Chiswick-Physio BLOG


Sleeping positions that reduce back pain
Back Pain, Sleeping
Plantar Fasciitis Stretch

The importance of getting good quality, restorative sleep

High-quality, restorative sleep is crucial for maintaining overall health and well-being, especially for those with back pain. During sleep, our body undergoes essential processes that aid in muscle repair, tissue growth, and protein synthesis, which are vital for tissue healing and recovery. If sleep is disrupted, tissue regeneration and healing are suboptimal, worsening a current back issue or with accumulation being the cause of a new injury.

It’s important to get enough restorative sleep when dealing with back pain. Research has shown that lack of sleep can make the body more sensitive to pain by affecting the central nervous system. Furthermore, insufficient sleep has been linked to increased inflammation, which triggers the release of chemicals that sensitise nerves and heighten pain signals sent to the brain. This heightened sensitivity can amplify pain perception, leading to increased discomfort and potentially worsening pain conditions.

The psychological impact of poor sleep should also not be underestimated, particularly its impact on pain management. Sleep deprivation can lead to increased stress and anxiety, which can, in turn, heighten the perception of pain.

How back pain interferes with sleep

Back pain and sleep disturbance have a bidirectional relationship. Back pain disrupts sleep quality, duration, and daytime function, and poor sleep further exacerbates the perception and experience of back pain. Addressing both the physical and psychological factors underlying this relationship is crucial for improving outcomes for individuals suffering from chronic back pain.

Back pain during sleep can stem from various factors, including:

  • Poor sleeping posture: Sleeping in certain positions can place strain on the muscles, joints and discs of the vertebra.
  • Mattress and pillow quality: An unsupportive mattress or pillow that fails to cushion and support the spine adequately can contribute to back pain during sleep. Personal preference must be considered; hence, no one pillow or mattress is recommended.
  • Muscle tension and stiffness: If you have back symptoms, accumulated muscle tension and stiffness can worsen during the night as you are not moving
  • Underlying medical conditions: Conditions such as arthritis, herniated discs, spinal stenosis, and sciatica can worsen during sleep due to changes in position and increased pressure on affected areas.
  • Stress and tension: Psychological factors such as stress, anxiety, and tension can contribute to muscle tightness and exacerbate back pain.

Addressing these factors through proper sleep hygiene, ergonomic sleep setups, regular exercise, stress management techniques, and seeking medical attention for underlying conditions can help alleviate back pain during sleep.

Types of back pain and areas

Back pain can affect various regions of the back, including:

  • Lower back pain (lumbar region): This is one of the most common types of back pain and can be particularly aggravated during sleep. It may stem from muscle strain, injury, poor posture, or underlying conditions such as herniated discs or spinal stenosis. Sleeping positions that place excessive pressure on the lumbar spine, such as sleeping on the stomach or in a twisted position, can exacerbate lower back pain.
  • Upper back pain (thoracic region): Upper back pain is less common than lower back pain but can still cause discomfort during sleep. It is often caused by poor posture, muscle tension, or injury to the thoracic spine. Sleeping in positions that cause the shoulders to hunch forward or the spine to curve unnaturally can contribute to this pain.
  • Neck pain (cervical region): Neck pain is often caused by poor sleeping posture and worsened by positions that strain the neck muscles and cervical spine. Sleeping with the neck at an awkward angle, using a pillow that is too high or too firm, or sleeping on the stomach with the head turned to the side can all contribute to neck pain during sleep.
  • Sacral region pain: The sacral region, situated at the bottom of the spine, can be a source of pain during sleep. This pain can occur due to sacroiliac joint dysfunction or sacralisation, the fusion of the lower lumbar vertebrae. Lying flat on the back with straight legs can worsen sacral pain by putting pressure on the sacrum.

How are sleep and lower back pain related?

Back pain and sleep are intricately related, with each influencing the other:

  • Sleep quality affects back pain: Poor sleep quality exacerbates back pain. It increases pain sensitivity and discomfort perception and decreases pain tolerance, making existing back pain feel more severe.
  • Back pain impacts sleep: Conversely, Back pain can interfere with sleep by causing discomfort and difficulty finding a comfortable position, leading to disrupted sleep patterns.
  • Muscle relaxation and repair: During sleep, the body undergoes crucial repair and rejuvenation processes, including muscle relaxation and tissue repair. Disrupted sleep can impair these processes, prolonging recovery and exacerbating back pain symptoms.
  • Psychological factors: Both back pain and sleep disturbances can be influenced by psychological factors such as stress, anxiety, and depression. Psychological distress can contribute to muscle tension, exacerbate pain perception, and disrupt sleep patterns, creating a cycle of pain and sleep disturbances.

A multidirectional approach is often needed when addressing back pain and sleep disturbances. Comprehensive strategies during the day, such as a mobility and strengthening programme that works on the cause of your problem, can lead to a better night’s sleep, help break the cycle, and improve overall well-being.

How to Reduce Back Pain So You Can Fall To Sleep

If you struggle to fall asleep, there are several natural, drug-free ways to reduce back pain and help you get comfortable in bed.

A good starting point is to establish a nightly routine 30-60 minutes before you want to fall asleep. This could include drinking warm tea, reading, knitting, listening to soothing music, meditating, and avoiding electronic devices.

You could also take a warm shower or bath, apply gel heat pads, or do light mobility exercises to loosen your muscles, which can help reduce back pain.

If you find you are still struggling to fall asleep, then avoid alcohol and big meals in the evening, and avoid caffeinated drinks after noon.

If you apply some of these tips to your life, you should be able to reduce back pain and enable you to fall asleep.

Why Do I Wake Up With Back Pain?

Waking up with back pain can result from reduced movement during sleep, leading to stiff joints and tight muscles. Sleeping in a poor position exacerbates this discomfort. If you already have back symptoms, immobility during sleep can worsen muscle tightness and inflammation buildup, intensifying pain upon waking. To mitigate this, consider the supportive sleeping positions listed below.

Top sleeping positions that reduce back pain

Finding the sleeping position that feels most comfortable and supportive for your back is essential. Experimenting with different positions and using pillows or support cushions as needed can help alleviate pain and promote better sleep quality. The top sleeping positions for back pain that we recommend at Chiswick-Physio include:

1. Fetal: Curling up on your side with your knees drawn toward your chest can help open up the space between the vertebrae, reducing pressure and compression to the joints between the vertebrae of the back. This position can provide relief for individuals with facet joint irritation, herniated discs or spinal stenosis.

2. Reclined: Elevating the upper body slightly with pillows or an adjustable bed can help alleviate back pain by reducing pressure on the spine. This position can be especially helpful for individuals with degenerative disc disease or lumbar spinal stenosis.

3. Side: Side sleeping with a pillow between your knees can help alleviate back pain by reducing pressure on the spine. This position keeps the hips, pelvis, and spine aligned more neutrally, relieving any strain on the back.

4. Stomach: If you suffer from back pain in any spine region, we recommend avoiding sleeping on your stomach. Sleeping on your stomach can compress the joints of the spine at all levels, and lying like this for some time is likely to exacerbate your symptoms. If you end up in this position during the night, place a pillow under your pelvis and lower stomach to open up the lower back.

5. Back Sleeping on your back with a pillow under your knees helps maintain the spine’s natural curve and reduces compression, especially on the lower back. Placing a pillow under the knees can further support the spine’s alignment and alleviate strain on the back muscles.

Maintaining good sleep hygiene practices, such as sleeping on a supportive mattress and avoiding electronics before bedtime, can further support overall spinal health and reduce lower back pain. If you continue to experience persistent or severe back pain during sleep, you should consult directly with one of the team at Chiswick-Physio for personalised advice and treatment options.


What should you not do with lower back pain?

Avoid stomach sleeping, sagging mattresses, and unsupportive pillows to ease lower back pain during sleep. Opt for a firm mattress and a supportive pillow. Maintain a neutral spine position and avoid cramped or contorted sleeping postures. Additionally, practice good sleep hygiene by limiting electronic device use before bed and maintaining a regular sleep schedule.

How do I know if my back pain is a disc or muscle?

Differentiating between disc and muscle-related back pain can be challenging. Disc-related pain often radiates down the leg or arm, worsens with bending or lifting, and may include numbness or tingling. Muscle-related pain typically feels localised, improves with rest, and may involve sharp acute localised muscle spasms.

What is the fastest way to recover from lower back pain?

The fastest way to recover from back pain is to rest from activities that cause pain, stay active and mobile, and follow a structured strengthening programme. Applying ice packs initially can reduce inflammation, followed by heat therapy to relax muscles. Maintain good posture, avoid heavy lifting, and gradually resume activity. If pain persists, consult a healthcare professional for further guidance and treatment.

How do I know if my mattress is causing back pain?

You may suspect your mattress is causing back pain if you go to bed with no back symptoms and then experience discomfort upon waking that gradually improves throughout the day. Signs include morning stiffness, soreness, and achiness in the back. It is likely a factor if the pain lessens when you sleep elsewhere and not on your mattress.

Can a bad pillow cause lower back pain?

When one part of the spine, like the neck, lacks proper support, it can force other parts, such as the lower back, to compensate. This compensation often leads to undue stress on already sensitive tissues, potentially resulting in lower back pain. Therefore, ensuring adequate support for the entire spine, starting with the neck, is crucial in preventing such discomfort.

Is it better to sit or lie down when you have lower back pain?

Depending on the individual, sitting and lying down can alleviate lower back pain. Sitting reduces spinal pressure but may cause stiffness over time. Lying down relaxes muscles and relieves pressure, though prolonged periods can lead to stiffness. It’s crucial to find a balance between the two and incorporate gentle movement and stretching for optimal pain management.

What are the top 3 causes of lower back pain?

The top three causes of lower back pain include muscle strain or sprain from overuse or sudden movements, herniated or bulging discs irritating nearby nerves, and degenerative conditions like osteoarthritis, spinal stenosis, or degenerative disc disease.

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