How To Sleep With Lower Back Pain: Causes and How to Treat It

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. The good news: It doesn’t matter whether the chicken (pain) or the egg (poor sleep) came first — there are ways you can break the cycle to simultaneously reduce back pain and improve sleep quality.  

Here, learn more techniques on how to sleep with low back pain — especially with exercises from our Hinge Health physical therapists.

The Pain-Sleep Cycle

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.

Sleeping with 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. 

Best Sleeping Positions for Low 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 your comfy spot as you drift off. Here are a few positions you can try: 

• On your side with a pillow between your knees. This may help to support your natural posture and make you feel more comfortable lying in bed. A firm pillow between your knees usually works best to keep you comfortable through the night.

• Fetal position. This means 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 relaxes your whole body, including your low back,” explains Dr. Broach.

• Flat on your back. Consider placing a pillow under your head or neck and another under your knees. This setup can help relax your muscles and make you feel more at ease, contributing to a restful sleep.

Sleeping on Your Back? Really? 

If you sprain your ankle you want to temporarily put less load on that leg to prevent pain and let the injury heal. So if your back hurts, you probably want to put less load on it, including when you sleep, right? 

Actually, no. Research shows that sleeping on your back can be a really comfortable — and safe — position for low back pain and sciatica because it distributes your weight evenly across your body, which can help reduce pressure on sensitive structures in your lower back. It may also prevent you from twisting or bending in your sleep in a way that aggravates your symptoms. 

What if sleeping on your back isn’t comfortable? In fact, what if none of the positions above are comfortable for you? It might take some trial and error, but there’s 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. (More on this below.)

What About Stomach Sleeping? 

There’s nothing wrong with sleeping on your stomach. If sleeping on your stomach is the best way for you to fall asleep, then it’s the best position for you. This can, however, 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. While not bad, it might just be uncomfortable for you. Sleeping on your stomach also makes you turn your neck, which may contribute to neck and upper back stiffness. 

If you prefer sleeping on your stomach but are having back pain at night, 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.

Sleep Hygiene with Back Pain

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. Regardless, you don’t need to spend extra money on therapeutic pillows. Dr. Broach says standard or cheaper options work just as well. 

• Invest in a good mattress. A mattress that is too firm or too soft can contribute to pain for some people. For many, a medium-firm mattress is generally a comfortable option, according to a 2021 study published in the Journal of Orthopedics and Traumatology. But a softer or firmer mattress isn’t bad or wrong if those mattresses are more comfortable for you. Not sure if you need a firmer one than what you’re currently using? Put a plywood board under your mattress, or place your mattress on the floor. If you notice an improvement in pain or comfort, you might need something firmer. You could also try an egg shell mattress topper to see if a softer bed feels better. Or take note of how your back feels after sleeping in a hotel or another bed. 

• Rethink your bedtime routine. Be intentional about what you do before bedtime and be consistent with your evening routine to help you sleep better. It’s best to get up at the same time each morning so you feel tired around the same time each evening. Set a timer one hour before bed as a reminder to start winding down. During this time, you can:

  • Dim the lights. Bright lights are stimulating and can decrease levels of the hormone melatonin, which helps you sleep.

  • Turn off electronic devices. Or place them in another room or out of reach. The blue light from screens can make it harder for you to fall and stay asleep. Instead, read, journal, make a to-do list for tomorrow, reflect, color, or do anything else that soothes you. 

  • Drink herbal tea, such as chamomile or lavender.

  • Take a warm bath. In addition to helping you relax, soaking in a warm bath can increase circulation and reduce pain.

  • Do exercise therapy. Targeted movements, exercises, and stretches increase the strength and flexibility of the structures in and around your back.

• Keep your room quiet and dark. Experts suggest keeping the temperature of your room around 65 degrees Fahrenheit. You can use a white noise machine or blackout shades to help. 

• 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 published 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).