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How to Sleep With Lower Back Pain: Positions and Treatments

Sleeping with lower back pain can feel impossible, but sleeping on your side, a medium-firm mattress, massage therapy, and sleep hygiene can help.
Published
2022-07-06
Updated
14 MINS
Woman waking up with hand on back to relive lower back pain

If you don’t have lower back pain, you likely never think about that part of your body. But when you do have it, it’s all you can think about. Lower back pain during the day can get in the way of your workouts, your work, and even caring for your kids. But the pain can become a real problem at night when it stops you getting the sleep you need. 

Lower back pain can not only make it hard to fall asleep, it may also wake you up in the night if you move in your sleep and trigger a pain point. Even worse? When you don’t get enough sleep, your body is more sensitive to pain, meaning it’s a vicious circle of sleep loss and increased pain. 

Luckily, there are a few things you can do to break the cycle. Below, we cover the best sleeping positions for those with lower back pain as well as the things you can do to help you drift off, even if your lower back is playing up. 

What’s the Best Sleeping Position for Lower Back Pain?

Experts tend to agree sleeping on your side is the best position as it helps to keep your spine aligned. If you have lower back pain, try sleeping on your side, with your knees bent and a pillow between your legs.

One small study instructed those with lower back pain to sleep on their sides like this, and those with upper back pain to sleep on their backs with a pillow under their knees, which promotes the natural curve of your spine. After four weeks in the new sleeping postures, 90% reported a decrease in pain.  

So, if you’re already a side sleeper, consider adding a small pillow between your knees for extra support and to encourage spinal alignment. Sleeping in the fetal position like this has also been shown to reduce snoring and help with sleep apnea. 

If you have low back pain but you‘re a back sleeper, consider trying to train yourself to sleep on your side instead. Research shows poor sleepers spend more time sleeping on their back. 

Researchers from the study above told participants who preferred stomach sleeping to opt for sleeping on their sides or their backs instead. If you really can’t stop yourself from being a stomach sleeper, try sleeping with a thin pillow under your hips to keep your spine supported.

Image showing different sleeping positions.
The recommended sleeping position for lower back pain is A, upper back is B, and people were encouraged to not sleep in position C. Source: https://pubmed.ncbi.nlm.nih.gov/26835867/

How Can I Sleep with Lower Back Pain?

Lower back pain keeping you up? Here’s what science says you can do to reduce the pain to help you get better sleep. 

1. Try Massage Therapy 

If you’re in chronic pain or your lower back is regularly impacting your sleep, it’s worth speaking to a healthcare expert. They may recommend massage therapy, which the scientific literature shows is an effective treatment.

One study saw two groups with lower back pain receive treatment of either massage therapy or relaxation therapy. The massage therapy group got two 30-minute massage therapy sessions over five weeks, whereas the relaxation therapy group learned how to use progressive relaxation exercises and did these for two 30-minute sessions for five weeks. 

At the end of the experiment, both groups reported better mood, more pain-free movement, less anxiety and pain, and — most importantly — fewer sleep disturbances. However, of the two treatments, massage therapy was found to be the most effective. An earlier study with some of the same researchers found similar results. 

2. Learn Relaxation Techniques 

RISE app screenshot showing various relaxation techniques.
The RISE app can walk you through relaxation techniques.

Relaxation techniques can be useful as they help to reduce stress and anxiety, and provide a distraction from the pain. Plus, as the studies above found, relaxation techniques can also be effective at reducing lower back pain and the sleep disturbances it causes. And this is a treatment you can do at home, self-guided muscle relaxation has been shown to help reduce pain.

The studies above focused on progressive muscle relaxation exercises. Here’s what to do: 

  1. Take three to five deep breaths before getting started 
  2. Tense one muscle group (e.g. your calf) for five to seven seconds 
  3. Release and relax the muscle for 10 seconds 
  4. Move onto the next muscle group (e.g. your thigh), tensing, holding, and releasing
  5. Slowly move around your entire body 

Research suggests progressive muscle relaxation can reduce pain for those with mild chronic lower back pain and reduce anxiety — which impacts sleep by itself — and lower back pain in pregnant women

To get started with this treatment at home, the RISE app can walk you through relaxation techniques, including progressive muscle relaxation. To learn more about the often vicious cycle of anxiety and sleep loss — and what to do about it — head here. 

3. Get a Medium-Firm Mattress 

The right mattress can make all the difference. If you’re comfortable, you’ll find it easier to fall asleep, even if you are experiencing back pain. Plus, the right mattress can make sure you’re not exacerbating the problem. 

One study had people with lower back pain sleep on a medium-firm mattress layered with foam and latex based on their prominent sleeping position. After 12 weeks of sleeping on the new mattress, participants experienced less back pain and stiffness and improved sleep comfort and perceived sleep quality (sleep experts don’t have an agreed upon objective definition for sleep quality).

However, another study found sleeping on a foam mattress was associated with backache, but this was relieved after switching to a cotton mattress. 

A medium-firm mattress seems to be the best for those with lower back pain, as research shows it helps to reduce pain in bed, pain when getting up, and pain during the day. Another study found medium-firm mattresses reduced back pain by about 48% and improved perceived sleep quality by 55% — and this was felt after just one week of switching mattresses and improved from there.

If you sleep on your side, you should also make sure your mattress allows you to keep a neutral position for your spine. One way to do this is with an adjustable bed or with a mattress that’s firmer and softer in different areas, as that reduces pressure points while side sleeping. 

A 2022 study had participants with chronic lower back pain sleep on a mattress designed to reduce spinal curvature when sleeping on their side. The results showed an 18% reduction in pain scores while lying and a 25% increase in comfort scores. 

Image showing best mattress to keep spine aligned.
The best mattress is one that keeps your spine aligned. Source: https://link.springer.com/article/10.1186/s41606-022-00073-x

However, you should also consider getting medical advice to find the best mattress for you. Researchers from the above study concluded: 

“The ideal mattress is yet to be determined and likely depends on many variables illustrating the need for additional research. It may be overly optimistic to conclude that one type of mattress fits all individuals because of the range of varied anthropometric characteristics of the human body.” 

So, while a medium-firm mattress seems to win in the scientific literature, you could benefit from getting a second opinion based on your body. 

If you can’t get a new mattress, a mattress topper can help to give your back more support while sleeping. And don’t forget your pillow, either. Opt for one that keeps your neck straight to avoid neck pain.

4. Get Some Exercise 

RISE app screenshots showing you the best time to exercise.
The RISE app can tell you the best time to workout to not impact your sleep.

If you’re experiencing lower back pain, the last thing you may want to do is exercise. But research shows physical activity can actually help reduce the pain. Plus, exercising can help you fall asleep in general.

One meta-analysis concluded physical activity like aerobic exercise, strength and resistance exercise, coordination and stabilization exercises, motor control exercises, and pilates can all reduce pain. However, it found no specific exercise was better than another when it came to reducing lower back pain. Instead, it said to choose exercise based on your preferences and ability. 

However, more research needs to be done as the study concluded: 

“Exercise therapy is highly recommended, but it is not clear which duration, intensity and methods of training are best.”

One small study found eight weeks of stabilization exercises reduced pain, sleep disturbance, depression, and anxiety, and improved perceived sleep quality among people with chronic lower back pain. 

Another study found a combination of exercise therapy and relaxation therapy reduced pain, anxiety, and depression, and increased range of motion and quality of life in office workers with chronic lower back pain.

If your back pain is severe, speak to a physical therapist to find the best exercises for you, especially if your back pain is caused by a medical condition or things like spondylolisthesis or a herniated disc. 

However, exercising too close to bedtime can make it harder to fall asleep when you want as increased levels of the stress hormones adrenaline and cortisol work to change the timing of your circadian rhythm (your internal body clock that runs on a roughly 24-hour cycle). 

To stop this from happening, schedule your workouts earlier in the day, so they can still help to decrease lower back pain and help you fall asleep. The RISE app can tell you when you should workout each day to stop exercise impacting your sleep.

5. Improve Your Sleep Hygiene and Sync Up with Your Circadian Rhythm 

RISE app screenshot showing you when to get and avoid bright light.
The RISE app can tell you the best time to do 20+ sleep hygiene habits.

Getting your sleep hygiene right — the set of behaviors you can do throughout the day to help you sleep — and syncing up with your circadian rhythm will give you a much better chance of falling asleep and staying asleep. 

This advice is important for everyone, but especially those who have trouble sleeping due to something like lower back pain. If there’s a chance pain will disturb your sleep, you don’t want to risk things like ill-timed light exposure or caffeine adding to the problem. 

Here’s what to do: 

  • Get natural light in the morning: Aim to get at least 10 minutes of natural light first thing. This will reset your circadian rhythm, so you’ll feel refreshed that morning and sleepy later that evening. 
  • Avoid bright lights in the evening: Light suppresses the sleep hormone melatonin. To stop this impacting your sleep, dim the lights and put on blue-light blocking glasses 90 minutes before bed. 
  • Avoid sleep disruptors: Caffeine, alcohol, exercise, and large meals all have the power to keep you up or wake you up in the night. Check the RISE app to see your unique cutoff times for these sleep disruptors to stop that from happening.
  • Keep your bedroom dark, cool, and quiet: Make your sleep environment as easy to fall asleep in as possible. Aim for 65 to 68 degrees Fahrenheit and use an eye mask, blackout curtains, and earplugs
  • Go to sleep in your Melatonin Window: This is the roughly one-hour window of time when your body will be making the most melatonin it will all night. Check RISE for the timing of it each evening. If you head to bed in this window, you’ll have a much easier time falling and staying asleep as you’ll be working with your biology. 

To stay on top of your sleep hygiene, RISE reminds you when to do 20+ sleep hygiene habits and tells you the ideal time to do them based on your circadian rhythm each day. 

Does Poor Sleep Make Lower Back Pain Worse?

The bad news is yes — bad sleep can actually cause back pain. 

The more pain you have the harder it is to fall asleep, and moving in your sleep may trigger pain, which can wake you up. So, it’s easy to see the link between having lower back pain and not getting the sleep you need. But the link actually goes both ways. 

Not getting enough sleep increases our experience of pain and lowers our pain thresholds. It can also slow down your body’s healing process. Plus, poor sleep tanks our energy levels and mood the next day, which makes dealing with pain much harder to do.

This goes for lower back pain specifically as well as pain in general: 

  • One study found poorer sleep quality was significantly related to higher pain ratings the next day in those with chronic lower back pain. 
  • Another study found more movement during the night was associated with lower back pain, so opting for a comfortable mattress and sleeping position are more important than ever. 
  • And one study even concluded: “Our findings do not indicate whether sleep disorders are a cause or a consequence of CLBP” (chronic lower back pain). 
  • Finally, a meta-analysis looking at 21 studies found sleep disturbance increases the likelihood of back pain by 52%. This could be due to several factors, like the increased risk of depression due to insomnia, which ups your risk of back pain, or the likelihood of reduced physical activity if you don’t sleep well, which, again, ups your risk of back pain. 

So, improving your sleep can not only act as a natural pain relief, lowering your current back pain, it can protect you against developing back pain again in the future. There are even studies to back it up. One study found sleep interventions, such as cognitive behavioral therapy to improve sleep, decreased pain for people with lower back pain.

You can improve your sleep with the sleep hygiene tips above. Plus, when you’re not experiencing lower back pain, focus on keeping your sleep debt low to avoid it flaring up again. 

- Read more about why sleep is key for injury prevention and pain management and how to keep your sleep debt low to lessen the risk of injury.

Sleep debt is the measure of how much sleep you owe your body. In the RISE app we measure it over your last 14 nights. It’s measured against your sleep need, the genetically determined amount of sleep you need. 

RISE can work out your individual sleep need (it’s not eight hours of sleep for everyone) and uses your phone use behavior to calculate how much sleep debt you’re carrying. We recommend keeping this below five hours to be at your best and reduce the chances of lower back pain and other health problems.

If you find you’re carrying more than five hours of sleep debt, you can catch up on sleep by: 

  • Taking a nap: Check RISE to see the best time to nap for you, so you disturb your sleep later that day. 
  • Going to bed a little earlier
  • Sleeping in a little later: Keep this to one or two hours so as to not throw off your circadian rhythm.
  • Improving your sleep hygiene: This will help you fall asleep quicker and wake up less often, resulting in more sleep overall.

If you can, keep your sleep debt low while you’re experiencing low back pain, too. This will give your body the best chance to heal, boost your mood and productivity, and help you deal with the pain better. 

Sleep Soundly, Even With Lower Back Pain 

Falling asleep and staying asleep with lower back pain can feel impossible. But getting a good night’s sleep is not only important for your health, mood, and productivity, it has a direct link to how much pain you feel and your likelihood of developing back pain again in the future. 

Try the methods above — like massage therapy and sleeping on your side — to help you drift off. Plus, use the RISE app to maintain excellent sleep hygiene and sync up with your Melatonin Window. This will give you the best chance of falling asleep and staying asleep all night long, so you can focus on healing your lower back pain and boosting your energy each day. 

Get your best night's sleep:

Summary FAQs

How should I sleep to relieve lower back pain?

To relieve lower back pain, sleep on your side with your legs bent and a pillow between your knees. This will keep your spine as aligned as possible. 

Should I sleep with a pillow under my lower back?

If you sleep on your back, placing a pillow under your knees can help to keep your spine aligned and reduce pressure on your lower back. 

What position is best for lower back pain?

Sleeping on your side with your legs bent and a pillow between your knees is the best position for lower back pain as this keeps your spine aligned.

Why do I have lower back pain after sleeping?

If you have lower back pain after sleeping it could be your sleeping position, mattress, or simply not moving all night. Try sleeping on your side, a medium-firm mattress, and exercising first thing to relieve back pain after waking up.

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