How to Sleep With Lower Back Pain

Lower back pain can make it hard to fall asleep, and even harder to stay asleep. When you do not get good rest, your pain often feels worse the next day. It is a frustrating cycle. The good news is that a few simple changes to how and where you sleep can help you rest easier tonight.

Best sleeping positions for lower back pain

The way you sleep can either ease your back pain or make it worse. These two positions tend to work best for people with lower back pain.

1. On your side, with a pillow between your knees

Lie on your side and place a pillow between your knees. This keeps your hips, pelvis, and spine lined up instead of twisting through the night, which takes pressure off your lower back. For extra support, pull your knees up slightly toward your chest.

If one side feels better than the other, that is normal. Some people find it helps to switch sides partway through the night so the same hip and shoulder are not carrying all the weight for eight hours straight. A firmer pillow between your knees tends to hold its shape better than a soft one, so it keeps your hips level all night instead of flattening out after an hour.

This position can also help if your back pain travels down into your leg. Keeping your hips and spine in a neutral line takes some of the pressure off the nerves that run through your lower back, which is why side sleeping with a pillow is often recommended for sciatica-type pain.

2. On your back, with a pillow under your knees

Lying on your back spreads your weight evenly across your whole body. Adding a pillow under your knees helps keep the natural curve of your lower back in place and takes some of the load off your spine.

Not everyone finds back sleeping comfortable, and that is okay. If it feels like a stretch, try easing into it slowly, starting with just a few minutes before you fall asleep. Some people also like a slightly thicker pillow or a rolled towel under the knees for more lift, or a small pillow in the curve of the lower back for extra support.

Sleeping position to avoid

Stomach sleeping is one of the toughest positions for your lower back. It flattens the natural curve of your spine, and it can force your neck to twist to one side for hours at a time. Over time, that combination can leave your lower back and neck feeling stiff and sore before you even get out of bed.

If you are used to sleeping on your stomach, try tucking a thin pillow under your hips to ease some of the strain, or work slowly toward switching to your side instead. Many people fall asleep in one position and wake up in another, so do not worry if you cannot control this perfectly. Falling asleep on your side or back, even if you shift later in the night, still gives your spine a better starting point.

Try heat or cold therapy before bed

A little warmth or cold in the evening can make it easier to settle into a good sleeping position. A warm shower, bath, or 15-20 minutes of a heating pad before bed can help relax tight muscles around your lower back, so you are not fighting stiffness while you try to get comfortable. 

If your back feels more swollen or irritated than tight, a cold pack wrapped in a thin towel can help calm things down instead. Some people like to alternate between the two. There is no single right answer, so it is fine to try both and stick with whichever one leaves your back feeling looser at bedtime.

Build a short bedtime routine for your back

What you do in the hour before bed can affect how your back feels once you lie down. A few habits can help:

• Avoid heavy lifting, deep cleaning, or twisting movements late in the evening, since sore muscles tend to tighten up further once you stop moving.
• Do a few gentle stretches or a short, easy walk earlier in the evening to keep your back from stiffening up before bed.
• Keep a consistent bedtime. Going to sleep and waking up around the same time each day helps your body settle into a steady rhythm, which can make pain feel more manageable.
• Ease into your sleeping position slowly instead of dropping straight into bed. Sit on the edge of the bed for a moment, then lie down and adjust your pillows before you settle in for the night.

Mattress and pillow tips

Your sleep setup matters just as much as your position. A few small updates can make a real difference:

• Choose a medium-firm mattress. It offers support without putting too much pressure on your hips and shoulders.
• Replace an old mattress. Most mattresses lose their support after 7 to 10 years.
• Pick a pillow that supports your neck's natural curve, not just the back of your head.
• Use extra pillows for support. A pillow between your knees, or under your knees, can make almost any position more comfortable.
• Consider a body pillow. A full-length pillow can support your knees, hips, and arms all at once, which some side sleepers find more comfortable than a single small pillow.

When Sleep Disruption Signals It's Time to See a Doctor

Occasional back pain after a long day is common. But if back pain keeps waking you up night after night, or if it comes with numbness, tingling, or weakness in your legs, it is worth talking to a primary care provider. These signs can point to something that needs more attention than a few position changes. 

You can read more about low back pain causes, symptoms, treatment, and prevention on our Low Back Pain conditions page.