If you're one of the estimated 40% of people that will experience sciatica at some point throughout their lives, you probably know how difficult it can be to get uninterrupted sleep. The sharp, shooting pain from the lower back and radiating down the legs makes sleeping, and even relaxing in bed, a battle.
Sleep is vital for healing, and we do a lot of it while sleeping. Sciatica interrupts this process by causing discomfort, turning sleep into a cycle of pain and fatigue, so we don't get the restorative quality sleep we need. In this blog, we'll examine the best sleeping positions to take pressure off the sciatic nerve to sleep better and recover, backed with expert perspectives and from real experience in practice.
What is Sciatica?
Sciatica is not a condition in itself, it is a symptom of an underlying problem with the sciatic nerve, which is the longest and broadest nerve in the human body. Sciatica usually affects only one side of the body, and can be so mild that it is barely felt, or it can be so severe that the pain is debilitative.
The sciatic nerve extends from the lower lumbar and sacral spine (L4 through S3) and through the hips and buttocks, continuing along the back of each leg to the foot. The sciatic nerve controls several muscles of the lower legs, and provides sensation to the skin of the foot and to most of the lower leg.
What Causes Sciatica?
Sciatica is caused by compression, irritation, or inflammation of the sciatic nerve. The most common causes of sciatica can be:
- Herniated or slipped disc (most common cause)
- Spinal stenosis (narrowing of the spinal canal)
- Degenerative disc disease
- Spondylolisthesis (slippage of the vertebrae)
- Piriformis syndrome (compression by the piriformis muscle)
- Tumors or infections (very rare)
- Spinal pressure related to pregnancy
Symptoms of Sciatica
Sciatica often presents as:
- Radiating pain that starts in the lower back and goes down the back of the thigh and into the leg
- Numbness or tingling into the leg or foot
- Muscle weakness in the affected leg
- Pain that is worsened when sitting or standing for a long period of time or sudden movements
Pain levels vary widely - some people experience a dull ache, while other individuals experience sharp, burning or electric shock feelings.
How Does Sciatica Affect Your Sleep?
Sciatica impacts pain at night, not just during the day. The pain, numbness or tingling that radiates from the lower back down to the legs may limit your ability to find a comfortable position, leading to poor quality rest and increased tiredness. Here’s how sciatica affects your ability to recover and rest.
1. Increased Discomfort at Night
Sciatic nerve discomfort tends to be greater at night because of more inflammation causing increased muscle tension. Once your body relaxes, the inflammation acting on the nerve may increase, along with additional weight from your body lying flat, which increases pressure on the lower spine. Additionally, your mattress and lying posture may increase compression of the sciatic nerve, which may cause more symptoms and more pain at night.
2. Difficulty Finding a Comfortable Position
For many, sciatica hinders finding a comfortable, or pain-free position to sleep. Common sleeping positions, such as lying on the back, or possibly lying on the stomach, may cause more pressure on the lower back and legs. As such, this may result in:
- Constantly tossing and turning
- Frequent disruptions in deep sleep cycle
- Frequent awakenings due to discomfort
In short, restorative sleep becomes almost impossible without proper surface or positioning support.
3. Sleep Deprivation Increases Pain
Sleep and pain are well-connected. Studies show chronic pain sufferers were up to 67% more likely to experience sleep disorders, such as insomnia. When you are sleep-deprived:
- Your pain threshold decreases
- You tend to be sensitive to discomfort
- You have increased levels of inflammation
As can be seen, this is a vicious cycle: The more pain you have, the less sleep you get; the less sleep, the more pain.
4. Mental and Physical Effects
If left untreated and your rest is impeded, mood disorders, sleep anxiety, irritability or even a depression may develop. This is even before your body has difficulty healing, ramping up systemic stress, increasing fatigue at daytime -- and making daily tasks more difficult.
Best Positions for Sleeping with Sciatica
Finding the best sleeping position can be one of the simplest methods to relieve nighttime sciatica pain. Ensuring your spine, hips, and legs are aligned appropriately minimizes the pressure on your sciatic nerve and improves your chances of getting more restorative sleep. Below are the best positions as suggested by healthcare professionals, and evidenced by research.
1. Side Sleep with a Pillow Between Your Knees
Why it helps:
Sleeping on your side with a pillow between your knees keeps your spine, hips, and pelvis aligned. This position limits twisting and will prevent the top leg from pulling your spine out of alignment, which is a common trigger for sciatic pain during sleep.
Tips:
- Ensure you use a firm pillow between your knees.
- Keep your knees slightly bent during sleep.
- Avoid curling into the fetal position, as this will put extra strain on your lower back.
2. Sleeping on your Back with a Pillow Under your Knees
Why it helps:
Lying on your back with a pillow or rolled-up towel under your knees can reduce pressure in your lower back and will help support the natural curve of your spine. And it allows your body weight to be distributed evenly, limiting nerve compression.
Tips:
- Use a thin pillow for the head, so there is no pressure on your neck.
- Rest your arms where they are comfortable, like at your sides or belly.
3. Sleeping in a Reclined Position
Why it helps:
If your sciatica is due to a herniated disc or spinal stenosis, sleeping in a reclined position may be beneficial. Going slightly elevated, with your upper body and the legs in a flat-zero degree position, will alleviate lower back pressure and open up nerve pathways.
Tips:
- Use an adjustable bed or a wedge pillow to create a 45-degree incline.
- If you do not have an adjustable posture option, sleep in a recliner until you do.
4. Fetal Position (for Herniated Discs)
Why it helps:
Positioning yourself in a loose fetal position may open the space between vertebrae and relieve pressure on a herniated disc that is pressing on the sciatic nerve.
Tips:
- Lay on your unaffected side.
- Gently bring your knees to your chest without rounding your back.
5. Sleeping on the Floor (for Additional Firmness)
Why it helps:
Some people do find relief sleeping on a very firm surface. A hard floor may provide more support than your soft mattress, which could sag and contribute to misalignment in the spine.
Tips:
- A thin mat, such as a yoga mat, can help provide some minimal softness.
- Use a small pillow, or a rolled-up towel, under your knees or low back.
Positions to Avoid
- Sleeping in your stomach may lead to more strain on the spine and neck, leading to more pressure on the sciatic nerve.
- Twisting your body or crossing your legs while sleeping may also aggravate symptoms.
How to Sleep with Sciatica in Pregnancy?
Experiencing sciatica while pregnant is a common, yet painful, experience for up to 35% of pregnant women, particularly during the third trimester. As the baby grows, the uterus expands, resulting in changes to the pelvis and posture that can add more pressure on the sciatic nerve, leading to radiating pain, tingling, or numbness in the lower back, hips, and legs. Dealing with both pregnancy and sciatic pain makes it more challenging to get comfortable sleep, however getting quality sleep can help ease the pain.
1. Sleep on Your Left Side
Most professionals recommend sleeping on your left side during pregnancy since it allows for a higher circulation to the uterus and kidneys. For women who are also dealing with sciatica, lying on their left side reduces the pressure on the sciatic nerve and reduces strain on the lower back.
Pro Tip: For added support and alignment, try putting a pillow between your knees and another pillow under your belly.
2. Use Pregnancy Pillows
Pregnancy body pillows are specially designed to give added support and align the spine, hips, and legs while sleeping. Pregnancy pillows can come in many styles, with a C or U shape specifically designed to give full body support. Additionally, while hooked onto a pregnancy pillow, rolling onto your back or stomach from your side-whilst trying to sleep, will be limited for additional comfort to reduce further compression of the sciatic nerve.
Pro Tip: To aid in comfort while sleeping, you may want to try placing a wedge pillow under your belly, or a wedge pillow behind your back to avoid odd twisting of your body.
3. Slightly Elevate Your Legs
Elevating your legs slightly while sleeping can relieve swelling and reduce pressure in the lower back. If you are semi-reclined, place a thin pillow under your knees, or place a rolled towel under the back of your knees if you are sleeping on your side.
4. Semi-Reclined Position
Some pregnant women with severe sciatica report that sleeping with a slight recline, or propped-up position such as using a wedge pillow or adjustable bed would relieve some pain. Reclining places less pressure on the lower spine and pelvis when lying down, reducing nerve compression.
5. Gentle Stretches Before Sleeping
Gentle stretches that are safe for pregnancy can help loosen tight muscles and reduce sciatic tension. Include stretch for your hip flexors, gluteus, and hamstrings. Avoid stretches that are painful for you.
6. Heat or Cold Safely
You can help tense muscles relax by using a heat pad on your lower back for 15–20 mins before bed. You may also use a cold pack to reduce inflammation and pain. It is a good idea to always use a barrier, like a towel, to avoid direct skin contact with heat or cold. This is especially true if you are pregnant.
7. Sleep on a Supportive Mattress
It is important to have a supportive mattress. For example, a medium-firm mattress will be the best option as it will be supportive to your spine while contouring to your body. If you cannot get a new mattress, you can look at a memory foam topper.
8. Don't Sleep on Your Back
After the second trimester, your flat back is at risk for compressing your inferior vena cava, decreasing blood flow, and increasing sciatic pain and discomfort. It can also further aggravate back pain and diminish the oxygen flow to your baby!
Tips to Ease Sciatica Pain When Sleeping
Sleep on your side with a pillow in between your knees to keep the spine aligned and diminish pressure on the nerves.
- Place a pillow under your knees when sleeping on your back to help support the natural curve of the lower back.
- Sleep on a medium-firm mattress to help keep the spine align during the night.
- You can add a memory foam mattress topper to make the bed more comfortable without losing support.
- Use a heating pad before bed to relax the muscles around the sciatic nerve and alleviate tension.
- If inflammation is causing shooting pain, you can try an ice pack.
- Do gentle stretching exercises before bed to loosen any tightness in the hips, hamstrings, and lower back.
- Use a pillow or wedge to elevate your legs somewhat to decrease any compression on the sciatic nerve.
- Avoid sleeping on your stomach, because it can twist the spine and aggravate the pain.
- Try best to stay on a regular sleep-wake cycle to allow the body to heal and reduce sensitivity to pain.
- Try to relax with deep breathing or meditation to allow a more restful sleep.
- If your sciatica symptoms are keeping you from sleeping well, consider contacting a health care professional for help.
Final Thoughts
Getting to sleep with sciatica can be tough. However, if you use the right positions to help with your sciatica, you may achieve some meaningful relief. Distinct sleeping positions will assist with your spine being in the right position—side sleeping using a pillow between your knees or as a cushion when lying back slightly instead of flat--will relieve pressure on your sciatic nerve and decrease discomfort. Consider using supportive pillows, gentle stretching before bed, and a medium-firm mattress to improve nighttime symptoms related to your sciatica.
If sciatica continues disrupting your sleep function, you should consult a healthcare any provider, to discuss possible treatments to address your sciatica. With a commitment to these treatments, restful, pain-free sleep is completely attainable.
