How to Sleep When You Have Lower Back Pain

Lower back pain can leave you tossing and turning. Here are some proven tips to ease the aches and get better rest.

Person adjusting pillows on their bed before sleep
Maskot ./Getty Images/Maskot

From sciatica and inflammatory diseases to injuries and pregnancy, there are lots of different reasons for lower back pain. But regardless of the cause, lower back pain often creates another common problem: sleep troubles.

In fact, nearly 59% of people with lower back pain have sleep disturbances — and the worse the pain is, the more likely you are to have trouble getting a good night’s rest. That, in turn, can make you feel off-kilter the next day — making it even harder to drift off that night. It becomes a detrimental cycle.

That doesn’t mean you’re doomed to toss and turn indefinitely, though. Whether your pain is short-term or ongoing, making some small tweaks to your sleeping position and lifestyle could make it easier for you to nod off — and keep zingers from interrupting your Zzz’s.

Here are some expert-approved tips on sleeping with lower back pain.

Sleep on your back

Stomach sleepers, take note: Your preferred sleeping position might actually be worsening your pain. Sleeping on your stomach puts pressure on your back muscles, flattens your spine’s natural curvature, and forces you to keep your neck turned all night long. That’s a recipe for pain.

Lying flat on your back is the best sleeping position for back pain, according to assistant professors of clinical orthopaedic surgery at the Keck Medicine of the University of Southern California. Back sleeping helps keep your spine in a neutral alignment, which takes some of the stress off.

Pro-tip: Place pillows beneath your neck and knees for even more support and pain relief.

“If you are still experiencing pressure, you may want to put a rolled-up hand towel under the small of your back, which will add support,” says Nancy R. Kirsch, Ph.D., a physical therapy professor and vice chair of rehabilitation and movement sciences at Rutgers School of Health Professions. “This position distributes weight across a larger area of your body, with good alignment of your spine.”

Back sleeping tips:

  • Sleep with a pillow underneath your neck and knees.
  • Don't have the right pillow? Roll up a towel.
  • Sleep in a reclined position with the help of an adjustable base bed.

Sleep on your side

ballyscanlon/Getty Images

Despite the benefits of back sleeping, only about 8% of people can sleep in that position. So if it doesn’t feel right, lying on your side with your legs straight is a helpful alternative.

“On your side, allow your shoulder and the entire side of your body to make contact with the mattress, placing a pillow between your knees, which takes stress off the muscles and joints,” says Kirsch, adding that you should switch which side you sleep on regularly to avoid muscle imbalance.

Side sleeping tips:

  • Place a pillow between your knees to relieve pressure.
  • Curl in a fetal position to open up space between your vertebrae, taking pressure off the spine.
  • Add another pillow under your waist for additional support.

Adjust your pillows and mattress

A single pillow for your head might not cut it when trying to sleep better with lower back pain. Stock up on a few pillows of different thicknesses, shapes, and sizes — like bolsters and U-shaped puffs — to fill in any spaces between your body and the mattress, per the University of Rochester Medical Center. This extra support helps keep your spine neutral, offering pain relief.

Your mattress choice can also make a difference in how well you sleep with lower back pain. A medium-firm mattress can help prevent back pain by reducing curvature in your spine, according to the American Chiropractic Association. If replacing your mattress isn’t an option right now, adding a foam mattress topper to your bed could also do the trick.

Stretch before bed

Before bedtime, break out your yoga mat (or just grab a comfy spot on the floor) and plan to move your body for 10 to 15 minutes.

“Mild stretching before you get into bed helps you get the most of the musculoskeletal restoration that occurs during sleep,” says Kirsch.

Three common exercises that can help lower back pain include:

Exactly how you should stretch depends on what’s causing your lower back pain. In some cases, certain exercises could actually worsen your pain (case in point: standing toe touches, which can compress the spine, or standard sit-ups, which come with the risk of herniated disc injuries). So, it’s best to check in with a physical therapist to figure out the best bedtime stretches for you.

Get out of bed gently

There’s an art to getting out of bed that can help you avoid aggravating back pain. And keeping that pain at bay in the morning could lead to better sleep come bedtime.

Kirsch says: “Be very careful when you are changing position — do not twist or turn. Move your body ‘together’ and keep your core tight. Roll on to your side and swing your legs over the side of the bed to sit up slowly and reduce the strain on your back.”

Still feeling stiff? Your nighttime stretch routine can work for lower back pain in the a.m., as well.

Don’t force yourself to sleep

Still can’t sleep? Don’t just lie in bed and let your anxiety mount. Instead, get up and go do something that won’t be too stimulating (like playing a game of solitaire) in another room until you feel drowsy.

“Lying in bed forcing yourself to get to sleep makes things worse,” says Molin. “Changing this one routine can help your chances of sleeping more consistently through the night, even with ongoing back pain.”

Practice sleep hygiene

Man stretching and gently getting out of bed to avoid low back pain
Nomad/Getty Images

No need for sanitizer: Sleep hygiene is about habits, not cleanliness (although fresh sheets never hurt!). And building good ones can help boost your chances for good rest.

“The better sleep quality you are able to achieve will reduce the chances of waking up due to back pain,” says Dr. Cliff Molin, a primary care physician and sleep medicine specialist with Village Medical.

Plan to get to bed and wake up at about the same time every day (yes, that includes weekends, too!). Keep devices that emit blue light out of your bedroom. Get some physical activity, like a walk in the park, during the day to help your body feel tired in the evening. And prime your body and mind for rest with relaxing activities — meditation, reading, a hot bubble bath— before bed.

Don't forget to make these sleep habits a regular occurrence too:

Alternative treatments for back pain relief

No two people experience back pain and sleep problems in the exact same way, so it’s worth exploring a variety of techniques until you figure out what works best for you. You don’t have to only treat your back pain before you sleep either.

Other ways to relieve lower back pain include:

  • Using a heating pad or electric blanket (get one with a timer to avoid overheating) 
  • Massaging area with ointment that includes cayenne pepper, which reduces pain  
  • Practicing progressive muscle relaxation to help with physical and mental tension  
  • Acupuncture sessions, which has been shown to decrease pain after 12 months 

A doctor or other healthcare professional can also make personalized recommendations for sleeping better with lower back pain, and prescribe medication as needed.

Takeaway: Prioritize your comfort and sleep

Often sleep deprivation is a sign that pain may get worse. And since sleep debt takes a long time to recover from, you’ll want to start making tweaks to your sleep hygiene and bedtime routine ASAP. Whether that’s trying new sleep positions or engaging in nighttime self care, your efforts should focus on maximizing comfort and relaxation before sleep. This could also mean giving your bedroom a small makeover that noise and light are blocked from waking you up at night.

It’s the small steps that help you feel more fully restored overnight.