How to Sleep With Lower Back Pain

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Chances are you’re reading this right now because you are living with lower back pain. First off, you are not alone. Lower back pain is a common issue among people, and this is for a variety of reasons, such as age, muscle strains, arthritis, or a herniated disc.

Another factor that can deeply impact lower back pain is how you sleep. Here, we’ll give you some tips for sleeping with lower back pain, go over the types of lower back pain, the best sleeping positions for you, and other commonly asked questions.

9 Tips for Sleeping Better With Lower Back Pain

1. Start with the Right Mattress

A recent study1 shows that sleeping on a medium-firm bed, as opposed to a soft or extra-firm one, is best for people with back pain. This is because a medium-firm mattress supports the proper alignment of the spine while you’re sleeping.

2. Get a Mattress Topper

Buying a new mattress can be a big financial commitment, and if that’s not where you’re at, you can get a mattress topper instead. A mattress topper can add extra contouring and support for your back. Toppers are designed to alter the feel of a bed but come at a fraction of the price of a new mattress.

Illustration of a woman folding the mattress topper in the storage bag

3. Improve Your Sleep Hygiene

There is a long list of things you can do to improve your sleep hygiene, which is a term to describe a person’s sleep health habits. However, we’ll go over some of the most critical ones.

First, be sure you are getting outside and exposing yourself to sunlight within 30 minutes to an hour of waking, as this will help get your natural circadian rhythms on track. Second, you’ll want to wind down and turn off your screens at least an hour before bedtime because the blue light from these devices suppresses melatonin, a hormone that fosters sleepiness.

Third, keep your bedroom cool, quiet, and dark because these are the optimal conditions for sleeping. Lastly, avoid eating large meals before bed, especially if you’re prone to getting acid reflux or heartburn. Even if you don’t have these issues, though, eating too much before bed could lead to uncomfortable indigestion that could make it harder to fall asleep.

4. Change Your Sleeping Position

Keeping your spine in proper alignment while you’re sleeping is vital for navigating back pain. Proper alignment means the spine is straight with a natural curve and feels comfortable.

When people sleep on their stomachs, or even on their backs on a too-hard mattress, the alignment of the spine can get out of whack and cause a lot of low back pain.

The best sleeping position2 to avoid back pain in the first place is on your back. For optimal spine alignment, make sure you have a supportive pillow under your head, and you can place another one under your knees to support your low back. Though be sure to avoid this position if you are pregnant, as it can decrease blood circulation to the heart and baby.

If it’s difficult for you to sleep on your back, you can also try sleeping on your side with your legs straight and a pillow between your knees.

5. Reduce Your Alcohol and Caffeine Intake

Alcohol may help you doze off initially, but it can negatively affect the quality of your sleep. A 2015 study3 found that alcohol, whether consumed regularly or rarely, impacted participants’ second half of sleep during the night. Furthermore, alcoholics experienced a variety of sleep disturbances, both during drinking and abstinent periods. (

Caffeine, a stimulant, may seem like a more obvious sleep disruptor, but many people still drink caffeine well into the evening. Research4 has found that caffeine can disrupt sleep up to six hours before bed, so if you go to bed at, say, 10:00 p.m., it’s recommended you stop drinking caffeine by 4:00 p.m. to get a good night’s rest.

6. Try Relaxation Methods

Before bed, you can establish a calming nighttime ritual. This might look like making some chamomile tea, journaling, meditating, taking a bubble bath, or reading a good book. Whatever helps you wind down from the day should improve your sleep quality, and ultimately, improve your back pain.

Science has found a relationship between stress and chronic pain. A 2018 study5 found that reducing stress through exercise and mindfulness-based therapies had a significant impact on chronic pain. Meanwhile, another study6 found a tie specifically between psychological stress and lower back pain.

Minimizing the stress in your life should not be overlooked as a way to not only improve sleep but directly improve your lower back pain as well.

Illustration of a Man Sleeping Tight after a Cup of Tea

7. Use a Heating Pad

Using a heating pad on your lower back while you’re lying in bed could help reduce the pain. Do note, it’s recommended to only use heat on the back for up to 20 minutes at a time, so you should remove it before you fall asleep. Plus, it will probably make you feel hot if you use it all night.

During the day, doctors recommend7 alternating heat and cold for lower back pain. The cold should reduce inflammation, and the heat should improve circulation in the area. Use the heating pad for 15 to 20 minutes, then a few hours later, apply an ice pack for 10 to 15 minutes.

8. Get a Massage

If you’ve ever gotten a massage for lower back pain, you probably don’t need a study to tell you that they can help, but there is research to back it up. This study8 found that lower back pain and range of motion were improved significantly in participants who received massages. They also reported experiencing an improvement in depression, anxiety, and sleep.

9. Take Anti-Inflammatories

Studies show taking nonsteroidal anti-inflammatory drugs (or NSAIDs) can be effective in treating both acute9 and chronic10 lower back pain. These include common over-the-counter drugs like Ibuprofen, Aspirin, and Aleve, which work by blocking the production of certain chemicals that cause inflammation.

Unfortunately, if NSAIDs are taken frequently and long-term, they can have serious consequences11 like an increased risk of heart attack or stroke. Additionally, they could lead to stomach and bowel problems, including bleeding and ulcers.

If you’d prefer an alternative to anti-inflammatory medications, try taking turmeric or including it in your food. A 2017 study12 shows that turmeric (or curcumin) aids in the management of oxidative and inflammatory conditions, metabolic syndrome, arthritis, and even anxiety.

The Two Types of Lower Back Pain

There are two main types of back pain: acute and chronic. Whichever type you’re experiencing, making improvements to the way you sleep can have a big impact on your back.

Acute

Acute lower back pain is short-term, lasting somewhere between a few days and a few weeks. This type of pain is often connected to an injury or some other identifiable event. When acute back pain fades, there won’t be an ongoing effect on your mobility.

Chronic

Chronic lower back pain is pain that lasts for three months or longer and in many cases, doesn’t begin with a clear link to an injury. Interestingly, chronic lower back pain has increased by more than 100 percent13 in adults in the last decade and can be tied to things like stress, depression, and anxiety.

What is the Connection Between Sleep and Lower Back Pain?

Sleep and lower back pain have a sort of cyclical connection. This is because lower back pain can cause disturbances in sleep – if you are physically uncomfortable, you’re going to have a harder time sleeping.

The harder time you have sleeping, though, the more your back pain will be exacerbated. A 2020 study14 found that not only can back pain cause sleep disturbances, but sleep disturbances can lead to back pain. This is likely because, during deep sleep, one of the four sleep stages you experience during the night, your body performs tissue growth and repair15. In short, this is when much of your physical healing happens. Sleep deprivation impairs this healing process and can affect your mood in a way that heightens pain sensitivity.

Therefore, making changes in the way you sleep is vital to breaking this cycle.

Does Your Sleep Position Affect Lower Back Pain?

Your sleep position plays a big role in lower back pain. This is because certain positions support better alignment than others. We’ll go over the different sleeping positions and their benefits (or lack thereof) below.

The Best Sleeping Positions for Lower Back Pain

  • Back Sleeping (Best) – According to Keck Medicine of USC, the best position for those with lower back pain is lying flat on your back2. You might have tried this before and found it uncomfortable or hard to stay in this position. If that’s the case, try placing a pillow under your knees to prop them up and keep your spine flat on the mattress, rather than curved upward. You’ll also want to place a good, supportive medium-loft pillow beneath your head.
  • Side Sleeping (Good) – If lying on your back is too difficult or uncomfortable, or if you are pregnant, sleeping on your side is a good runner-up for back pain. Try sleeping with your legs straight, rather than bent, and put a pillow between your knees. This will keep your spine in neutral alignment. Unfortunately, the most popular sleeping position–on your side with legs bent upward– is less ideal for back pain, because it promotes an uneven distribution of weight that can create more back pain2.
  • Stomach Sleeping (Worst) – If you have back pain, sleeping on your stomach is probably making it worse. This position puts the most pressure on your lower back because it flattens the natural curve of your spine. Plus, it causes you to have to turn your neck to the side, which can cause neck and upper back pain as well2.
Illustration of a Spine Alignment when Person Sleeps on Their Back

Can a Mattress Cause Lower Back Pain?

If you have slept on a good mattress and then on a bad one, perhaps while traveling or staying at someone else’s house, you know first-hand that mattresses can cause lower back pain.

Research16 backs this up. In a study, participants’ beds were replaced by medium-firm mattresses, specifically layered with foam and latex based on the participants’ sleeping positions. Over 12 weeks, participants rated their sleep quality, comfort, back pain, and stiffness. Progressively over the weeks, participants reported not only less and less back pain and stiffness but better quality of sleep and less discomfort during the day as well.

This shows us that the mattress we choose is vital to minimizing and even healing existing back pain.

When Should You See a Doctor for Lower Back Pain?

Back pain is common and often goes away on its own or by making lifestyle and sleeping changes. According to the American Academy of Family Physicians17, though, you should talk to your doctor if:

  • The pain began with an injury
  • The pain is debilitating
  • The pain goes down your leg below your knee
  • Your leg, foot, groin, or rectum feel numb
  • You have fever, chills, nausea, vomiting, stomach pain, or weakness
  • You have trouble going to the bathroom
  • Your pain gets worse or doesn’t improve after 2-3 weeks

Frequently Asked Questions

How should I sleep to relieve lower back pain?

The best position for lower back pain is on your back with one pillow behind your head and one pillow tucked behind your knees. If you can’t sleep well on your back, you can try sleeping on your side with your legs long and straight, with a pillow tucked between your knees. These positions should keep your spine in its best alignment to relieve lower back pain.

Is it better to sit or lie down with lower back pain?

Sitting in a chair for long periods is a major cause of lower back pain because it creates a lot of compression in the lower back. If you have lower back pain, you’ll want to avoid sitting if you can. Try lying flat on the floor with a pillow underneath your knees or with your legs long and propped up, flat against the wall.

What’s the best sleep position for lower back pain during pregnancy?

Lower back pain during pregnancy is extremely common, and unfortunately, it can make sleeping comfortably difficult. Try to avoid sleeping on your back when pregnant, as this can put pressure on your uterus and cut off blood flow to your baby. Instead, sleep on your side. You can place pillows underneath your stomach and between your legs if this feels comfortable and supportive. You can also try sleeping with a heating pad on your back but avoid putting extreme temperatures on your stomach.

Sources:

  1. Caggiari G, Talesa GR, Toro G, Jannelli E, Monteleone G, Puddu L. “What type of mattress should be chosen to avoid back pain and improve sleep quality?”. National Library of Medicine. 2021.
  2. King H T. “The Best — and Worst — Sleep Positions for Back Pain”. Keck Medicine of USC. 2019.
  3. Thakkar MM, Sharma R, Sahota P. “Alcohol disrupts sleep homeostasis”. National Library of Medicine. 2015.
  4. Drake C, Roehrs T, Shambroom J, Roth T. “Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed”. National Library of Medicine. 2013.
  5. Wippert PM, Wiebking C. “Stress and Alterations in the Pain Matrix: A Biopsychosocial Perspective on Back Pain and Its Prevention and Treatment”. National Library of Medicine. 2018.
  6. Vinstrup J, Jakobsen MD, Andersen LL. “Perceived Stress and Low-Back Pain Among Healthcare Workers: A Multi-Center Prospective Cohort Study”. National Library of Medicine. 2020.
  7. Use Heat or Ice to Relieve Low Back Pain”. Kaiser Permanente. Last modified March 9, 2023.
  8. Hernandez-Reif M, Field T, Krasnegor J, Theakston H. “Lower back pain is reduced and range of motion increased after massage therapy”. National Library of Medicine. 2001.
  9. Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW. “Nonsteroidal anti-inflammatory drugs for low back pain: an updated Cochrane review”. National Library of Medicine. 2008.
  10. Enthoven WTM, Roelofs PD, Koes BW. “NSAIDs for Chronic Low Back Pain”. 2017.
  11. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)”. Cleveland Clinic. Last modified January 25, 2020.
  12. Hewlings SJ, Kalman DS. “Curcumin: A Review of Its Effects on Human Health”. National Library of Medicine. 2017.
  13. Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, Baciarello M, Manferdini ME, Fanelli G. “Mechanisms of low back pain: a guide for diagnosis and therapy”. 2016.
  14. Amiri S, Behnezhad S. “Sleep disturbances and back pain : Systematic review and meta-analysis”. National Library of Medicine. 2020.
  15. 4. “What Happens During Sleep?”. National Institutes of Health. 2019.
  16. Jacobson BH, Boolani A, Dunklee G, Shepardson A, Acharya H. “Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain”. 2010.
  17. Patel D S. “Low Back Pain.” American Academy of Family Physicians. 2023.
Natalie G.
Natalie G.
Writer

Natalie is a content writer for Sleep Advisor with a deep passion for all things health and a fascination with the mysterious activity that is sleep. Outside of writing about sleep, she is a bestselling author, improviser, and creative writing teacher based out of Austin.

When she's doing none of these things, you will most likely find her outdoors, at the gym, or... asleep.

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