How to Sleep With Lower Back Pain

• Persistent lower back pain can affect sleep quality, though there are some sleeping positions and other tips that can help.
• Some positions may reduce tension and make it easier to sleep, while others, such as stomach sleeping, may exacerbate neck and back conditions..
• Continue reading to learn about the best sleeping positions for alleviating lower back pain and other steps that promote a good night’s sleep.

Back pain is a common symptom, whether it stems from an injury, a chronic condition, or poor posture. In fact, it’s estimated that up to 84% of adults will experience back pain at least once during their lifetime. Regular back pain may disrupt sleep, causing you to toss and turn at night, making restful sleep feel like an impossibility.

Some sleeping positions and other bedtime habits may help alleviate discomfort and improve overall sleep quality. Additionally, chronic pain, which lasts for weeks or months at a time, is often a sign to see a healthcare provider. They can diagnose your back pain, identify contributing underlying medical conditions, and offer additional support.

Lower back pain is commonly associated with a decrease in sleep quality. In a 2022 study, for example, 80% of people with lower back pain due to fibromyalgia reported sleep troubles. 

At the same time, the relationship between sleep problems and back pain is bidirectional, meaning a lack of sleep can also make back pain worse. A different study followed people managing lower back pain for two years. By the end of that period, those with worse sleep quality reported more pain.

This doesn’t mean sleep problems cause back pain or that back pain will always lead to sleep difficulties. It does, however, mean that there is a connection between the two. Improving sleep may reduce pressure and pain on the lower back, and alleviating back pain may help with sleep.

An effective way to relieve pressure and pain in the lower back is to sleep with proper spine alignment. Certain sleep positions promote alignment and reduce muscle tension, while others can intensify it. 

These four sleep positions may help relieve excessive pressure by offering more support to your lower back.

1) Sleeping On Your Back (With Optional) Knee Support

One of the most recommended positions for lower back pain relief is to sleep on your back, which is referred to as the supine position. This position does not strain the spine, making it a more neutral position for the back.

Tip: If you feel pain sleeping on your back, place a pillow underneath your knees to possibly help with spinal alignment.

2) Sleeping On Your Back In a Reclined Position

Another position that may help is Sleeping on your back in a reclined position, meaning your upper body is raised slightly, maintains the natural curve of your spine, relieving stress and strain on your vertebrae and spine muscles. 

Tip: This position may relieve pressure in the lumbar region for back sleepers, but it’s easier to maintain if someone has a bed that allows them to adjust their head level.

3) Side Sleeping 

If sleeping on your back doesn’t feel naturally aligned, sleeping on your side may be ok too. Side sleepers, however, want to make sure their body isn’t uneven, by avoiding positions such as tightly pulling the knees toward the chest or having one leg curled and the other straight.

Tip: To keep the hips and spine aligned, place a firm pillow between your knees. Depending on your preferences, a soft pillow might work better.

While the best sleeping position varies from person to person, a few are associated with worsening lower back pain:

Sleeping on Your Stomach 

The position that most frequently exacerbates back pain and spine discomfort is stomach sleeping. This position not only puts more strain on the back, it may also cause neck strain since the head must be turned one way or another to breathe. For stomach sleepers, placing a pillow between your pelvis and lower abdomen may help relieve some pain, though this position isn’t recommended.

Sleeping in the Fetal Position 

Evidence is mixed on whether sleeping in the fetal position (on your side with your legs curled up into your abdomen) is supportive or harmful. For those who do sleep in this position, a rolled towel or firm pillow between your knees may help keep the spine aligned.

Climber Position 

Lying on your stomach with one leg up higher or closer to your chest than the other may promote muscle imbalances between the bottom and top leg, along with the other issues associated with sleeping flat on your stomach.

Beyond finding the right sleep position, these practical tips can help improve your overall sleep quality:

• Reduce stress: Anxiety and excessive worrying can make it hard to fall asleep. To relieve stress, practice deep breathing exercises or a sleep meditation before bed. Avoiding stressors, like work social media or technology altogether, right before bed may also help.
• Invest in the right mattress: The right mattress varies, but for many, a medium-firm mattress works well. Some people may need a softer or firmer mattress depending on their preferred sleeping position.
• Add more pillows: Pillows can be a tool to help align the body when sleeping. For some, a thin pillow or flat pillow between the knees helps keep the hips and back in proper alignment. It may take some time to find the right place to position a small pillow. If you’re struggling to find the right pillow positioning or adding pillows has not lessened your pain, a healthcare provider may be able to provide additional insight.
• Try an adjustable bed: For those with lower pain sensitivity thresholds or a chronic condition, an adjustable bed can help maintain alignment while sleeping. With an adjustable bed, someone can elevate the head and neck or the legs in order to relieve pressure in the lumbar region.
• Practice gentle stretching before bed: As part of a calming nighttime routine, consider adding in some stretches. Stretching may also help in the morning if you wake with any stiffness or pain.

Even if you find the best position to sleep in, the underlying cause requires medical treatment. Below are some common reasons for chronic low back pain. 

Muscle Strains and Injuries

A common cause of low back pain is injuries, which can be caused by strains (tears in muscle or tendons) or sprains (torn or overstretched ligaments). These may result from lifting something improperly or something that is too heavy, overuse over time, or a traumatic event, such as a car accident.

Degenerative Conditions

Degenerative conditions occur when there is a gradual breakdown of a body part or system. Many conditions fall in this group, from Alzheimer’s disease to osteoarthritis. 

Ones that may affect the lower back include:

• Inflammatory conditions: Various types of arthritis, as well as other inflammatory conditions, like spondylitis, may affect the spine, resulting in lower back pain.
• Intervertebral disc degeneration: Spinal discs provide cushioning to the lower back and absorb pressure in the spine – when they wear down, pain may ensue.
• Spondylosis: Common in those over the age of 65, spondylosis occurs due to wear and tear on the cartilage, bones, and joints in the neck and back and repeated pressure on this region as one ages.

Nerve and Spinal Problems

Problems with the nervous system or spine (a series of bones, muscles, tissue, and tendons that run from the skull to the tailbone) may also contribute to back and neck pain. These include:

• Spinal stenosis: a narrowing of the spaces in the spine, which creates pressure in the back
• Sciatica: when there’s pressure on the sciatic nerve
• Spondylolisthesis: when the lower spine slips out of place
• Osteoporosis: when bone density decreases, potentially leading to painful fractures in the region
• Fibromyalgia: a condition that affects the nervous system and causes pain in joints throughout the body

Other Potential Causes

This is not a complete list of all the potential causes. Some people, for example, are born with skeletal irregularities that cause back pain, and conditions ranging from endometriosis to kidney stones may contribute to back pain. The long list of potential causes is one reason why it’s important to work with a healthcare provider on diagnosing and managing your pain.

If pain in the back doesn’t go away in a few weeks or gets suddenly worse, visit a healthcare provider. If not working with a specialist on back pain already, a primary care provider can conduct an initial assessment, refer you to the appropriate specialist(s), and possibly provide a few customized tips to reduce pain and get better rest.

The correct treatment for lower back pain depends on the cause. A treatment plan will be made by an appropriate specialist, but may include treatments such as:

• Medications to manage pain, such as cortisone shots
• Acupuncture, where needles are inserted into specific areas on the back
• Physical therapy to rehabilitate and strengthen the back
• Lifestyle changes to prevent future pain, such as strengthening the abdomen or lowering body weight to a healthy range
• Massage to help temporarily relieve any tension in the back
• Cupping, a technique that uses suction to increase blood flow to the affected areas
• Surgery, in severe cases

During treatment, a provider will probably recommend avoiding activities that may make back pain worse, such as jogging, lifting heavy objects, poor posture, or contact sports.