How to Sleep With Lower Back Pain: 3 Sleeping Positions for Increased Comfort

You’ve had a long day and your back is hurting. All you want is a good night’s sleep. But you can’t seem to fall asleep or stay asleep because your back hurts. Experts call this the pain-sleep cycle. It’s when back pain interferes with sleep, and when poor sleep worsens back pain. 

About one in three adults report that they don’t get the sleep they need to feel their best. That number is even higher for people with any type of musculoskeletal pain. A 2021 study published in the European Journal of Pain found that people with chronic low back pain are 58% more likely to report sleep problems than those who get enough zzz’s. 

“Sleep is important for back pain because your body repairs itself when you sleep,” explains Heather Broach, PT, DPT, a physical therapist at Hinge Health. “But if you’re in pain, you’re less likely to get the sleep you need.“ While this can be frustrating and upsetting, there’s always something you can do to break the cycle. 

Here, learn more techniques on how to sleep with low back pain and get exercises from our Hinge Health physical therapists for pain relief.

3 Best Sleeping Positions for Lower Back Pain 

Let’s start with this important takeaway: There’s no right or wrong sleeping position for back pain. You should sleep in whatever position is most comfortable for you and helps you feel your best, says Dr. Broach. But if you’re struggling to sleep because of back pain, you may be able to tweak the position you fall asleep in to find a comfy spot as you drift off. Here are a few positions you can try. 

On your side 

Sleeping on your side helps to support your natural posture and may make you feel more comfortable lying in bed. Placing a pillow between your knees helps alleviate some pressure on your spine. Dr. Broach also recommends that your shoulder and side of your body make contact with the mattress. If there’s a gap between your waist and the mattress, consider adding a small pillow there for added support.

You can also give the fetal position a try. Here, your knees are tucked in toward your chest, and your torso is curled in toward your knees. “It’s a very primal, instinctual position that helps your whole body relax, including your low back,” explains Dr. Broach. 

On your back 

This one surprises some people. If you sprain your ankle you want to temporarily put less load on that leg to prevent pain and let the injury heal. So many people assume that if your back hurts, you should try to put less load on it, including when you sleep. But research shows that sleeping on your back can be a really comfortable — and safe — position for low back pain because it distributes your weight evenly across your body, which can help reduce pressure on sensitive structures in your lower back.

If you want, you can place a pillow under your knees. This setup can help to further reduce pressure on your spine and relax your muscles, contributing to a restful sleep. If you don’t want to use a pillow, a rolled up towel works well, too. 

On your stomach

This can be a slightly less comfortable position for some people with lower back pain, partly because it tends to make your back arch a bit more than you might be used to. If you prefer sleeping on your stomach but are having back pain at night, though, Dr. Broach recommends putting a small, flat pillow under your hips and ribs to elevate your mid and low back. This helps put your back in a position that more closely mimics what you likely have during the day. 

Some stomach sleepers find that they are actually more comfortable not placing a pillow under their head. (Feel free to play around with this and see what works for you, advises Dr. Broach.) You can also try placing a firm pillow under your shins. This might put your knees and ankles in a relaxed, comfortable position that helps you sleep. 

If you like sleeping on your stomach but want to explore other positions, you could try sleeping on your side while holding a body pillow. The body pillow will give you the feeling of pressure against your stomach while allowing you to sleep in a different position.

How to Sleep With Lower Back Pain? 4 Sleep Hygiene Best Practices

In addition to finding a sleep position that works for you, take a look at your sleep habits. Small changes to your sleep routine can help you sleep better, which can reduce back pain and help you break the pain-sleep cycle. Here’s what Hinge Health physical therapists recommend. 

• Move your body during the day. Just 30 minutes of moderate exercise can increase your quality of sleep (though it may be best to avoid strenuous activity within two hours of bedtime as this can actually disrupt sleep for some people). Take breaks throughout the day for walking, stretching, or anything else that gets you moving. If you can get your exercise outside, it’s even better. Exposure to natural sunlight (or bright light) during the day helps keep your circadian rhythm — or sleep cycle — on track. 

• Do exercise therapy. Exercise therapy refers to targeted movements that help strengthen and stretch the muscles that support your spine. A physical therapist can design a customized routine to address your pain. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Find a good pillow. It doesn’t matter if it’s firm or soft. You just want one that will help you find a position that is comfortable for your neck and back. Stomach sleepers usually gravitate toward thinner pillows. If you’re a back or side sleeper, you may prefer a thicker option. 

• Practice relaxation techniques. Techniques such as guided meditation or listening to calming music can help distract you from your back pain and help you fall asleep. Diaphragmatic breathing, or belly breathing, is one technique that can be particularly effective. A 2017 study in the Journal of Sports Rehabilitation found that this type of exercise helped to reduce back pain. To do it, sit upright and breathe in slowly through your nose using only your diaphragm (your belly should swell out as you breathe in). Then exhale slowly through your mouth (your belly should fall back in as you breathe out).

While changing your sleep position and habits can help you get some much-needed rest, one of the most effective ways to manage back pain and improve sleep is exercise therapy. The above gentle exercises from Hinge Health physical therapists are great for stretching your back. You can do them throughout the day when you’re experiencing a pain flare or before bed to calm down your pain system and help you fall asleep. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Sleeping with Lower Back Pain: A Hinge Health Perspective

Good sleep is so essential for daytime energy, a strong immune system, a healthy metabolism, and so much more. No matter how rough your sleep or back pain may be, know that you can always do something to help improve it. And the silver lining about the pain-sleep cycle is that small tweaks to either your sleep routine or to your back pain management can positively affect the other. 

It might take some trial and error to find the right sleeping position for you, but there is a solution. It might just require thinking outside the box, says Dylan Peterson, PT, DPT, a physical therapist at Hinge Health. Start by finding which position is most comfortable for you — even if it’s not perfect. Then experiment with a few additional interventions, like sleeping on a different mattress, taking a warm bath before bed, or getting up to walk around your home if pain wakes you up in the middle of the night. 

PT Tip: Get Creative with Pillows 

No matter which sleeping position you prefer, using pillows for additional support can help prevent pain. You can place a pillow between your knees if you sleep on your side, under the backs of your knees or under your thighs if you sleep on your back, or under your lower abdomen for stomach sleeping to help keep your low back comfortable all night. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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