How should I sleep with back pain?

What the sources suggest

The advice below comes from clinic and public health pages, and the pages present it as practical tips. Cleveland Clinic states plainly that there is no one right sleeping position that guarantees a restful night and a pain-free morning. Treat what follows as options that are commonly suggested, not as a proven plan.

Cleveland Clinic describes the general aim as a neutral posture, with the head, shoulders and hips lined up so that the natural curves of the back and neck are supported. Mayo Clinic says that simple changes in sleeping position can take strain off the back.

Side sleeping

Mayo Clinic advises side sleepers to draw the legs up slightly toward the chest and put a pillow between the legs. It says the bent knees and the pillow help align the spine, pelvis and hips and take pressure off the spine. A full-length body pillow is an alternative if you prefer one.

Cleveland Clinic gives similar advice about a pillow between the legs, which it says helps stop the upper leg pulling forward and twisting the torso. It also suggests a head pillow thick enough to support the neck without letting the head droop, and says to avoid curling tightly into the fetal position. NIAMS, the US National Institute of Arthritis and Musculoskeletal and Skin Diseases, gives the same side-sleeping tip with a small pillow between the knees.

Back and stomach sleeping

For people who sleep on their back, Mayo Clinic suggests a pillow under the knees, which it says may help relax the back muscles and keep the curve of the lower back. A small rolled towel under the waist is mentioned for extra support, and the neck pillow should keep the neck in line with the chest and back. Cleveland Clinic gives the same knee-pillow tip and says back sleeping puts the least pressure on the spine.

Stomach sleeping is the position these sources favor least. Mayo Clinic says it can be hard on the back and suggests trying other positions if possible. If that is not possible, it suggests a pillow under the hips and lower stomach. Cleveland Clinic says stomach sleeping often turns out to be the culprit when pain is related to sleep.

Trial and error

Cleveland Clinic recommends experimenting with positions and pillows, and adds that if something leads to pain, it should not be done. The cause of the pain can change what is comfortable, particularly with sciatica. NIAMS also lists poor sleep among the factors linked with more frequent and more severe back pain, which is one reason sleep questions come up so often. Related reading includes whether to rest or keep moving, how long back pain usually lasts and the wider recovery and daily life set.

None of the pages reviewed here gave guidance on mattresses, so this page leaves that out. If pain keeps interrupting sleep for months, what chronic low back pain is explains how longer-lasting pain is defined and approached.

When to get help

The NHS says to see a GP if back pain does not improve after treating it at home for a few weeks, is worse at night, does not improve after resting, or is stopping you doing day-to-day activities. It advises urgent help from a GP or 111 for severe pain that starts suddenly or gets worse quickly, or if you feel hot, cold, shivery or unwell. It says to call 999 or go to A&E for pain, tingling, weakness or numbness in both legs, loss of feeling around the genitals or anus, bladder or bowel changes, or pain after a serious accident. The article on when back pain is an emergency covers these signs in more detail.

Advice differs between countries and clinicians, and none of this replaces an assessment of your own situation.