At some point in our lives, many of us will suffer from lower back pain. Not only does this type of discomfort interfere with your day-to-day life, but it can also stop you from getting the quality sleep you need.
Additionally, an unhealthy sleeping position, or using the wrong bedding or mattress, can actually make back pain worse or even be the root cause. So, what is the best sleeping position to improve or even prevent lower back pain? In this article, our experts have collated all the information you need to get a comfortable and pain-free night’s sleep.
How does lower back pain affect your sleep?
Anyone with lower back pain will tell you that it makes it tough to get good sleep. While people with back pain often report poor sleep quality, they also sleep for a shorter overall period than those without pain. While it may seem obvious that pain makes it harder to fall and stay asleep, it affects sleep in other ways too. Discomfort can cause an event known as a microarousal in the brain. This means that you enter a light sleep stage and may wake up for a short period of time (although it’s unlikely you’ll remember it in the morning). Sometimes this happens on numerous occasions while you sleep, leading to a very poor quality of sleep.
How does sleeping position affect lower back pain?
If you don’t adopt a healthy and supportive sleeping position, it can make your back pain significantly worse. In addition, sleeping in the wrong position can actually turn out to be the root cause of your discomfort. This is especially true if your sleeping position is putting your neck, hips or spine under unnecessary strain.
The best sleeping positions for lower back pain supports the spine and allows it to rest in its natural curve. Therefore, these positions keep the head, shoulders and hips in a correct and healthy alignment while ensuring adequate support for your back. For most people, the most beneficial position will, therefore, be lying on their back.
That being said, back sleeping isn’t suitable for everyone. For example, many people find it simply too uncomfortable to sleep on their backs or have a habit of lying in another position that’s become deeply ingrained. Also, some health conditions make back sleeping unsafe, such as sleep apnea. It’s also not recommended for pregnant women to sleep on their backs in the later stages. Fortunately, there are plenty of non-back sleeping positions if this is the case for you.
What causes night-time back pain?
Night-time back pain has a variety of possible causes. These include:
- Issues with the way the spine moves
- Disc problems, including degenerated, bulging or herniated discs
- Injury to the spine such as fractures caused by a fall or road traffic accident
- Scoliosis: a condition which causes curvature of the spine
- Spinal stenosis: this causes the spinal column to become too narrow
However, in some cases there is no clear cause of night-time back pain.
What are the best sleeping positions for back pain?
If back pain has been affecting your sleep, you’re probably wondering if changing your sleeping position will help. Here’s our list of the best sleeping positions to keep you more comfortable at night:
1. Back sleeping with support under your knees
If you can get comfortable on your back, great news! This is one of the best sleeping positions to help with back pain. This is because it spreads your weight equally across your spine. It also helps to reduce pressure at common points of discomfort and makes sure your back is healthily aligned.
To make this position even more supportive, try positioning a pillow or cushion underneath your knees. This works to reduce back pain by encouraging your spine into optimal alignment.
2. Fetal position
The fetal position can be a great way to sleep to relieve lower back pain, especially if you have a bulging or herniated disc. Sleeping with your knees drawn up towards your chest on your side stops your spine from becoming twisted and helps to stretch out stiff or painful joints. Remember to support your head and neck with a pillow if you choose to sleep in the fetal position.
3. Sleeping in a reclining chair
Some people may find that they sleep better in a reclining position. This is especially likely if they have a back condition called isthmic spondylolisthesis where the vertebrae slip out of place. However, it’s not practical to sleep in a reclining chair long-term. Furthermore, a reclining chair doesn’t provide the same support that a mattress does. Therefore, if you find yourself sleeping in a reclining chair on a frequent basis, you may be better off investing in an adjustable bed to allow you to adopt this position with adequate support.
4. Side sleeping with knee support
Side sleeping is the most commonly-used position. Many people get into the habit of sleeping on their backs during childhood. As sleeping positions go, it’s not the worst you could have chosen. On the other hand, sleeping in this position can lead to misalignment of the spine while you sleep, leading to back pain.
To correct this, you can tweak this position by placing a pillow between your knees. You can either use a very firm regular pillow or buy one specifically designed for the purpose. This helps to realign the hips, which prevents your spine being pulled out of alignment.
5. Front sleeping with stomach support
In general, front sleeping is not encouraged. This position can be particularly uncomfortable for those with back pain. Front sleeping doesn’t provide your back with much support and can cause an unhealthy alignment of the spine. It can also reduce circulation.
However, if you’ve developed the habit of sleeping on your stomach, this can be a hard one to break. You may even find that you just can’t nod off in any other position. To improve this, try removing the pillow from under your head and repositioning it under your hips. This can help to encourage your spine into a healthy alignment.
In certain situations, you may find that stomach sleeping actually improves your lower back pain. This is more likely if you suffer from a condition affecting the discs in your spine.
What’s the worst position for lower back pain?
Although it may feel comfortable at the time, unfortunately stomach sleeping is generally regarded to be the very worst position for lower back pain. This position puts a very large amount of strain on your back and could be to blame for your aches and pains. The best solution is to try and switch to sleeping on your side or back. However, if you just can’t make the switch or get comfortable in any other way, check out our tips for tweaking the stomach sleeping position above to take some of the strain off your lower back.
Choosing a pillow to help with back pain
Although your sleeping position affects your back, it’s also important to check that your bedding is up to the task of reducing lower back pain. This usually means choosing the right pillow to relieve body pain . This is important because it will support your neck, which in turn encourages your spine into a healthier alignment.
Are you wondering if your pillow could be causing your back pain? Ideally, your head pillow should feel comfortable to sleep on, should adapt to the shape of your body and shouldn’t lose its shape or feel lumpy or clumpy after use. If your pillow doesn’t meet these standards, it could be time to go shopping for a replacement. Additionally, pillows older than 12-18 months are unlikely to provide enough support and will need to be replaced.
A common question we are often asked is which pillow thickness to go for. In general, side sleepers will need a thicker pillow. However, people who sleep on their back may need a thinner pillow to prevent their neck becoming strained and misaligned. This may also be true of people who sleep on their stomachs, as a thin pillow is better suited for placing under the hips.
Any pillow stuffing is suitable as long as it is supportive and can adapt to the shape of your sleeping body. However, we particularly recommend memory foam. This is because memory foam offers a great level of support while molding perfectly to your individual body shape.
Mattresses for lower back pain
The right mattress can significantly improve lower back pain at night. However, the wrong mattress can also make back pain much worse. So, how do you know if your mattress is the culprit? Common signs include:
- You find it difficult to find a comfortable position to sleep in
- Your pain is worst when you wake up in the morning and gradually improves once you’re up and about
- The mattress is lumpy
- The mattress has sagging or ‘dips’ where you have been lying
- It’s more than 10 years old
Your mattress is probably the most important thing you will purchase when it comes to treating and correcting lower back pain. A medium-firm to firm mattress is generally the best option for people with lower back pain. However, it’s important that you don’t pick a mattress that’s too firm to be comfortable, as this will also disrupt your sleep. Whichever firmness you go for, the mattress should provide a high level of support to your spine.
Sleeping position makes a difference to which mattress firmness you go for. People who sleep on their sides require a slightly softer mattress as this allows the curves of their body to sink in comfortably without creating pressure. Back and stomach sleepers generally require firm mattresses.
Some people assume that a soft mattress will be the most comfortable sleeping surface for those with lower back pain. However, this is a myth. Soft mattresses are unlikely to provide the type of support needed for people with back pain and don’t encourage a healthy spinal alignment.
Another commonly-held belief is that an orthopedic mattress is the best thing for back pain. The term ‘orthopedic’ when used to describe mattresses is simply shorthand for extremely firm. It’s true that some people may find an orthopedic mattress works for them. However, most people will find these mattresses too firm to be comfortable, especially if they sleep on their sides. Therefore, we don’t usually advise buying an orthopedic mattress unless one has been specifically recommended by your healthcare provider.
If you can’t afford to replace your mattress right now, you could try purchasing a foam mattress topper to make your current mattress more supportive.
Could a night roll help with my lower back pain?
If you have lower back pain at night, you might benefit from a pillow known as a McKenzie Night Roll. This helps to improve lower back pain by improving your spinal alignment and preventing twisting of your back. You can use it whether you sleep on your back or on your side.
Night rolls don’t help everyone with back pain and aren’t going to solve the problem on their own but could be part of the solution to your night-time aches and pains. Before splashing out, you might want to test to see whether a night roll would help with your back pain. To do this, try placing a rolled bath towel below your waist to give you a little extra support during the night and see if you notice any improvement.
How to change your morning routine to help with lower back pain
When you wake up in the morning, the discs that cushion your vertebrae temporarily contain more fluid. This is because the discs have gradually decompressed while you were sleeping. The extra fluid will gradually leave, although this takes time to happen.
This extra fluid is one of the reasons that people with lower back problems often experience more pain and stiffness in the morning. Additionally, the extra pressure means that you are more likely to sustain a disc injury during the morning than at any other time. Even basic tasks involving bending such as brushing your teeth could cause such an injury.
To avoid this happening, it’s a sensible idea to avoid high amounts of physical exertion and any tasks involving bending your spine for around an hour after you get out of bed.
Adjustable bed frames for back pain
Some people find that sleeping on an adjustable bed frame helps relieve their back pain. These beds can be raised or lowered at various points along the body to relieve pressure and improve overall comfort. This can be handy for finding a comfortable position to watch TV or read in if you have back pain. Most bed frames of this type adjust using a remote control, although some of the cheaper models are manual.
When you’re choosing an adjustable bed frame for back pain, it may be worth looking for one with additional features such as a massage setting to ease sore or cramped muscles. Some also come with a pre-set position for back pain which allows you to find the optimum position to ease discomfort at the click of a button.
Bear in mind that you may need to buy a new mattress to go with your adjustable bed frame. Not all mattresses are compatible. However, it is possible that your current mattress is suitable for an adjustable bed frame, so it’s worth checking.
Adapting your day-to-day life to improve back pain
Chances are, your back pain is caused by something you’re doing during the day. It could be an issue with your posture or by the way you’re performing day-to-day movements. By changing your behaviour during the day, you may be able to improve your back pain at night and therefore your sleep.
Many people nowadays live far more sedentary lifestyles than we are naturally designed to have. This can lead to back pain. Try to move at regular intervals during the day to prevent back pain due to poor posture or simply remaining in the same position for too long.
Some simple tips you can try to change your daytime behaviour to improve night time sleep include:
- Trying to move at least every half hour
- Using a lower back support cushion while sitting
- Try using a standing desk
- Bend at the knees when you lift objects from the ground instead of bending your back
Method for getting in and out of bed for lower back pain
One of the most frequently ignored ‘flash points’ for worsening lower back pain is getting in and out of bed. However, it’s not uncommon for pain to worsen when you perform this activity. Excessive bending of the spine or sudden movements can make your back pain much worse or even cause a new injury.
So, when you get in and out of bed it’s very important not to rush. Instead, slowly roll your body over to one side and make use of your arms to lever yourself upwards. You can then swing your legs round very carefully to complete the process. Performing this ritual backwards is the safest way to get into bed at night without hurting your back.
How does the total time spent in bed affect lower back pain?
In days gone past, people were told to spend lots of time lying on their back if they had a painful back condition. It can certainly be tempting to rest in bed when back pain is really plaguing you. However, this is now known to be ineffective advice. If fact, the more time you spend lying down, the worse your pain is likely to be.
This is because lying down puts extra pressure on your lower back. This is especially likely if you are a stomach sleeper as this is the worst possible position when it comes to exerting pressure on your spine.
For this reason, you should not exceed the recommended sleep time for adults (7-9 hours) lying down in bed.
Exercises to improve lower back pain
Any type of exercise is a good way to improve the quality of your sleep whether or not you suffer with lower back pain. However, some exercises are better than others if you specifically have back pain in mind. The best type of physical exercises for lower back pain are those that improve your core muscle strength. These include the muscles in your stomach, hips and lower back.
So, how do these exercises help with lower back pain? A strong and flexible core makes the overall chance of sustaining a back injury lower. It also provides support to your spine. Furthermore, you are less likely to experience painful muscle spasms in your lower back when you’re lying in bed trying to sleep. You may wish to join a fitness class specifically aimed at improving core muscle strength. Some people with ingoing lower back problems may benefit from working with a qualified physiotherapist to find ways to strengthen their core muscles safely and effectively to reduce their back pain.
Which medications can help lower back pain at night?
If your lower back pain is causing problems with sleep, you may wish to take an over-the-counter painkiller to ease your discomfort. Anti-inflammatory medications are often the most effective at treating lower back pain. However, as long-term use can cause stomach problems, you should consult with your doctor if you need to take them very frequently.
If your back pain is severe, you may be given strong prescription-only pain relief by your doctor. Many doctors don’t prescribe these for long-term use as some of these medications come with risk of addiction. So, your healthcare provider may suggest other therapies alongside your pain relief such as physiotherapy to help treat the underlying cause of your pain and get you off painkillers as soon as possible.
Over-the-counter or prescription painkillers can interact with any other medicines you are taking. So, it’s important to check with a pharmacist or your healthcare provider to check that you can take them safely if you’re already on medication.
Best sleeping position for lower back pain in pregnancy
When you’re pregnant, it’s even more likely that you’ll suffer from lower back pain, especially in the later stages. This is partly down to your ligaments loosening in preparation for childbirth. However, the added weight of your growing baby and change in your centre of gravity can cause your posture to change and create or worsen back pain.
Pregnant women can’t adopt many of the recommended sleeping positions for lower back pain for health and safety reasons. Back sleeping is not recommended in the later stages of pregnancy as it can reduce blood flow to the placenta and is associated with an increased risk of stillbirth. Stomach sleeping isn’t recommended either, and most women find this impossible in any event as their baby bump grows.
Pregnant women should sleep on their sides, ideally on the left, to allow maximum blood flow to the placenta. However, this can cause pressure on the hips and lower back and may lead to back pain, especially if you’re not used to sleeping in this way. However, you can help to reduce any pressure and pain by placing a pillow between your knees.
Some women find that using a u-shaped body pillow can help to reduce lower back pain at night. These are designed to fit the contours of a pregnant woman’s body and provide extra support to the back, hips and pelvis.
How to improve sleep hygiene if you have lower back pain
Acute or chronic back pain can wreak havoc with your sleep. However, there are steps you can take to improve your ‘sleep hygiene’ and increase the volume or quality of your sleep. While these methods won’t help your back pain, they should make it easier to fall and stay asleep.
In general, adults require 7-9 hours of sleep per night. If you’re getting significantly less than this, you may wish to look at ways to improve your sleep hygiene. If you’re not getting enough sleep, it can be tempting to have late morning lie-ins or take naps during the day. However, the best remedy is to stick to a consistent sleep schedule with the same wake-up and sleep times every day, even on the weekend. You could also try:
- Cutting out stimulants or reducing your intake several hours before bedtime
- Taking plenty of exercise, but not too close to the time you wish to fall asleep
- Taking part in a relaxing pre-bed activity such as reading or yoga
- Creating a relaxing sleeping environment
- Avoiding screens for an hour before bedtime
Products to help with lower back pain at night
There are certain products you can buy to help with lower back pain and improve your nightly sleep. These include:
- Cushions designed to fit between your knees: These are especially suitable for those who sleep on their sides as they reduce pressure on the hips and lower back
- Body pillows: These cradle your entire body and may be of use for side and back sleepers. They are particularly suitable for pregnant women with back pain
- Heat or cool pads: Heating or cooling pads can help to ease tense muscles and reduce painful inflammation
- McKenzie Night Rolls: These provide support at your waist to reduce pressure and lower back pain. They can move with you if you frequently change positions in the night
- Adjustable bed: These bed frames can change position to ease back pain. Some even have special settings for lower back pain to provide as much relief as possible
Seeking medical help
If your back pain is affecting your sleep, you should seek advice from your doctor. They may be able to suggest treatment or self-help measures that could help you to sleep better. Even if it’s not affecting your sleep, severe pain or pain caused by an accident or injury always requires assessment by a medical professional.
In rare circumstances, back pain may indicate a medical emergency. Signs that the situation is urgent include back pain that you’re experiencing alongside:
- High-grade fever
- Chest pain
- Change of sensation in your lower body
- Problems passing urine
- Unexplained weight loss
The bottom line
Night-time back pain can be extremely painful and cause serious issues with your sleep. If you are suffering from pain in your back at night, it’s important to adopt the best possible sleeping position to try and ease your pain.
However, this isn’t the only approach. As well as switching up your sleeping position, you will most likely need to make lifestyle changes to maintain a healthy spine. You may also need to invest in specialist sleep products designed to ease back pain during the night.
Always consult your doctor if your back pain is causing you ongoing problems. There may be a treatable reason for your discomfort. Severe back pain can occasionally indicate a serious health problem, so it’s important to get this checked out as soon as possible.