Alex Simotas, MD

Hospital for Special Surgery
Board Certified Physiatrist
Specializing In Spine & Sports Medicine

Home > Wellness & Exercise > Behavioral Strategies > Sleeping Positions, Bedding & Pain

Sleeping Positions, Bedding & Pain


Getting adequate sleep is helps recovering from any painful condition, in particular, pain involving the back, neck or shoulder. What’s more, people with sleep problems may be more likely to get chronic musculoskeletal pain problems. A 2008 study of over 4000 subjects revealed that subjects with at least 3 out 4 sleep issues including difficulty falling asleep, trouble staying asleep, waking early in the mornings, and non-restorative sleep, were more likely to develop chronic musculoskeletal pain after one year.

There are several possible reasons that include:

  • Pain can interfere with the normal cycles of sleep, creating a non-specific pattern of sleep waves.
  • Some studies show inadequate sleep may makes you more sensitive to pain.
  • Sleep deprivation may aggravate mood disorder which is a factor in pain.
  • Having pain can make it really hard to sleep.

It is one factor in a vicious cycle of pain. Back pain can make it harder to sleep—and when you can’t sleep, your back pain can be worse.


This is one of the most common questions. The first rule of thumb is just sleep in a comfortable position. The most important issue with sleep is usually actually getting enough of it. Use you good judgment and find a comfortable position and wherein you are sleeping better and without pain.

During periods of lower back pain you can try:

  • Sleeping on your side in a fetal position with a pillow between your legs.
  • Sleeping on your back with a pillow under your knees.

If you have spinal stenosis:

Avoid sleeping on your stomach. Most will find it too uncomfortable to do anyway. This can lead to provoking symptoms and in unusual instances may lead nerve injuries. If you have to, do so only with pillows placed under your stomach. This will to reduce any lordosis (arch) in your spine.

If you have cervical stenosis:

  • Sleep on your back with proper head and neck cushioning. This is the most advisable position.
  • Avoid stomach or side sleeping.
  • Consider using a cervical collar while sleeping.

For neck pain and radiculopathy (pinched nerve):

  • Again sleeping on your back is usually optimal.
  • Consider using a cervical collar while sleeping.
  • A cervical pillow or pillowing with a rolled towel under the nape of the neck is another option.
  • Avoid excess pillowing that leaves your neck in an excessively flexed position.



First of all:

  • There is no ideal mattress.
  • No study has ever linked mattresses to back pain or spinal disease of any kind.
  • Consider that in third world countries, where people sleep on hard surfaces, hammocks, and cheaper mattresses, there is no higher and perhaps less incidence of these problems.

Some guidelines:

  • The general rule of thumb is to pick a mattress that is comfortable for you. Most investigations suggest that a medium firmness is best for most people, but you may be different.
  • If your at a store try it out.
  • Most of the technical jargon a salesman or the mattress companies throw at you is not based on any real science,…so use common sense.
  • The most expensive mattress will not guarantee you better sleep and less pain.



Some medications can help you get sleep while helping with your chronic back pain. However, some of these drugs have side effects and the potential for addiction. They should be part of your comprehensive medical care. Over-the-counter pain relievers, such as aspirin, acetaminophen (Tylenol or Tylenol PM), or ibuprofen (Aleve or Motrin), can be effective for short-term but use them only as directed and let your doctor know what you are taking.


Theses are some of the common suggestions getting better sleep.

  • Limit or eliminate caffeine. Even moderate caffeine use can cause insomnia and sleep disturbances.
  • Avoid eating heavily before bedtime. A heavy meal can cause acid reflux (heartburn) and keep you awake.
  • Establish a bedtime routine. Try to go to bed at the same time each night. Follow a routine, such as setting the alarm, putting on your pajamas, and brushing your teeth. Do not read, work, or watch TV in bed.
  • Don’t self-medicate with alcohol. Alcohol impairs the quality of sleep.
  • Avoid the pattern of reading, writing, eating, watching TV, or talking on the phone in bed.
  • Wait until you’re sleepy to get in bed.
  • Do something relaxing before bedtime. Begin a ritual that helps you relax each night before bed, like a warm bath. Try some relaxation techniques.
  • Choose a comfortable mattress and pillow. You don’t have to spend thousands of dollars on a mattress. Find the one that’s right for you.
  • Get a full night’s sleep on a regular basis. Getting good sleep is often the first step in recovery from a painful condition. A good night’s sleep can make a huge difference in your ability to recover full function and eliminate pain in your life.