I have pain in my lower back, what posture is best for a good nights' sleep?

Divya Rakesh, MD
Kedar Angirus, MD
April 15, 2022

Debbie and I are best friends. We’ve known each other since high school and we both played in the school’s softball team. Debbie hurt her back during one of games. She seemed fine after the game and even continued playing through the rest of high school. We are now in our mid 40s and we work for the same company. She is very passionate about her work and often goes out of her way helping her clients. Of late, I’ve been noticing she is not at her usual best. She’s not a morning person anymore, gets irritated at little things, she’s also unable to sit at her desk even for short periods of time. She told me she has not had a good night’s sleep for weeks now. Her lower back hurts right from the time she gets out of bed and  gets worse as the day progresses. Can you please advise any changes she can make to her sleep routine to help her feel relaxed and refreshed the next day?

Low back pain is the most common causes of chronic pain. In fact, low back pain is commonly seen because of injury to the back muscles, tendons or ligaments such as strains and sprains that result while lifting heavy objects or twisting or bending actions of the upper body.  It can also result from injuries to the back due to falls or accidents, compression of the nerve by bulging of the disks that cushion the vertebrae, arthritis affecting the spine (inflammation and stiffness), slipped disks and tumours.  You may be at risk of getting low back pain if you are an adult over 30 years, are obese, have a sedentary lifestyle, have a job that requires heavy lifting or bending.  Low back pain can affect your day-to-day activities, including the ability to sleep well. Studies have shown that about 15-30% of adults have sleep difficulties and low back pain is one of the main causes of poor sleep quality.  Low back pain can make it difficult to fall asleep, to sleep comfortably for long period of time or to just get in and out of bed.  Here, we tell you how making small but effective changes in your sleeping position and sleep routine can get you a good night’s rest to make you feel like a million dollars. Whether you are a back sleeper, a side sleeper or a stomach sleeper, we have something for everyone. We will also talk a bit about mattresses and pillows and how to choose ones that work for you. Continue reading further to know more.

1. Sleeping positions

For the back sleepers out there: Sleeping on your back has many benefits - it evenly distributes weight across the body, minimizes pressure points and ensures good alignment of your organs. However, it can put a slight strain on the low back muscles.  This can easily be relieved by keeping a pillow under the knees to help maintain a neutral spine. A neutral spine keeps your muscles long and loose and thus reduces the risk of soreness or tightness in the body.  You can provide additional support to the low back by rolling a small towel and placing it under the small of the back.  You can also use a small pillow to support your neck.


This is for all you side sleepers: Sleeping on the sides is the most popular position and offers good benefits.  However, in this position your upper leg tends to pull and twist your spine forward.  Hence, when sleeping on your sides, keep a pillow (full-length if you like) between your legs and slightly draw your legs towards your chest.  This ensures proper alignment of your hips, pelvis and spine. If you prefer sleeping on a particular side all night, you are not alone. Often people tend to have a favourite side, but this can lead to muscle imbalance and pain that develops over a period of time.  To avoid this, make sure to alternate the sides during the night.


Sleep on your stomach, no problem: This position is not normally recommended by sleep specialists as it can increase the amount of pressure on your spine and lead to pain when you wake up. But if you prefer this position or have to sleep in this position, use a small, flat pillow under your lower belly or hips.  This small support prevents sagging of the spine from its neutral position.  Try to sleep without a pillow under your head if you are comfortable or use a softer or flatter pillow under the head.


It is important to try and find the position that best suits your body.  This will eventually reduce or prevent the onset of low back pain.  The basic goal for you is to find a comfortable position that helps maintain and support the natural curves of your neck and back.

2. Mattress matters

Several studies support the claim that medium-firm mattress help in improving sleep quality and reducing the onset of low back pain.  A study showed that very soft mattress can cause sinking and twisting of the joints while a very hard mattress can cause too much stress on your pressure points causing pain. Additionally, it was observed that auto-adapting bedding system helps in maintaining good spinal alignment throughout the night. Improving sleep quality and temperature manipulation using a high heat capacity mattress, that helps in lower body temperatures while sleeping, favoured good sleep quality.

A good night’s sleep can be affected if you feel too hot or too cold in the night.  When we go to sleep, our body temperature continues to decrease about 2°F (-1°C) which helps in maintaining a good sleep. Sweating is a result of our body trying to keep our core temperature cooler when it rises above a certain point.  If you are a hot sleeper, don’t use mattresses that retain heat such as memory foam mattresses, instead use mattresses or mattress toppers with a cooling gel and bedding (like cotton) that help in good air circulation. 

Also avoid having a heavy meal or exercising close to bedtime as they can increase your temperature.  Keeping your room cool by using air conditioning or fan and taking a hot bath or shower are known to aid in a good night’s sleep.  If you are a cold sleeper, use a mattress that retains heat such as memory foam or viscoelastic foam and keep yourself warm with socks, warm clothing and good comforter.

3. Picking pillows

Pillows aid in supporting the natural curves of your spine and maintaining a neutral position.  As detailed in sleeping position section, use a pillow for head and neck, not your shoulders, and between knees for best results

4. Sleep Hygiene

No, it doesn’t mean you have to wash your hands before you hit the bed. These are basically habits that you need to avoid or new habits that you need to start working on.  Below are a few tips on good sleep practices:

·       Our body loves routines, so try to sleep and wake up at the same time everyday including weekends and vacations

·       Make sure your bedroom is dark and relaxing and maintain a comfortable temperature (between 60-67 F or 15 to 19 C)

·       Stay away from electronic devices 30 minutes before your bedtime

·       Avoid having large meals and alcohol before bedtime

·       Exercising regularly during the day helps you fall asleep more quickly at night 

Read our article on reducing wakefulness during sleep for an in-depth review on these factors and how they can influence you sleep quality.

5. Trial and error

Modifying your sleeping positions, testing a few mattresses and pillows to understand what feels best for you, incorporating good sleep hygiene in your lifestyle can appear tedious and time consuming but it is worth the time and effort as in the long run it helps in reducing low back pain, improving sleep quality and maintaining good health.

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Here are references we used to put together this article ;-)


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