This article provides a guide to the six best sleeping positions for lower back pain, as well as offering advice on pillows and mattresses, sleep hygiene, and when to see a doctor.
The best sleeping positions
Not only can lower back pain get in the way of a good night's rest, but poor sleeping posture may make the existing pain worse.
A poor sleeping position may even be the underlying cause of lower back pain. This is because certain positions can place unnecessary pressure on the neck, hips, and back.
It is important to maintain the natural curve of the spine when lying in bed. A person can do this by ensuring the head, shoulders, and hips are in alignment, and that the back is properly supported. The best way to do this is usually by sleeping on the back.
However, many people are uncomfortable sleeping on their back or find it causes them to snore. Everyone sleeps differently, so there is a variety of options for people who want to sleep better and reduce their back pain.
For people experiencing lower back pain at night, trying out the following postures and tips may provide relief.
1. Sleeping on the back with knee support
Lying on the back is usually considered to be the best sleeping position for a healthy back.
This position evenly distributes weight the full length of the body's largest surface. It also minimizes pressure points and ensures good alignment of the head, neck, and spine.
Placing a small pillow under the knees can provide additional support and help maintain the natural curve of the spine.
To adopt this sleeping position, a person should:
- Lie flat on their back facing the ceiling, and avoid twisting the head sideways.
- Position a pillow to support the head and neck.
- Place a small pillow under the knees.
- For extra support, fill in any other gaps between the body and mattress with additional pillows, such as beneath the lower back.
2. Sleeping on the side with a pillow between the knees
Although lying on the side is a popular and comfortable sleeping position, it can pull the spine out of position. This can strain the lower back.
Correcting this is easy. Anyone who sleeps on their side can simply place a firm pillow between their knees. This raises the upper leg, which restores the natural alignment of the hips, pelvis, and spine.
To adopt this sleeping position, a person should:
- Get into bed and carefully roll on to one side.
- Position a pillow to support the head and neck.
- Pull the knees up slightly then place a pillow between them.
- For extra support, fill in any gaps between the body and mattress with more pillows, especially at the waist.
People who habitually turn to sleep on their front may also want to try hugging a large pillow against their chest and stomach to aid sleep and keep their back aligned.
3. Sleeping in the fetal position
For people with a herniated disc, adopting a curled-up fetal position may bring relief during the night. This is because lying on the side with the knees tucked into the chest reduces bending of the spine and helps open up the joints.
To adopt this sleeping position, a person should:
- Get into bed and carefully roll on to one side.
- Position a pillow to support the head and neck.
- Draw the knees up towards the chest until the back is relatively straight.
4. Sleeping on the front with pillow under the stomach
Lying on the front of the body is usually considered the worst sleeping posture. However, for those who struggle to sleep in another position, placing a slim pillow underneath the stomach and hips can help improve spinal alignment.
Sleeping on the front may also benefit people with a herniated disc or a degenerative disc disease.
To adopt this sleeping position, a person should:
- Get into bed and roll on to their front.
- Place a slim pillow underneath the abdomen and hips to raise the mid-section.
- Use a flat pillow for the head or consider sleeping without one.
5. Sleeping on the front with the head face down
Another reason sleeping on the front is considered bad is because the head is usually turned to one side. This twists the spine and places additional stress on the neck, shoulders, and back.
To avoid this, try lying face down. A small but firm pillow or tightly rolled-up towel can be used to prop up the forehead, allowing room to breathe. This should be done in addition to placing a pillow under the stomach.
To adopt this sleeping position, a person should:
- Get into bed and roll onto their front.
- Place a slim pillow underneath the abdomen and hips to raise the mid-section.
- Position a pillow or rolled-up towel under the forehead to create adequate breathing space between the mouth and mattress.
6. Sleeping on the back in a reclined position
Sleeping in a reclined position may benefit lower back pain, particularly in people with isthmic spondylolisthesis.
If significant relief is found from resting in a reclined chair, it may be worth investing in an adjustable bed that can be positioned accordingly.
Choosing a pillow
A head pillow should maintain the natural posture of the neck and help support the spine. Ideally, it should be comfortable, adaptable to different positions, and keep its overall shape after use.
Pillows should be changed every 12–18 months.
Someone who sleeps on their back may be better suited to a thinner pillow. Raising the head too much can place a strain on the neck and back.
There are also thin pillows specifically designed to help the neck. These pillows are also ideal for placing under the hips if a person sleeps on their front.
Memory foam is a good option as it is firm but also molds to the shape of the head and neck.
People who prefer to sleep on their sides may want to consider a thicker pillow. For best support, it should fill space between the neck and mattress completely. A gusseted pillow is an excellent choice for this.
People who sleep on their stomach should use a thin pillow or no pillow at all. Pushing the head backward can put pressure on the neck.
Alternatively, they may wish to try sleeping face down with a small but firm pillow propping up only the forehead. This leaves enough room to breathe but allows a person to keep their neck straight.
Choosing a mattress
A mattress should be well made, fully supportive, and comfortable. Firm mattresses are often recommended, but there is some evidence to suggest that medium-firm may be better for people with long-term lower back pain.
Body shape, size, and proportions can help determine how much support is needed. Wide hips may be better suited to a softer mattress and slim hips to a firmer one to keep the spine properly aligned.
Although they can seem more comfortable, softer mattresses provide less support. Sinking too deep can cause joints to twist and the spine to come out of its natural alignment.
A foam mattress topper can be used to provide additional support to a spring mattress. Alternatively, a plywood board can be placed underneath the mattress to increase firmness.
Ideally, mattresses should be replaced every 10 years.
Sleep hygiene
Back pain can significantly disrupt sleep. People should avoid sleeping in late to compensate for lost sleep overnight. Instead, they should try to maintain a regular schedule with consistent bedtime and wake times. Most adults need between 7 and 9 hours every day.
General sleep hygiene tips include:
- avoiding stimulants, such as caffeine, in the evening
- avoiding heavy exercise in the hours leading up to bedtime
- winding down before bedtime by reading, taking a warm bath, listening to relaxing music, or doing gentle yoga stretches
- making the bedroom a relaxing environment by dimming the lights and removing distractions, such as computers and TVs
When to see a doctor
Anyone with severe or worsening back pain, particularly after a fall or injury, should speak to a doctor. People should also speak to a doctor if they experience pain that gets worse after resting or at night.
People should seek immediate medical advice for back pain if it is accompanied by any of the following:
- fever
- chest pain
- numbness in the legs, buttocks, or groin area
- difficulty passing urine
- loss of bladder or bowel control
- unexpected weight loss
If back pain is causing long-term lack of sleep, a person should speak to a doctor about treatment options and lifestyle changes to improve their symptoms and help them feel better rested.
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