How to sleep with sacroiliac joint pain: best sleeping positions and tips
Discover how to sleep comfortably with sacroiliac joint pain and get pain relief tips from Hinge Health physical therapists.
Table of Contents
Getting a good night’s sleep can be challenging when you have sacroiliac (SI) joint pain. It quite literally can be a pain in the butt (and lower back). You have two SI joints — one on each side of the sacrum (the triangular bone in your low back), where it connects to the upper part of your pelvis. When one or both SI joints become inflamed due to injury or a chronic condition like arthritis, discomfort can linger day and night.
“The SI joints sit right between your hips, which is why you may feel pressure in that area when you lie down,” explains Melia Lewis, PT, DPT, a physical therapist at Hinge Health. “This can make it tricky to find a comfortable sleeping position with SI joint pain.”
When SI joint pain keeps you from falling or staying asleep, it can lead to a difficult cycle, as not getting enough quality sleep each night can make SI joint pain feel worse the next day.
You can break the pain-sleep cycle by switching up your sleeping positions and adopting a sleep hygiene routine.
Read on to learn how to sleep comfortably with SI joint pain, with strategies and tips recommended by our Hinge Health physical therapists.
Reviewed by our clinical and medical experts
Bijal Toprani, PT, DPT
Melia Lewis, PT, DPT
Why does sacroiliac joint pain feel worse at night?
SI joint pain can sometimes feel more intense at night. A few theories include:
Positioning. Sleeping in a way that doesn’t support your body may put extra stress on SI joints. Because SI joint pain is often one-sided, even small movements or adjustments might increase discomfort on the affected side.
Inactivity overnight. Being still for several hours can lead to stiffness by morning — especially if your hips and back remain in one position for a long time, says Dr. Lewis.
Body awareness and pain perception. As you relax and settle into bed, you might become more aware of sensations, and discomfort can feel more noticeable. “This increased awareness can make some people more tuned in to what’s hurting,” Dr. Lewis says.
Best sleeping positions for sacroiliac (SI) joint pain
There’s not just one best or worst sleeping position for SI joint pain — what works best for you may take some trial and error, says Dr. Lewis. The goal is to find a position that helps your back and pelvis feel supported so you’re more comfortable through the night.
Small adjustments to classic sleeping positions can make a difference. “Get creative with pillows,” Dr. Lewis says. “When you’re in pain, your pillow can be your best friend.” Try these tips to sleep comfortably with SI joint pain.
For back sleepers
Lying on your back can help distribute your weight evenly, but it may put extra pressure on your SI joints and flatten the natural arch in your low back. If you prefer this position, try placing a pillow under your knees, to help ease SI joint pain, Dr. Lewis says.
For stomach sleepers
Sleeping on your stomach can feel uncomfortable for people with SI joint pain, as it can add extra pressure to your low back and pelvis. To make this position easier on your body, Dr. Lewis suggests placing a pillow under your pelvis and lower abdomen, or just above your ankles. “Many people find that using pillows this way helps their back feel better,” Dr. Lewis says.
For side sleepers
Lying on your side can sometimes put pressure on the irritated SI joint, but there are ways to make it more comfortable. First, sleep on your unaffected side, if possible. Place a pillow between your knees to help keep your hips and pelvis in a comfortable position. Let your shoulder and the side of your body rest fully on the mattress for support. If you feel a gap between your waist and the bed, try tucking a small pillow there for extra comfort.
How to sleep better with SI joint pain
Sleep is important for managing SI joint pain, but it can be hard to do when you’re uncomfortable. “Sleep is so important; it’s when a lot of healing happens,” says Dr. Lewis. Without enough quality sleep, you can become more sensitive to pain. Try these tips for better sleep:
Sleep on a supportive surface. “The right mattress can make a difference,” says Dr. Lewis. If your mattress is too soft, your body may sink in; if it’s too firm, your back might not feel well-supported. A mattress topper can be a cost-effective way to adjust firmness without needing to replace your whole mattress. Aim for a medium-firm surface that offers support while still feeling comfortable. If your mattress feels comfortable for you, there’s no reason to change it. There are other ways you can address SI joint pain as you sleep.
Apply heat or cold therapy. Many people find relief with gentle heat, like a warm bath or heating pad before bed. Cold packs can help too. “Try both options to see what feels best for your body,” says Dr. Lewis.
Walk before bed. Taking a short walk in the evening can boost blood flow, ease SI joint discomfort, and help you unwind for better sleep. “Even 10 to 15 minutes of walking can make a difference,” says Dr. Lewis.
Prioritize sleep hygiene. Back pain or not, everyone can benefit from a consistent bedtime routine. Adopting good sleep hygiene habits, such as powering down screens at least one hour before bed, reading a relaxing book, and doing stretches and breathing exercises can help create a restful environment for sleep. Regulating your body’s internal clock promotes better sleep, which can reduce pain perception.
Practice relaxation techniques. Relaxation exercises, like slow diaphragmatic breathing, can help calm your nervous system and reduce pain. Practicing these techniques before bed can help you fall asleep more easily — and make it easier to get back to sleep if you wake up during the night.
Stretch before sleep. “It’s common to stay in one sleeping position for most of the night, so doing some gentle stretches to ease tension in your lower back and hips before bed can prepare your body for rest and help you wake up feeling less stiff,” says Dr. Lewis.
Soothing nighttime stretches for SI joint relief
Want expert care? Check if you're covered for our free program →- Child’s pose
- Cat cow
- Knee rocking
- Diaphragmatic breathing
Doing all of these gentle movements and exercises before bed can help relax and prepare your body for rest. By easing tension in tight areas of your low back and pelvis, you may find it easier to get comfortable and stay asleep throughout the night.
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.
Physical therapy (PT) is for more than just recovering from surgery or injury. It’s one of the top treatments for joint and muscle pain. It helps build strength, improve mobility, and reduce pain. And it doesn't always need to be in person.
Hinge Health members can conveniently access customized plans or chat with their care team at home or on the go — and experience an average 68% reduction in pain* within the first 12 weeks of their program. Learn more*.
When to see a doctor
SI joint pain often improves on its own with conservative treatments, Dr. Lewis says. But if your pain seems unusual, severe, getting worse, or causing difficulty with daily activities, see a healthcare provider. It’s also a good idea to get care if you have:
Continued or worsening numbness, tingling, or weakness in your legs or groin
Difficulty controlling your bladder or bowels
Pain makes it hard to sleep or do daily activities
You feel worried about moving or exercising due to the pain
You have a personal history of cancer or unintentional weight loss
PT tip: Move slowly while getting in and out of bed
To help prevent SI joint pain when getting in or out of bed, Dr. Lewis recommends moving slowly and keeping your legs together, so your hips stay level and supported. “Try swinging both legs in or out at the same time, rather than moving one at a time, to avoid extra strain on your hips,” Dr. Lewis says. Taking your time and avoiding quick movements in bed can also help reduce discomfort.
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.
Looking for pain relief? Check if your employer or health plan covers our program
References
1. Jerath, R., Beveridge, C., & Barnes, V. A. (2019). Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia. Frontiers in Psychiatry, 9(780). doi: 10.3389/fpsyt.2018.00780
2. O’Byrne, N. A., Yuen, F., Butt, W. Z., & Liu, P. Y. (2021). Sleep and circadian regulation of cortisol: A short review. Current Opinion in Endocrine and Metabolic Research, 18(18), 178–186. doi: 10.1016/j.coemr.2021.03.011
3. Caggiari, G., Talesa, G. R., Toro, G., Jannelli, E., Monteleone, G., & Puddu, L. (2021). What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. Journal of Orthopaedics and Traumatology, 22(1). doi: 10.1186/s10195-021-00616-5
4. Sprouse-Blum, A. S., Smith, G., Sugai, D., & Parsa, F. D. (2010). Understanding Endorphins and Their Importance in Pain Management. Hawaii Medical Journal, 69(3), 70. https://pmc.ncbi.nlm.nih.gov/articles/PMC3104618/