As if living with back pain wasn’t bad enough, when the sun sets, the pain can intensify. Whether it is the act of settling down for the night or if the pain truly does increase as the night wears on, finding the best sleeping position for lower back pain can be very difficult. Yet numerous studies show that poor sleep – both quality and quantity – does affect pain. Here’s how sleep and pain are connected and why it’s important to find the best sleeping position for lower back pain to ensure a good night’s rest.

What is the best sleeping position for lower back pain?

It is difficult to answer this question without examining why sleep is so important in the first place. Lack of sleep can have health risks and consequences that go far beyond just being a little sleepy in the afternoon.

Consider these surprising effects of poor sleep:

  • Increased accidents: Chernobyl, the Exxon Valdez oil spill, and the nuclear meltdown at Three Mile Island were all attributed to lack of sleep.
  • Poor health: The risk of heart attack, high blood pressure, stroke, and diabetes increases with each hour of sleep lost.
  • Decreased sex drive: Libido drops for both men and women with lack of sleep.
  • Weight gain: People who sleep less than six hours a day are 30% more likely to become obese.

Of those who experience lack of sleep, poor quality sleep, or both, 57% report having had either chronic or acute pain in the past week. Only 45% of those with acute pain and 37% of chronic pain sufferers reported “good or very good sleep quality,” as compared to 65% of people without pain. While it is hard to say whether pain causes poor sleep or poor sleep increases pain, it seems fair to connect the two in order to find the best sleeping position for lower back pain.

Here are the best sleeping positions for lower back pain (and one of the worst).

Position: The back

Sleeping on the back is the optimal way to support the spine at night, especially if you sleep without a pillow. Provided your mattress isn’t too soft, a medium-firm to firm mattress can help provide support. It can also help maintain the natural curves of the spine. This can be the best sleeping position for lower back pain because the lumbar spine is able to rest naturally.

Unfortunately, many people sleep on a mattress that is far too soft for this purpose. Adding multiple pillows also makes the head jut forward of the shoulders all night, a position many of us maintain all day in front of the computer.

Additionally, the very worst sleepers report that they spend the majority of time sleeping on their back.

How to make it work

If you can sleep on your back without a pillow or with a very slender pillow, this may be a good position for you. Adding a pillow underneath the knees can help support the lower back as well. Skip the fluffy mattress and opt for something firm and supportive.

Position: The side

Those who sleep on their sides are in the majority, and with good reason. Sleeping on the side can take pressure off the lower back, especially when the knees are drawn up in the fetal position. Side sleeping can help with heartburn and acid reflux, a bonus for those who suffer from these two conditions during the night.

Sleeping on the side with both knees curled up in the fetal position helps level and balance the pelvis. If the bones of the knees are uncomfortable together, placing a pillow between the knees can help. Pillows for this sleeping position should be just thick enough to rest the head while keeping the neck level and long on both sides.

Position: The stomach

Almost universally, this is not the best sleeping position for lower back pain. In fact, it’s not the best sleeping position for any type of back pain. Sleeping on the stomach compresses the muscles of the lower back all night long.

Santhosh Thomas, DO, a spine specialist with the Cleveland Clinic and associate medical director of the Richard E. Jacobs Medical Center in Avon, Ohio puts it this way:

“Typically, sleeping on your stomach can flatten the natural curve of your spine, putting some additional strain on your back muscles.”

Paul Grous, MSPT, a physical therapist and spine specialist with Good Sheppard Penn Partners in greater Philadelphia agrees and adds another major issue that affects the upper part of the back, noting:

“…stomach sleeping means that your neck is rotated, which can actually result in back pain between your shoulders.”

How to make it work

If you are an inveterate, unrepentant stomach sleeper, give yourself a hand by