The Best Sleeping Position for Your Back Pain

When you sleep, you lose conscious control over your body, and you can end up twisting your spine or tucking your pelvis in. An existing back pain can get further aggravated, resulting in a restless night of sleep. ¹ Pavilack L, Alstedter N. Pain-Free Posture Handbook, 40 Dynamic Easy Exercises to Look and Feel Your Best. Althea Press; 2016. Using supported sleeping postures can prevent the concentration of stresses on your spine, keep your back relaxed, and create a healing environment.

As a general rule, avoid sleeping on your stomach—it disturbs the normal alignment of your spine. ¹ Pavilack L, Alstedter N. Pain-Free Posture Handbook, 40 Dynamic Easy Exercises to Look and Feel Your Best. Althea Press; 2016. Also avoid sleeping on the side that hurts more, especially if you have sciatica – and follow these guidelines:

Back sleepers: Elevate your knees

If you prefer sleeping on your back, place a pillow beneath your knees. ¹ Pavilack L, Alstedter N. Pain-Free Posture Handbook, 40 Dynamic Easy Exercises to Look and Feel Your Best. Althea Press; 2016. By slightly raising your knees, you will reduce stresses on your lower back and maintain the natural curve of your spine.

Use a head pillow for head and neck support and to maintain spinal alignment.

See Pillow Types to Consider

Side sleepers: Keep your hips stacked

If you’re a side sleeper, place a firm, flat pillow between your knees. ¹ Pavilack L, Alstedter N. Pain-Free Posture Handbook, 40 Dynamic Easy Exercises to Look and Feel Your Best. Althea Press; 2016. The pillow will align your lower spine with your hips and prevent the leg on top from creating pressure on your lower back and/or pelvis. This position also helps relieve stresses in your lower spine, creating room for your spinal nerves.

Use a head pillow to slightly raise your head so that your shoulders are in alignment.

See Best Pillows for Different Sleeping Positions

Align your ribs and pelvis

While sleeping on the side you may also consider using a lumbar support cushion or waist pillow under your waist. This pillow will help maintain alignment between your ribs and pelvis for upper and lower back support. ¹ Pavilack L, Alstedter N. Pain-Free Posture Handbook, 40 Dynamic Easy Exercises to Look and Feel Your Best. Althea Press; 2016.

See Pillow Support and Comfort

Avoid excessive curling in the fetal position

Curling up while sleeping on your side (fetal position) may provide a nestled feeling, but make sure to not curl too tight, which can restrict your breathing and leave you with a sore back—especially if you have spinal osteoarthritis. ² National Sleep Foundation website. National Sleep Foundation website. Which Sleep Position is the Best?. Accessed October 29, 2019.

Select a medium-firm mattress

To get a comfortable night of sleep, your mattress needs to be adequately supported. A mattress with ergonomic standards and the right level of firmness may help promote better sleep, typically by providing an even surface and reducing body aches and pains. ³ Wong DW, Wang Y, Lin J, Tan Q, Chen TL, Zhang M. Sleeping mattress determinants and evaluation: a biomechanical review and critique. PeerJ. 2019;7:e6364. Published 2019 Jan 25. doi:10.7717/peerj.6364 ^{, 4} Ancuelle V, Zamudio R, Mendiola A, et al. Effects of an adapted mattress in musculoskeletal pain and sleep quality in institutionalized elders. Sleep Sci. 2015;8(3):115–120. doi:10.1016/j.slsci.2015.08.004

See Selecting the Best Mattress

Excessively firm or soft mattresses can cause back pain and aches in other areas of the body. For example, ⁵ Leilnahari K, Fatouraee N, Khodalotfi M, Sadeghein MA, Kashani YA. Spine alignment in men during lateral sleep position: experimental study and modeling. Biomed Eng Online. 2011;10:103. Published 2011 Nov 30. doi:10.1186/1475-925X-10-103 :

• A firm mattress can disturb your neck and back support and lead to the concentration of stresses on your shoulder joint, causing pain and stiffness.
• A soft mattress may cause your pelvic area to sag in due to your body weight, causing your upper body to be pulled out of alignment.

A medium-firm mattress is generally accepted as a well-supportive option. ⁴ Ancuelle V, Zamudio R, Mendiola A, et al. Effects of an adapted mattress in musculoskeletal pain and sleep quality in institutionalized elders. Sleep Sci. 2015;8(3):115–120. doi:10.1016/j.slsci.2015.08.004

See Mattress Guidelines for Sleep Comfort

Restorative sleep is imperative when trying to reduce your back pain. Follow these postural tips while you sleep to help keep your spine and its surrounding tissues in alignment and in a relaxed state, to help you get more restful, deep sleep.

Learn more:

Choosing the Best Mattress for Lower Back Pain

Considerations When Buying a New Mattress