Lower back pain makes it hard to fall asleep, and it can startle you awake at any hour of the night.
Your back pain and sleeping problems need to be treated together.
Read: Chronic Pain and Insomnia: Breaking the Cycle
To help you reclaim your sleep schedule, here is a simple guide to sleeping with lower back pain:
See Practicing Good Sleep Hygiene
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1. Sleep on your side to relieve pain from a pulled back muscle
One of the most common causes of lower back pain is a pulled back muscle, which occurs when a muscle in your lower back is strained or torn as a result of being over-stretched. Symptoms from a pulled back muscle typically resolve within a few days, but the intense pain can make it difficult to fall asleep at night. Worse yet, the longer you lie in the bed, the more deconditioned your body gets and the worse your symptoms may become.
See Causes of Lower Back Pain
No single sleeping position works for every person with a pulled back muscle, but a good place to start is to test sleeping on your side. When sleeping on your side, try the following:
- Avoid a tight curled-up fetal position (knees pulled in toward the body), and instead sleep with your body slightly elongated.
- Slip a slim pillow between your knees to support the natural curvature of your spine.
See Mattresses and Sleep Positions for Each Back Pain Diagnosis
- Find a head pillow that holds your head midway between each shoulder. If your pillow is too thin or too thick it can bend your neck at an uncomfortable angle.
You may also benefit from wearing a disposable heat wrap to bed to help alleviate the pain from a pulled back muscle. These wraps deliver muscle-relaxing, low-level heat over the course of several hours—and so they may help you both fall asleep faster and stay asleep longer.
See Using an Adjustable Bed for Back Pain
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2. Listen to soothing audio
When your lights go out and your head hits the pillow, almost all of the stimuli that have held your attention during the day dissipate, and you tend to focus more on your back pain. As you pay more attention to your back pain, your anxiety can start to rise—which in turn often makes it harder to fall asleep.
See 11 Chronic Pain Control Techniques
The practice of listening to various forms of soothing audio can relieve both your anxiety and your experience of back pain by redirecting your focus away from your symptoms. Several nighttime audio options you can try include:
- Classical music
- Audio books intended for children
- Relaxation podcasts
Regardless of what kind of audio you choose to play, make sure it is free of harsh sounds or intense plot lines.
3. Don’t skimp on your mattress
If you scour the internet, you will discover all sorts of suggestions to extend the life of a sagging mattress. These include methods like sliding plywood under your mattress and ditching your box spring. While these tricks may work for some, the best approach is usually to replace a worn-out mattress.
It is important not to neglect your mattress because, for some people, a sagging mattress can exacerbate lower back pain by placing additional stress and strain on your spinal structures. In turn, this can make it harder to fall asleep at night.
When it comes to sleeping with lower back pain, the most expensive mattress is not always best. Instead, the best mattress for you is ultimately the one that provides the best night’s sleep. With this in mind, here are a few mattress guidelines to help get you started in your search:
- Your mattress needs to support the natural curvature of your spine. This means your spine should look similar when you are lying on your back or side as when you’re standing with good posture.
- Visit your local mattress store and try out various types of mattresses. After 15 minutes on a mattress, you will have a general idea if it is a good fit for you. Don’t be afraid to take your time.
- If you sleep with a partner, consider a larger-sized mattress. This will allow you both room to sleep without startling one another awake at night.
See Selecting the Best Mattress
Learn more:
Natural Remedies and Herbal Supplements as Sleep Aids
Best Mattress for Low 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 Using supported sleeping postures can prevent the concentration of stresses on your spine, keep your back relaxed, and create a healing environment.
Using a pillow to elevate your knees in bed can help to alleviate sciatica symptoms.
Watch: 3 Tips for Sleeping with Sciatica Video
As a general rule, avoid sleeping on your stomach—it disturbs the normal alignment of your spine.1 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 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
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Side sleepers: Keep your hips stacked
If you’re a side sleeper, place a firm, flat pillow between your knees.1 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
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
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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.3,4
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:
- 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
See Mattress Guidelines for Sleep Comfort
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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
References
- 1.Pavilack L, Alstedter N. Pain-Free Posture Handbook, 40 Dynamic Easy Exercises to Look and Feel Your Best. Althea Press; 2016.
- 2.National Sleep Foundation website. National Sleep Foundation website. Which Sleep Position is the Best?. Accessed October 29, 2019.
- 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
- 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