Sleeping Positions and Back Pain

While there are no absolute rules, there are a few general guidelines about sleeping positions that are most comfortable for the spine. In general, the best sleeping position is to lie on your back with a small pillow tucked underneath the back of the knees. This position completely unloads the stress on the spine and allows for the natural curve of the lower back.

For people who prefer sleeping on their side, it is helpful to place a pillow between the knees to help keep stress off the hips and lower spine.

For people who sleep best on their stomach, placing a flat pillow beneath the stomach and hips can reduce stress on the spine.

A person's specific back condition will often influence their preferences for their sleeping positions and mattresses.

Osteoarthritis  Patients with pain from osteoarthritis of the facet joints may prefer to sleep on their sides with their knees curled up (in the fetal position). This helps open up the facet joints in the spine and can relieve any corresponding pressure. Alternatively, sleeping in a reclining chair or an adjustable bed that allows the head and knees to be elevated can also relieve pressure on the facet joints.

Degenerative disc disease  Patients with pain from degenerative disc disease may prefer to sleep on their stomach as this can relieve pressure on the disc space. Patients may feel most comfortable using a relatively firm mattress and placing a flat pillow under the stomach and hips, which can further reduce stress on the lower back.

Spinal stenosis  People with pain from spinal stenosis may prefer to sleep on their sides with their knees curled up (in the fetal position). This helps relieve pressure on the nerve root. Sleeping in a reclining chair or an adjustable bed that allows the head and knees to be elevated can also relieve pressure on the nerve.

Bursitis  Patients who have inflammation of the bursa over their hips (greater trochanteric bursitis) can be especially susceptible to pain from a mattress that is too firm. If the mattress is too hard, a new mattress with thick padding on top, or placing an egg crate foam mattress cover over the old mattress, can help provide some relief from the firmness.

Hip pain  Patients with hip pain who sleep on their sides can usually find some pain relief by placing a pillow between their knees. This decreases stress across the hip.

Herniated lumbar disc The most comfortable sleep position depends on the position of the disc. For a paracentral disc herniation (most common), patients will tend to do better lying on their stomach. For a foraminal herniated disc, sleeping on the side in a fetal position is usually better tolerated.

In general, elevating the knees slightly by placing a pillow under them while lying on the back can help many general forms of low back pain. Many patients also find that this is the most comfortable way to sleep after spine surgery.

Sleeping in a reclining chair, or an adjustable bed that allows one to put the head and knees up (the semi-Fowler position), can also help people with lower back pain sleep better. Specifically, patients who suffer from conditions in which the pain feels worse when standing up straight and better when bending forward may benefit from a reclining chair or adjustable bed.