How to sleep with lower back pain and sciatica 

Sleep, lower back pain and sciatica don’t often go hand in hand. After all, who can sleep well when their lower back and legs are restless with tingling, throbbing, or shooting pains? Not many! But don’t lose hope. With an informed approach, shut-eye with lower back pain and sciatica is possible. Bodyset Physiotherapist, Soham Deb tells us what you can do to relieve lower back pain and sciatica and get a good night’s sleep.

What is sciatica?

Your sciatic nerve is the largest nerve in your body. It starts at your spinal cord and runs through your hips, glutes, and down the back of each of your legs. Sciatica refers to nerve pain that happens when your sciatic nerve is compressed, irritated, or injured. It is what is referred to as ‘an impingement of your sciatic nerve’. Getting a good night’s sleep with sciatica can be difficult, as lying down in particular positions (dependant on the cause of your sciatica) can put further pressure on your irritated nerve and cause your symptoms to flare up.

What are the symptoms of sciatica?

If you have sciatica, you may experience the following symptoms:

• Lower back pain
• Sharp, burning or shooting pain that travels from your lower back to your foot
• Muscle weakness in one or both of your legs and/or feet
• Numbness in one or both of your legs
• A pins-and-needles sensation in your leg, foot or toes

“Sciatica is experienced differently by everyone. It’s dependant on what is causing it, how it has developed, and which area of the nerve has been affected. You may feel the pain constantly, or only in certain aggravated positions. You might feel pain. You may alternatively feel numbness” Says Soham.

What causes lower back pain and sciatica?

It’s worth noting that lower back pain can often be a symptom of sciatica. However, it can also be caused by many other conditions. Your local physiotherapist will work with you to source the cause of your lower back pain and sciatica, and get you feeling better in no time with a sound diagnosis, exercise therapy, hands-on therapy and a roadmap to long-lasting recovery.

Common causes of sciatica can include:

• Bulging, herniated, or slipped disc
• Lumbar spinal stenosis (a narrowing of the spaces within your spine)
• Compressed or irritated nerve
• Tight muscles in your back or hips
• Vertebrae misalignment
• Injury to the sciatic nerve from a fall or accident.
• Spinal tumour or growth near the sciatic nerve (in extremely rare cases)

Why is lower back pain and sciatica worse at night?

Many people with lower back pain and sciatica feel their symptoms increase in bed. Lying down often increases pressure on your irritated nerve, especially if you sleep on a soft mattress.

Best positions for sleeping with back pain and sciatica

“The cause of your sciatica will affect when you feel pain and what sleeping positions are most suited to you. For example, someone with a slipped disc may prefer sleeping on their back with pillows under the knees, while a person with spinal stenosis may find it more comfortable sleeping in a fetal position with a pillow between their knees. Your physiotherapist will be able to determine what’s causing your lower back pain or sciatica and be able to advise on exercises and sleeping positions to relieve the pain.” Soham

Sleep on your side with a pillow between your knees

Some people with sciatica find that sleeping on their side is comfortable. It can help to take some pressure off your sciatic nerve when you sleep on the side opposite of where it hurts most. Sleeping on your side with a pillow helps to align your hips and takes pressure off your pelvis. It also helps to prevent you from rolling onto your back.

1. Allow your right or left shoulder to rest on mattress, along with the rest of that side of your body
2. Place a medium-sized pillow between your knees
3. If there’s a gap between your waist and the mattress, place a small pillow there too for additional support.

Sleep in the fetal position

While some people find that this position further aggravates their symptoms, many others find it a great comfort. What you find comfortable is personal to you and what is causing your sciatica. The fetal position helps to increase space between your vertebrae and is often helpful in reducing back pain caused by a herniated disc.

1. Lie on your side and bring your knees up to your chest
2. For added comfort you can also try adding a pillow between your knees or under your waist.
3. Be sure not to crunch yourself too tightly in the fetal position as this can restrict breathing, further interrupting your sleep.

Sleep on your stomach

Sleeping on your stomach can come with its own discomforts as it requires you to sleep with your head turned to one side. However, if arching your back relieves some of your pain then this sleeping position could be for you.

1. Lie on your front with your head placed on a pillow and your head turned to one side
2. Widen your legs for increased lower back support
3. To further alleviate some pressure from your back, you can place a thin pillow under your pelvic/abdominal region.

Sleep on your back with a pillow under your knees

Placing a pillow under your knees can help to maintain the curvature of your spine, while letting your back and legs relax.

1. Lie on your back with a pillow under your head
2. Place a thick pillow under your knees and let your legs relax onto your mattress
3. It is also important to ensure your neck is in neutral position as increased flexion or extension may cause tension on your neural tissue.

Research has shown that there is a strong relationship between the quality of sleep and how you experience pain. Those in pain generally do not sleep well and those who do not sleep well are prone to developing pain. It’s a vicious circle! While it’s important to find comfortable sleeping positions during your recovery journey, it’s best to nip the cause in the bud as soon as you start noticing symptoms.