Best Sleeping Position for Back Pain

Key Takeaways 

• Around 28% of adults in the United States report having chronic low back pain, and it’s highest in the 50–59 age group.
• 90% of people with back pain reported a lower overall quality of life due to their pain.​​​
• An estimated $200 billion is spent each year on managing back pain.

• Sleep positions that keep the spine in alignment are best for reducing back pain.
• A medium-firm mattress is recommended for sleeping with back pain.

Chronic pain can significantly diminish our overall quality of life and is more common as we grow older. A 2022 survey found that 28% of U.S. adults reported having chronic lower back pain, with the highest percentage in the 50–59 age group. Survey respondents reported difficulty standing, exercising, and sleeping due to pain. 

As the leading cause of disability worldwide, back pain also has severe negative financial and social impacts. According to the Centers for Disease Control and Prevention (CDC), more than one in four (26%) working adults experience low back pain in the U.S. Treatment is costly, with an estimated more than $100 billion spent annually on addressing back pain.

Effective back pain management involves more than medication and physical therapy. Sleep quality is critical. A poor sleeping position can increase back pain, leading to restless nights and ongoing discomfort. Choosing the right position may help lessen pain and promote better sleep. In this article, we explore the best sleep positions for managing back pain and provide practical advice to help you achieve restful sleep and reduce discomfort.

Understanding back pain

Understanding the types and causes of back pain is crucial for effective management and prevention. It can also help people maintain a healthy spine and reduce discomfort.

Types of back pain

Back pain can be classified into two main types: acute and chronic. 

Acute back pain

Acute back pain usually comes on suddenly and lasts a short period, typically less than six weeks. It often results from an injury or strenuous activity. 

Chronic back pain

Chronic back pain typically persists for 12 weeks or more, even after treating the initial injury or underlying cause. It can greatly impact daily life and may require ongoing management and treatment​.

Causes of back pain

Several common causes can lead to back pain: 

Posture

Poor posture may contribute to back pain, especially for people who spend long hours sitting or standing in improper positions. This can strain the spine and surrounding muscles, leading to discomfort and pain. 

Medical conditions

Medical conditions, such as arthritis, osteoporosis, degenerative disc disease, and scoliosis, also contribute to back pain. Arthritis can cause inflammation and stiffness in the spine, while osteoporosis weakens bones, making them more vulnerable to fractures. Degenerative disc disease leads to increased pressure on spinal nerves and joints, causing inflammation, spinal instability, and the development of bone spurs. ​

Scoliosis, a condition characterized by an abnormal curvature of the spine, can cause severe back pain.

While these are some of the more common causes, there are a variety of health reasons why a person may have back pain.

Injuries

Injuries from accidents or sports can also lead to back pain. Herniated or slipped discs, where the soft tissue between the vertebrae protrudes, can press on nerves and cause pain. Muscle or ligament strains from heavy lifting or sudden movements are other common causes. 

Lifestyle factors

Also, lifestyle factors like lack of exercise, obesity, and smoking can increase back pain by reducing flexibility and weakening muscles​​.

Back sleeping for back pain

Sleeping on your back can promote spinal alignment by distributing your weight evenly across the body, which reduces pressure on the spine and joints.

Back sleeping tips:

• According to research, the best mattress for back pain is a medium-firm mattress that can provide enough support for people who experience back pain. 
• Place a pillow under your knees to maintain the natural curve of your lower back.
• Use a supportive pillow under your head to align your neck with your spine​.
• Consider a bed with an adjustable base to raise your head or feet. 

Of course, firmness feels different depending on your body type, so higher-weight people may need something firmer, while lower-weight people may need something softer that offers the support and cushion they need. 

Side sleeping for back pain

Side sleeping can help reduce pressure on the spine, especially if you use the right pillow and mattress. It’s also a potentially good position for reducing snoring and sleep apnea.

Side sleeping tips

• Side sleepers: Use a taller pillow to align your head and neck with your spine.
• Place a pillow between your knees to prevent the top leg from pulling the spine out of alignment.
• The best mattress for side sleepers​ is typically medium with good support and contour to accommodate your body’s curves. 

Fetal position for back pain

The fetal position, another form of side lying, has you curl up on your side with your knees drawn toward your chest and may provide relief for people with herniated discs and other lower back issues. 

Fetal position tips

• Ensure your pillow supports your neck.
• Avoid curling up too tightly, because it may restrict breathing and cause discomfort.
• Switch sides periodically to prevent imbalances​​.

Stomach sleeping and back pain

Sleeping on your stomach is generally not recommended for back pain because it can strain the neck and spine. But for those who find it comfortable, you’ll typically want to look for a medium-to-firm mattress to support your hips and keep your spine aligned. Here are some other tips for back pain prevention while stomach sleeping.

Stomach sleeping tips

• Use a thin pillow or no pillow to keep your neck in a neutral position.
• Place a pillow under your lower abdomen to reduce pressure on your lower back.

Additional tips for better sleep with back pain

Managing back pain while trying to get a good night’s sleep can be challenging. But a few small changes  can make a significant difference. Here are some additional tips to improve sleep quality when dealing with back pain.

Choosing the right mattress and pillow

Selecting the right mattress and pillow is crucial for spinal alignment and comfort. A medium to slightly firm mattress often provides the best support, preventing the spine from sinking into positions that cause pain. Hybrid mattresses can be particularly beneficial because they provide the support and cushion to conform to the body’s shape while providing targeted support. 

Our tips for choosing the right mattress and pillow:

• Look for a mattress that supports the natural curve of your spine while providing good support. 
• Replace old mattresses that sag or have lost their support.
• Look for a mattress that’s responsive or has good bounce. It can be more painful if it takes a lot of effort to change position or get in and out of bed, but a responsive mattress can aid in your mobility, making it easier to move around on the bed. 
• Proper pillow support for back pain involves choosing a pillow that keeps your neck and spine aligned, such as a tall pillow for side sleepers or a thinner, conforming one for back sleepers​​. Research shows that pillow design can have a big impact on your spine health, showing that the best pillow for you largely depends on your sleeping position.

Optimize sleep environment

Creating a good sleep environment can make getting to sleep and staying asleep easier. Consider these factors:

• Temperature: Keep the room cool, ideally between 68–77 degrees Fahrenheit. Studies have shown older adults sleep better in a cooler environment, falling asleep faster and staying asleep longer. 
• Noise: Use white noise machines or earplugs to help block out disruptive sounds. 
• Light: Install blackout curtains or wear a sleep mask. Darkness promotes the production of melatonin, a hormone that regulates sleep.

Proper sleep hygiene

Establishing good sleep hygiene practices can improve sleep quality, helping to reduce how much pain you feel. This means following behaviors and habits that are helpful to your overall sleep experience, including:

• Establish a regular sleep schedule by going to bed and waking up at the same time every day, even on weekends.
• Create a pre-sleep routine that includes calming activities, like reading a book, meditating, or taking a warm bath.
• Avoid stimulants, like caffeine and sugar, before bed. Also avoid alcohol. Even though it’s a sedative, it can interfere with the neurotransmitters that regulate sleep.
• Avoid using electronic devices before bed because blue light can interfere with melatonin production​.

Pain management techniques

Incorporating pain management techniques into your routine can help ease back pain before bed. Consider the below:

• Heat/cold therapy: Applying heat can relax muscles and improve blood flow, while ice can reduce inflammation and numb pain.

Stretching: Gentle stretching exercises before bed can relieve muscle tension and improve flexibility. Focus on stretches that target the lower back, hamstrings, and hip flexors​.

Always consult your health care team before beginning any new therapies. They can recommend the best type for your specific condition.

Lifestyle changes

Making lifestyle changes can also contribute to better sleep and reduced back pain.

• Diet: Maintain a balanced diet rich in anti-inflammatory foods, such as fruits, vegetables, and whole grains. Avoid large meals close to bedtime. Try to avoid caffeine, along with other sleep-disrupting substances, less than six hours before it’s time to wind down.
• Exercise: Regular physical activity strengthens muscles, improves flexibility, and promotes overall well-being. Research shows it can also help reduce sleep disorder symptoms and promote better sleep. The CDC recommends 30 minutes of moderate exercise five days a week for adults 65 and older.
• Weight management: Keeping at a healthy weight can reduce stress on the spine and help prevent back pain. Excess weight, especially around the abdomen, can shift your center of gravity and strain your back muscles​.
• Smoking cessation: Smoking impairs blood flow, reducing oxygen and nutrients to spinal tissues, which can increase back pain. Quitting smoking improves circulation and overall spine health​​.

Bottom line

Back pain can greatly impact your sleep quality and overall well-being, but the right strategies can help make a difference. Creating a good sleep environment is crucial. Start by talking to your doctor about the best sleeping position for your specific needs. Ensuring your spine is aligned with a quality mattress and pillow can help support and prevent future back pain. Incorporate good sleep hygiene practices, pain management techniques, and lifestyle changes, like regular exercise, a balanced diet, and weight management. By taking these steps, you may be able to achieve better sleep quality, reduce discomfort, and enhance your overall health.

Have questions about this article? Email us at reviewsteam@ncoa.org.

Sources

1. Percentage of U.S. Adults Who Reported Having Chronic Low Back/Sciatic Pain as of 2022, By Age. Statista. Jan. 29, 2024. Found on the internet at https://www.statista.com/statistics/1447559/chronic-low-back-pain-among-adults-by-age-us
2. Elflein J. Negative Impacts Associated With Chronic Lower Back Pain (CLBP) According to Adults in the United States in 2022. Statista. April 12, 2023. Found on the internet at https://www.statista.com/statistics/1368800/associated-clbp-negative-impacts-among-adults//niosh-science-blog/2019/07/08/lbp

3. Low back pain. World Health Organization. June 19, 2023. Found on the internet at: https://www.who.int/news-room/fact-sheets/detail/low-back-pain
4. Iker K. Low Back Pain Among Workers: The Problem and What to Do About It. Centers for Disease Control and Prevention. July 8, 2019. Found on the internet at https://blogs.cdc.gov/niosh-science-blog/2019/07/08/lbp

5. Katz, J. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. The Journal of Bone and Joint Surgery. April 2006. Found on the internet at
6. https://pubmed.ncbi.nlm.nih.gov/16595438/
7. National Institute of Arthritis and Musculoskeletal and Skin Disease. Back Pain. Found on the internet at https://www.niams.nih.gov/health-topics/back-pain
8. Mayo Clinic. Back Pain. Found on the internet at https://www.mayoclinic.org/symptoms/back-pain/basics/causes/sym-20050878
9. University of Rochester Medical Center. Good Sleeping Posture Helps Your Back. Found on the internet at https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=4460
10. Cary D, et al. Identifying Relationships Between Sleep Posture and Non-Specific Spinal Symptoms in Adults: A Scoping Review. BMJ Open. June 28, 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609073
11. Whibley D, et al. Sleep and Pain: A Systematic Review of Studies of Mediation. The Clinical Journal of Pain. June 2019. Found on the internet at https://journals.lww.com/clinicalpain/fulltext/2019/06000/sleep_and_pain__a_systematic_review_of_studies_of.14.aspx
12. Melone L. 7 Easy Fixes for Snoring. WebMD. Nov. 15, 2023. Found on the internet at https://www.webmd.com/sleep-disorders/features/easy-snoring-remedies

13. Mount Sinai. Obstructive Sleep Apnea. Found on the internet at https://www.mountsinai.org/health-library/report/obstructive-sleep-apnea
14. Radwan A, et al . Effect of Different Pillow Designs on Promoting Sleep Comfort, Quality, & Spinal Alignment: A Systematic Review. European Journal of Integrative Medicine. February 2021. Found on the internet at https://www.sciencedirect.com/science/article/abs/pii/S1876382020314505
15. Centers for Disease Control and Prevention. NIOSH Training for Nurses on Shift Work and Long Work Hours: Create a Good Sleep Environment. March 31, 2020. Found on the internet at https://www.cdc.gov/niosh/work-hour-training-for-nurses/longhours/mod6/02.html
16. Baniassadi A, et al. Nighttime Ambient Temperature and Sleep in Community-Dwelling Older Adults. Science of The Total Environment. Nov. 15, 2023. Found on the internet at https://sciencedirect.com/science/article/abs/pii/S0048969723042468?via%3Dihub
17. Zhou E. Does Sleeping With an Eye Mask Improve Learning and Alertness? Harvard Health Publishing. Feb. 21, 2024. Found on the internet at https://www.health.harvard.edu/blog/does-sleeping-with-an-eye-mask-improve-learning-and-alertness-202402213017
18. Ian M. Colrain, et al. Alcohol and the Sleeping Brain. Handbook of Clinical Neurology. Feb. 21, 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259
19. Shechter A, et al. Blocking Nocturnal Blue Light for Insomnia: A Randomized Controlled Trial. Journal of Psychiatric Research. Oct. 21, 2017. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5703049

20. Keillor, J. Using Heat and Cold for Pain. Mayo Clinic Connect. February 11, 2021. Found on the internet at https://connect.mayoclinic.org/blog/take-charge-healthy-aging/newsfeed-post/using-heat-and-cold-for-pain/
21. Advanced Orthopaedic Associates. Heat and Cold Therapy for Pain Management. Jan. 5, 2023. Found in the internet at https://aoaortho.com/heat-and-cold-therapy-for-pain-management

22. Princeton Orthopaedic Associates. Unlocking Back Pain Relief – Causes and Solutions for Upper and Lower Back Discomfort. Found on the internet at https://www.princetonorthopaedic.com/unlocking-back-pain-relief-causes-and-solutions-for-upper-and-lower-back-discomfort
23. Zuraikat FM, et al. A Mediterranean Dietary Pattern Predicts Better Sleep Quality in US Women from the American Heart Association Go Red for Women Strategically Focused Research Network. Nutrients. Sept. 16, 2020. Found on the internet at https://www.mdpi.com/2072-6643/12/9/2830
24. Alnawwar MA, et al. The Effect of Physical Activity on Sleep Quality and Sleep Disorder: A Systematic Review. Cureus. Aug. 16, 2023. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503965

25. Centers for Disease Control and Prevention. Older Adult Activity: An Overview. Found on the internet at https://www.cdc.gov/physical-activity-basics/guidelines/older-adults.html
26. Lee CA, et al. The Relationship Between Change of Weight and Chronic Low Back Pain in Population over 50 Years of Age: A Nationwide Cross-Sectional Study. International Journal of Environmental Research and Public Health. April 9, 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069450
27. Green BN, et al. Association Between Smoking and Back Pain in a Cross-Section of Adult Americans. Cureus. Sept. 26, 2016. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5081254

Lauren Sherman Author

Lauren Sherman, M.S., is a health content writer with a master’s degree in human genetics from the University of Colorado Anschutz Medical Center, laboratory experience from National Jewish Health, and clinical experience from Children’s Hospital Colorado.

Suzanne Gorovoy Medical Reviewer

Suzanne Gorovoy is a clinical psychologist, behavioral sleep medicine specialist, and member of the Sleep and Health Research Program at the University of Arizona College of Medicine. She received her graduate degree in School Psychology from Teachers College at Columbia University, her PhD in Clinical Psychology from Case Western Reserve University, and completed a postdoctoral fellowship in Behavioral Sleep Medicine at the University of Arizona College of Medicine.

Susan Stiles Reviewer

Susan Stiles, PhD, provides leadership in the design and development of consumer products that inspire, educate, and activate older adults. She’s been instrumental in bringing the Aging Mastery Program® to market and scaling it nationwide via strategic alliances and business partnerships. Stiles has 20+ years of experience in design thinking, multimedia, strategic communications, and management consulting.