medium-firm mattress is better for people with long-term lower back pain.

Body shape and size can help determine how much support a mattress should have. A person with wider hips may be better suited to a softer mattress, and a person with narrower hips may need a firmer one to keep their spine properly aligned.

Although they can seem more comfortable, softer mattresses provide less support. Sinking too deep can cause the joints to twist and the spine to come out of alignment.

A foam mattress topper can provide additional support to a spring mattress. Alternately, placing a plywood board beneath a mattress can increase firmness.

Sleep hygiene

Back pain can significantly disrupt sleep. Even so, it is best to try to maintain a regular schedule with consistent sleep and wake times, rather than sleeping in to compensate for lost sleep.

Most adults need 7–9 hours of sleep in every 24-hour period.

General sleep hygiene tips include:

  • avoiding stimulants, such as caffeine, in the evenings
  • avoiding heavy exercise in the hours leading up to bedtime
  • winding down before bed by reading, taking a warm bath, listening to relaxing music, or doing gentle yoga
  • making the bedroom a relaxing place by dimming the lights and removing distractions, such as computers and phones or TVs

When to contact a doctor

Anyone with severe or worsening back pain, particularly after a fall or injury, should speak with a doctor. Also, do so if any back pain gets worse after resting or sleeping.

Seek immediate medical guidance if back pain is accompanied by any of the following:

  • fever
  • chest pain
  • numbness in the legs, buttocks, or groin areas
  • difficulty passing urine
  • a loss of bladder or bowel control
  • unexpected weight loss

If back pain is causing long-term lack of sleep, speak with a doctor about treatment options and other strategies that can help.

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