How To Sleep With Lower Back Pain

At Sleepopolis, we understand the importance of restorative sleep and believe that a proper mattress can help deliver it. Our team of sleep experts has helped over 15,600 people find a mattress according to their unique sleeping needs since 2024 alone. Furthermore, with guidance from our chief medical advisor, Dr. Raj Dasgupta, MD, FACP, FCCP, FAASM, and our chief medical product tester, Dr. Joseph Tedesco, we seek to help answer the questions of sleepers struggling with chronic pain, fatigue, or other consequences of not getting the sleep our bodies need.

When it comes to our lumbar region, there are numerous things that can cause lower back pain, which can range from a daytime injury to regularly sleeping on an unsupportive mattress. Figuring out what may be behind yours is a good start, so you can make any necessary changes.

From the best to worst sleeping positions when you’re dealing with back pain, in this article, we’ll explore some of the connections between lower back pain and the way you sleep. With insights from our team’s medical staff, thorough reviews of available studies, and our years of researching sleep products, we hope this article will help to offer guidance on ways to improve your sleep and potentially ease back pain.

Disclaimer: Please note that the content in this article is meant for informational purposes only and should not be construed as medical advice or serve as a substitute for seeing a medical professional regarding any sleep problems you may have. Please see your doctor regarding any urgent medical issues.

Causes of Lower Back Pain

There could be many reasons that your lower back isn’t feeling quite right, which are often related to lifestyle habits that are working against you or specific physical health issues. 

Dylan Petkus, M.D., founder at Optimal Circadian Health, says, “ Imagine your spine like a tower of Legos; if those blocks aren’t perfectly lined up, the whole structure is wobbly and painful.”

First, many of us are guilty of practicing poor posture during the day. With so many of our day jobs involving prolonged sitting or standing, this can strain the muscles and ligaments in the lower back and cause discomfort. It’s not uncommon to be working at a desk all day, only to suddenly realize you’ve been hunched over for the better part of an hour (or more). This may seem routine, but one 2023 review article by multiple health experts suggests that sustained hunched sitting and poor ergonomics may contribute to the creation of lower back pain. (1)

Muscle strain is another common culprit, often resulting from overexertion, heavy lifting, or sudden movements that “tweak” your back muscles, like that time you decided to join the impromptu break-dancing competition at your cousin’s wedding. More seriously, according to the U.S. National Library of Medicine, “Acute low back pain is commonly caused by sudden overload to the back (for example, heavy lifting or abrupt movements).”

Carrying extra body weight also puts additional pressure on your spine, which increases the risk of injury and pain in your lower back. One 2022 systematic review and meta-analysis found strong connections between obesity and lower back pain, suggesting that heavier people may be more likely to struggle with chronic back pain. (2)

Physical problems can also cause lower back pain, such as herniated discs, in which your spinal discs bulge or rupture and press on nearby nerves. This can also cause concerning numbness or tingling, according to a 2023 systematic review on the management of lumbar disc herniation. (3)

Furthermore, your everyday habits are key. For instance, one 2021 systematic review and meta-analysis found that leading a sedentary lifestyle, characterized by a lack of regular intentional exercise, can also contribute to lower back pain. Factors like stress were also found in a 2021 cross-sectional study to have a significant direct association with chronic lower back pain. Even smoking can further exacerbate pain by weakening your muscles and ultimately reducing blood circulation to your spinal tissues, according to an observational study involving 4,796 participants. (4) (5) (6)

Another major contributor to back pain is poor sleep. According to a 2022 cohort study involving schoolteachers, poor sleep quality predicted future chronic lower back pain, with chronic lower back pain also leading to worse sleep. Or, as our chief medical advisor, Dr. Raj Dasgupta, has said, “If you get poor sleep, the pain will feel worse.” (7)

While we aren’t all dealt the same deck of cards when it comes to lower back pain, it’s critical that we find everyday ways of appropriate intervention for lower back pain. Considering how lack of restorative sleep can make back pain worse (and back pain can in turn worsen sleep), this could include spine-neutral sleeping positions, a more supportive mattress, and/or speaking to your doctor for medical guidance.

Types of Lower Back Pain 

Understanding the type of lower back pain you’re experiencing can help you navigate the best treatment and recovery strategies. To start, according to the clinical overview “Low Back Pain: Evaluation and Management,” lower back pain can be categorized into two main types: acute and chronic. (8)

• Acute Lower Back Pain: This type of pain typically lasts for a short duration, often less than six weeks. It could be a result of sudden injuries like muscle strains, sprains, or trauma from a car accident. Acute pain tends to improve with rest, over-the-counter medications, and physical therapy. (8)
• Chronic Lower Back Pain: Pain that persists for more than 12 weeks is classified as chronic. It can develop gradually or come after you have an acute injury that never fully heals. Chronic pain may be caused by underlying conditions such as arthritis, degenerative disc disease, or nerve damage, and often requires long-term management through therapies, medications, and sometimes surgery. (8)

In some cases, acute back pain can turn into a chronic problem. One meta-analysis of 12 studies involving 5,459 people found that approximately 84 percent of people reported suffering from low back pain during their lifetime, and 23 percent eventually developed chronic low back pain. (1)

Causes of Lower Back Pain at Night

If you’ve ever tried to sleep when your lower back is throbbing, you’re already familiar with the connection between the two. Not only can lower back pain negatively affect your ability to sleep, but a lack of decent sleep can also worsen your back pain. (9)

Petkus says, ”If you sleep in a way that causes your spine to twist or puts uneven pressure on your lower back, you can develop muscle, ligament, and disc strain in that area.” When your back hurts, it can feel nearly impossible to find a comfortable position to relax in — let alone sleep — which can lead to overall poor sleep quality, frequently waking up during the night, and trouble falling asleep at all. 

Kevin Lees, director of chiropractic operations at The Joint Chiropractic, broke down the connection between lower back pain and sleep for us, depending on the type of sleeper you are: 

• Back sleepers: When sleeping on your back, the weight of the legs can push the hips and pelvis down, increasing the lower back curve. For some, this can cause back pain due to the increased stress on the spinal joints. 
• Side sleepers: Side sleepers often experience lower back and pelvis twisting. Ideally, the spine should remain neutral to alleviate added stress. 
• Stomach sleepers: Like back sleeping, sleeping on one’s stomach can increase the lower back curve. This added stress can aggravate the joints in the lumbar spine. Stomach sleeping can also affect the neck, shoulder, and upper back, so it’s not a recommended position.

These consequences become most apparent when proper support is lacking. But it is possible to sleep on your back, side, or stomach without causing or worsening back pain. However, one systematic review found stomach sleeping was associated with more back pain than side or back sleeping and should be avoided if possible. 

Regardless, the same systematic review concluded that “Ergonomic interventions, such as proper bedding and posture education, are suggested for LBP (low back pain) relief.” Simply put: with a proper mattress and awareness of how your sleeping position may affect your spine’s alignment, you may be able to either prevent or manage lower back pain. (10)

This is why it’s important to ensure you are using the right mattress according to your sleeping habits and medical needs. This is also why putting off buying a new mattress when it’s clearly time for a new one, or putting off seeing your doctor when the pain is excruciating, can both lead to worsening of lower back pain in the longer term. 

RELATED: Mattress Quiz—Find Your Perfect Mattress

When your body suffers from a lack of restorative sleep, this can exacerbate back pain by increasing sensitivity to discomfort and slowing down its natural healing processes. Plus, factors like poor sleeping posture, an improper pillow or mattress, or inconsistent sleep hygiene habits can make this worse. (11)

The Best Sleeping Positions for Lower Back Pain 

Choosing the right sleeping position is essential for managing lower back pain. Doing so not only helps you fall asleep and stay asleep during the night, but can also prevent worse pain in the morning. 

Lees says specific positions aggravate certain injuries and that maintaining a neutral position (a sleeping position that keeps the natural curves of your spine intact) is typically the most common recommendation. “Sleeping on your back or side can be comfortable with proper support (like small pillows or body pillows as necessary)”, he adds. 

Petkus says that the best position for someone with low back pain is to lie on their back with a pillow under the knees. “This position is helpful because it maintains the lumbar curve, keeps weight equally distributed over the body, and minimizes the load on the lower back.”

“Another good sleeping position is side sleeping with a pillow between the knees,” Petkus notes, because it also helps to maintain a neutral spine position. (12)

While the right mattress may reduce the risk of lower back inflammation when sleeping on your stomach, this position should be avoided if possible. A review of six studies found that stomach sleeping was associated with greater back strain than back or supported side sleeping. (10)

Of course, the best sleeping position for one person may not be the same one for someone else. Consider trying these sleep positions out to see which one(s) work best for your needs: 

• Side sleeping with a pillow between the legs helps keep the spine in alignment, reducing strain on the lower back. (13)
• For back sleepers, placing a pillow under the knees supports the natural curve of the spine, relieving pressure on the lower back. (13)
• Stomach sleepers can reduce strain by placing a pillow under the hips to support the lower spine. (13)

Additionally, one study found that a medium-firm mattress may better maintain proper spinal alignment than a firmer mattress, potentially reducing discomfort during sleep and improving pain in patients with non‑specific low‑back pain. (14)

The Worst Sleeping Positions for Lower Back Pain 

Just as some sleeping positions can be therapeutic for lower back pain, others can make it worse by putting extra stress on the spine. One of the most important considerations when choosing a sleeping position for lower back pain is finding one that allows your spine to be neutral.

According to Petkus, sleeping on your stomach is the worst position for lower back pain. He notes that this position forces the neck to twist and the lower back to arch, which can put excessive strain on the spine. “It’s like trying to balance a heavy load on an unstable surface — the misalignment creates tension and pain,” he says.

Lees agrees, stating that your mattress should fully support your body, and to sleep on your stomach, you often have to prop yourself up on an angle to breathe or twist your neck to one side while extending it slightly. “With your lower back flat, your natural curve can be increased, which may cause pain,” he says.

Sleeping in a twisted or uneven posture, like with one leg higher than the other or lying on your side without a pillow between your knees, can also misalign your spine, exacerbating pain. 

Finally, cushy mattresses and pillows may seem like a cozy idea, but they’re not great for your back. Overly soft bedding won’t offer proper support and can also worsen the pain, as it allows your body to sink into awkward positions that strain the back muscles. 

Can A Mattress Cause Lower Back Pain? 

Yes, a mattress can play a role in lower back pain if it doesn’t provide proper support or promote good spinal alignment. And as it turns out, finding the right mattress for lower back pain prevention is very much a Goldilocks story. 

“A mattress should provide full body support, keeping the spine neutral,” says Lees. When it loses support, it can cause sagging in the most worn areas and cause you to feel like you’re sleeping in a “C” shape. “This, over time, can lead to waking up sore, not getting a good night’s rest, tossing and turning, and even long-term injuries.”

That’s why, if you have existing lower back pain, a good rule of thumb is to choose a medium-firm to firm mattress, as is recommended by sleep experts. This type of mattress supports the natural curvature of your spine without allowing you to sink too much or put extra pressure on your back. (15)(16)

On the other hand, Petkus tells us, “A mattress that’s too hard can cause pressure points (hips and shoulders are the usual culprits), also resulting in pain.” Instead, you want a mattress that’s supportive enough to keep your spine neutral, but with enough cushioning that you feel comfortable. “Finding that balance between support and comfort leads to pain-free slumber,” he says.

Our team, being the mattress experts, has compiled a list of the best mattresses for back pain in 2026. Below are some of our top picks you may want to have on your radar if you’re struggling with back pain and seeking a bed that could help. 

• Nectar Mattress – The Nectar is our overall top pick for the best mattress for back pain. The Nectar offers great responsiveness and quality pressure relief. After testing the Nectar, Dr. Tedesco said “This bed can be great for those with back pain, especially if you need to stay aligned to feel comfort because it creates a very supported feeling. Those with back pain who need structural support will likely think this bed is great.” You can check out the full Nectar mattress review for more information.
• Bear Elite Hybrid Mattress – The Bear Elite Hybrid combines coils and foam to help offer a balance of support and comfort. When Dr. Tedesco tried it out he said “I don’t notice any pressure that would lead me to believe that people with back pain wouldn’t enjoy this mattress.” Read our full Bear Elite Hybrid mattress review for more information.
• Leesa Sapira Chill Hybrid – This mattress demonstrated excellent pressure relief when our tester, Riley Otis, tried it out. She described resting easy on the Leesa Sapira Chill, saying, “I really enjoyed the feeling of the soft pillow top around my hips and shoulders, and it did an excellent job filling in the space at my lumbar zone.” Our full Lessa Sapira Chill mattress review explains more.
• Saatva Classic – The ultra-luxury Saatva offers excellent edge support and responsiveness, providing consistent lumbar support as well. After Dr. Tedesco tried it out, he stated “This is an excellent bed for people with back pain — no matter their preferred sleeping position.” Read our Saatva mattress review for all of the details.
• WinkBed Mattress – The WinkBed demonstrated excellent pressure-relieving capabilities. After trying it, Dr. Tedesco found the WinkBed to be an excellent choice for people with back pain. He also described his experience on it, saying “I prefer sleeping on my back, and when I was in that position, I could have fallen asleep during the few minutes I spent on the WinkBed.” Check out our full WinkBeds mattress review for more information.

	Nectar Classic Memory Foam Mattress	Bear Elite Hybrid Mattress	Leesa Sapira Chill Hybrid	Saatva Classic	WinkBed Mattress
Rating	4.6	4.6	4.3	4.5	4.3
Firmness	Medium-Firm: 6.5/10	Multiple Firmness Options	Multiple Firmness Options	Multiple Firmness Options	Firm: 7/10
Material	Foam	Hybrid	Hybrid	Innerspring	Hybrid
Cooling	—		—	—
Best For	Side Sleepers, Back Sleepers, Stomach Sleepers, Back Pain, Couples	Side Sleepers, Back Sleepers, Hot Sleepers, Hip Pain, Seniors	Side Sleepers, Back Sleepers, Stomach Sleepers, Hip Pain	Back Sleepers, Stomach Sleepers, Hot Sleepers, Back Pain, Seniors	Side Sleepers, Back Sleepers, Stomach Sleepers, Hot Sleepers, Back Pain
	Check Price	Check Price	Check Price	Check Price	Check Price

Also, while you’re considering the pros and cons of your mattress, you might be interested in an adjustable bed base as well. This option allows you to customize your sleeping position even more. For instance, you could slightly elevate your head and feet to reduce lower back strain and promote better spinal alignment. 

When to See a Doctor About Lower Back Pain 

Fortunately, many cases of lower back pain are temporary and resolve on their own with a little extra rest and self-care. However, there are other times when it’s important to seek personalized medical guidance. 

“If you have low back pain that persists for more than three or four weeks, or if you have back pain that wakes you at night and/or is associated with numbness, tingling, and/or weakness in your legs, see your physician,” Petkus tells Sleepopolis. He notes that these kinds of symptoms could indicate an underlying issue, such as a herniated disc or spinal stenosis, where professional treatment is warranted. “Those are cases where your body is waving a red flag – don’t ignore that,” he adds. (17)

Immediate medical attention should be sought if you experience severe, sudden pain after a trauma to your body, are having trouble controlling your ability to use the bathroom, or notice unexplained and unintentional weight loss. 

Lees says that back pain that starts for an unknown reason can worsen over time, affecting the quality of sleep and creating new health problems. It’s important to be aware of these potential issues and speak with your doctor. “Sleep quality can affect weight gain, stress hormones, healing rate, and even focus ability,” he says. (18)(19)(20)(21)

Finally, any time you’re concerned about your health is a good reason to speak with your healthcare provider — that’s what they’re there for. A doctor can help you identify underlying causes of your lower back pain and help determine appropriate treatment interventions.

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