Sciatica pain often gets worse during the night.
Why does this type of nerve pain intensify when you’re trying to sleep, and more importantly how can you calm the pain?
Here are 5 insights on this topic. (You may want to try solutions to number 3 tonight!)
1. Some sleep positions increase pressure on the sciatic nerve
The best sleep position is one that minimizes pressure on your sciatic nerve during the night. This is determined largely by the specific cause of your sciatica symptoms.
For example:
With a pathology like a herniated disc, the best sleep position depends in part on the position of the disc.
- For a paracentral disc herniation (most common), people tend to do better lying on the stomach.
- For a foraminal herniated disc, sleeping on the side in a fetal position often brings relief.
With a pathology like spinal stenosis, you may feel best sleeping on your side with your knees curled up (in the fetal position), and a pillow between the knees.
This position helps relieve pressure on the nerve root. Sleeping in a reclining chair or an adjustable bed that allows the head and knees to remain elevated can also relieve pressure on the nerve.
Read more about specific sleep positions
2. Increased inflammation during the night
Inflammation is almost always a contributor to sciatic nerve pain, and research shows that pro-inflammatory cytokines are elevated during rest time and, conversely, anti-inflammatory cytokines are elevated during activity time (Sleep Science and Practice)
For example, swelling around the nerve can increase, leading to more pain or tingling in the legs. Inflammatory materials tend to settle around the sensitive nerve root, increasing irritation and nerve pain.
Solutions:
- Adopt an anti-inflammatory Diet: Develop a diet rich in anti-inflammatory foods, and supplement as needed, such as omega-3s (salmon) and polyphenols (berries, spinach). Avoid food and drink that increases inflammation, such as alcohol, processed sugar, seed oils and ultra-processed foods. Avoid smoking.
- Take anti-inflammatory medications or supplements before bed: Check with your doctor to see if you would benefit from medication and/or supplementation in the evening, such as taking an NSAIDs (e.g., ibuprofen, naproxen, or a prescription NSAID), and/or if taking an anti-inflammatory supplement (e.g. black cumin seed oil or a curcumin plus black pepper) to target pro-inflammatory cytokines.
- Consider topical anti-inflammatory creams and gels: Some people benefit from topical applications of anti-inflammatory creams, gels or patches, such as Voltaren. There are also local applications for pain relief, such as lidocaine patches.
Always follow your doctor’s guidance for medical treatments and supplements.
3. Increased stiffness and lack of movement
When you’re asleep, your body remains relatively still for hours.
This prolonged immobility tends to lead to stiffness in your joints and soft tissues in the lower back, hips, and legs.
This is especially true if inflammation is already present due to a herniated disc, spinal stenosis, spondylolisthesis or other common cause of sciatic nerve compression.
For example:
- Inflammatory material can collect around inflamed tissues when circulation slows during sleep, increasing local inflammation.
- Muscles supporting the spine may become tight or spasm after long periods of inactivity, increasing pressure on the sciatic nerve.
Solutions:
- Gentle stretching: Do 5–10 minutes of gentle stretches, such as sciatic nerve glides, hamstring stretches, or pelvic tilts to keep tissues mobile.
- Easy movements: Slowly bring your knees to chest or do gentle side-to-side lower back rolls in bed to reduce stiffness.
- Morning routine: Upon waking, use gentle sciatica stretches to restore circulation and range of motion.
If you are especially stiff upon waking, slide a heating pad on a low setting under your low back for 10 to 15 minutes to warm up your muscles prior to getting out of bed.
Bonus tip: Consider trying McKenzie Exercises that specifically target sciatica pain.
4. Muscle Imbalances and Posture Problems
Over time, muscle imbalances from prolonged sitting, poor posture, or structural issues like scoliosis tend to lead to problems with tension in the lumbar spine and pelvis. For example:
- One-sided tightness in the piriformis or hip flexor muscles may pull on the pelvis, encroaching on the space your nerve needs as it exits the spine and travels to your leg.
- Spinal misalignment that can be managed during the day with gentle movement and shifts in posture is more difficult to manage while sleeping.
Solutions:
- Focus on strengthening weak muscles (e.g., glutes, core) and releasing tight ones (e.g., hip flexors, hamstrings) through individualized physical therapy
- Incorporate more movement during the day, as tolerated, such as gentle walking or water therapy
- Try an approach focused specifically on muscle balance and posture improvements, such as the Alexander Technique
5. Increased Nerve Sensitivity at Rest
During the day there are a lot of environmental stimuli to distract you from pain perception.
However, without distractions at night, your brain tends to become more sensitive to internal pain signals.
Solutions:
- Use deep breathing, guided imagery, or progressive muscle relaxation to lower pain perception before bed.
- Create a calming routine and dark, quiet sleep setting to reduce stress and sensory input.
- Consult with a physical therapist or physiatrist to learn how sciatic nerve flossing can gradually reduce hypersensitivity.
P.S. Don’t forget to evaluate your mattress – it may be putting pressure on your sciatic nerve and intensifying nighttime pain. For example:
- A mattress that is too soft or too firm can lead to poor spinal support, increasing lumbar pressure.
- Lack of support for the pelvis or shoulders may cause spinal misalignment and muscle tension overnight.
Solutions: Try using a medium firm mattress; find a mattress that has supportive inserts that can be customized to where and how you need them, or use pillows for this purpose.
If you have severe nerve compression, try sleeping in a reclined position such as using an adjustable bed or sleeping in a recliner.
Best wishes that this helps you get a more restful, restorative sleep tonight!
