Five Sleeping Positions for Back Pain

When you struggle with lower back pain, it can be difficult to find peace in the evenings. The pain makes it hard to sleep well, and then your body is unable to heal effectively.

Most often, a stiff back is caused by bad habits such as slouching or improper heavy lifting. An awkward sleeping position, like sleeping with your spine twisted or with your neck slumped to the side, can be the trigger.

If you struggle with back pain, adjust your sleeping position to maintain proper spinal alignment. Here are some of the sleeping positions we recommend to reduce your lower back pain so you can sleep better.

1. Side Sleeping With a Pillow Between Your Knees

Side sleeping is one of the most common sleep positions, especially since it can alleviate snoring and sleep apnea. However, side sleeping can cause painful pressure points in your hips and shoulders and throw your body out of alignment if you’re sleeping on the wrong mattress.

Using a pillow between your knees properly aligns your spine, hips, and pelvis, and reduces back pain. Side sleeping with a pillow between your knees is also safe for pregnant women, who commonly suffer from back pain.

2. The Fetal Position

Sleeping on your side with your knees tucked in towards your chest, also known as the fetal position, can alleviate pain in your spine. Most sleepers actually prefer this position regardless of whether or not they have pain since it’s so comfortable.

If you have a bulging or herniated disc, curling up creates space between your vertebrae and reduces nerve pain. It’s also a safe sleeping position if you’re pregnant and ensures healthy circulation for both you and your baby.

3. Back Sleeping With a Pillow Under Your Knees

Back sleeping is often recommended to ease back pain, but lying flat on your mattress can put pressure on your spine and lower back.

To prevent pressure build-up while on your back, try sleeping with a pillow or rolled-up towel under your knees. Elevating your knees helps distribute your weight evenly and puts less stress on your spine and internal organs. It also maintains the natural curve of your back.

For more information, read our guide to the proper way to sleep on your back.

4. Back Sleeping at an Incline

If you find your pain is relieved most when you’re sitting in a recliner, you may benefit from using a wedge pillow or adjustable bed base. Adjustable bases are an investment, though wedge pillows are easily available and require no set-up.

Sleeping at an incline reduces the pressure on your spine and lower back, especially if you have isthmic spondylolisthesis, a condition where one spinal vertebra slips onto the one below it.

In addition to alleviating back pain, sleeping at an incline may also reduce your sleep apnea, snoring, or acid reflux.

5. Stomach Sleeping With a Pillow Under Your Hips

Stomach sleeping is not recommended as it can exacerbate and cause back pain. However, if it’s difficult for you to switch positions at the moment, you can adjust the position to reduce the strain on your body.

Start by sleeping with a pillow under your hips—this takes the pressure off your lower back. If you struggle with degenerative disc disease or a herniated disc, stomach sleeping with a pillow under your lower back can reduce your pain.

As a stomach sleeper, you might even consider skipping the pillow under your head entirely and just using one under your hips to prevent straining your neck.

Other Ways to Relieve Your Back Pain

Although trying new sleeping positions is a valuable step toward relieving your back pain, don’t stop there. Look into switching out your bedding, moderate exercise, and improving your posture. If you’re still unable to find relief, you might consider a medical professional’s help.

Buy the Best Mattress and Pillows

A good mattress and pillows are the foundation for alleviating back pain in bed. For many people, a poor mattress and pillows may be the underlying cause of their pain. If your bedding is too soft or firm for your sleeping position, it can throw your spine out of alignment and strain your back.

Mattresses for Back Pain

To minimize your back pain, look for a mattress with excellent support and pressure relief—we recommend memory foam and hybrid mattresses. However, the exact firmness you’ll need depends on your preferred sleeping position.

Back sleepers should steer towards medium to medium-firm mattresses to alleviate their back pain.

Side sleepers are typically comfortable on a medium to medium-soft mattress that properly aligns their spines while providing pressure relief. We strongly recommend memory foam mattresses for side sleepers because they conform well and maximize pressure relief. Memory foam hybrids can offer similar amounts of pressure relief, excellent for side sleepers who want a bouncy bed.

Stomach sleepers are best supported on medium-firm to firm mattresses for back pain to prevent them from sinking in bed.

If your mattress is fairly new, but turned out to be too soft or firm for your preference, use a mattress topper instead for extra cushioning or support. We recommend our Zoma Balance Pad, which has a medium feel suited for most sleepers.

Pillows for Back Pain

Regardless of the position you sleep in, your pillow should support and cradle your head and neck, keeping them in line with your spine. Memory foam pillows are a good option as they conform to your head and fill the space between your neck and the mattress.

The best pillow for you depends on your sleeping position. In any position, avoid placing your shoulders on your pillows, as your neck and head won’t receive proper support.

Back sleepers should use a medium loft pillow (4 to 5 inches thick). This way, your head won’t curl inwards towards your chest or fall backward and grow stiff.

Side sleepers need the highest loft pillows (5 to 7 inches thick) so the space between your head and the mattress is filled. You can even rest against a body pillow: place your head on the top half of it and rest your knees on the bottom half. Many recommend firm pillows for side sleeping.

Stomach sleepers do best with a low loft pillow (3 inches or less) or no pillow at all so the head isn’t raised too much.

When using a pillow under your body, use at least a medium loft pillow. However, you can find pillows specially made for between the knees or under the hips.

Avoid Resting Too Much

You’d think bedrest would help your back pain, but it can actually worsen it. Resting too much can weaken your muscles and further strain your back. At most, rest for a day or two after a mild injury or strain.

Activity is actually beneficial for your back pain. Light aerobic exercises (stretching, swimming, or walking) and back and core strengthening exercises build muscles, in turn easing the stress on your back. With this in mind, avoid overstressing your body with aggressive workouts, such as powerlifting or running.

Practice Good Posture

Bad posture is a big culprit for back pain. It strains your spine, creates tension in your back, shoulders, and neck, and can even impair circulation. Avoid slouching or rounding your shoulders during daily activities such as cooking or brushing your teeth.

When you’re sitting at a desk, don’t slump over or sit in an awkward position. Use a good quality chair with lower back support and keep your feet planted on the floor while working. You might also place a small pillow behind your back when seated to maintain your spine’s natural curve.

Speak to a Medical Professional

If your pain lasts longer than 12 weeks or is too excruciating to the point where you’re unable to function normally, it’s time to seek medical attention. The treatments your doctor may suggest vary, but they may prescribe medications such as pain relievers, muscle relaxants, or topicals.

Your doctor might refer you to physical therapy or conduct procedures such as injecting cortisone or implanting nerve stimulators. However, most back pain treatment is noninvasive and does not require surgery.

Frequently Asked Questions

How do I know if my mattress is causing my back pain?

If you cannot get comfortable in bed or if you’re going to sleep with no pain, but waking up with it, this is likely a sign your mattress is causing your back pain. Also, if your bed is at least 7 years old, it’s likely wearing down and no longer supporting your body. A good mattress eases pain instead of causing it, so if you wake up sore it's probably time to replace your mattress.

Too soft of a mattress causes your spine to curve incorrectly and misalign, while too firm of a mattress creates tender pressure points around your hips, shoulders, and lower back.

If your bed is just a bit old, it’s best to invest in a new and supportive mattress. However, if it’s a newer bed but just too soft or firm for you, use a mattress topper.

Why does my back pain get worse when I lay down?

Nocturnal (nighttime) back pain is when your pain worsens or begins upon getting into bed and is not relieved by changing positions. Similar to regular back pain, there’s no clear cause for nocturnal back pain, but it may be due to strain or fractures, infections, and diseases. Always speak with your doctor for treatment options if your pain is not improving.

Should I sleep on the floor with back pain?

No, while some people may find relief from floor sleeping, it does little for spinal alignment and can potentially worsen your back pain. The floor also collects dust and dust mites, a trigger for allergies, and can be drafty. It’s best to just sleep on a supportive mattress.

How long does back pain last?

It’s difficult to determine how long your back pain will last as it varies based on the cause. Milder back pain will typically last between a few days and a few weeks. However, any back pain lasting longer than 12 weeks may be a sign of an underlying issue and you should receive medical attention.

How do I know if my back pain is serious?

Some signs your back is serious include:

  • Radiating pain down your legs or glutes
  • Sharp pains as opposed to a dull ache
  • Numbness or tingling in your glutes
  • Morning stiffness or difficulty getting out of bed

Your back pain may be symptomatic of other conditions, such as arthritis, sciatica, herniated discs, or spinal stenosis. It’s best to speak with your doctor for diagnosis and treatment if your pain is worsening or if it has lasted longer than 12 weeks.

Conclusion

Restorative sleep is vital to relieving your back pain, but if you can’t fall asleep because you’re so uncomfortable, healing can feel impossible. However, making a few adjustments at night to improve your posture and keep your spine aligned can lessen your back pain. Also, always use a mattress and pillows suited for your sleep position to promote healthy alignment and further reduce your pain.

Most back pain is caused by mild issues such as bad posture or sleeping poorly. It’ll often go away with proper care, but if it’s more severe or paired with symptoms such as fever, numbness, or sharp pains, speak to your doctor.

This article is for informational purposes and should not replace advice from your doctor or other medical professional.

Andrew Russell, Wellness Writer Andrew Russell

Andrew Russell is a part-time writer and full-time sleep enthusiast. At Zoma, Andrew lends his sleep expertise and writes many of our “better sleep” guides. Outside of Zoma, Andrew puts his advice to the test, always trying new ways to get deeper, more restorative sleep. We appreciate Andrew because he doesn’t give advice that he doesn’t follow himself, so you can feel confident his solutions for better sleep really do the trick.

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