How to Protect Your Back While You Sleep

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image of man lying on mattress with lumbar support
Illustration by Edward Ubiera

Back pain happens to the best of us. In fact, it’s estimated that close to 80% of adults will experience back pain at some point in their lives. If you’ve ever had back pain, then you know that making the wrong sleep choices, like snoozing on your stomach or lying on a too-soft mattress, can hurt you. You don’t have to grin and bear it, though.

There are a number of steps you can take to alleviate back pain and even prevent it from happening in the first place. One of the most important is making sure that any mattress you sleep on has adequate lumbar support. Here’s what that means.

The lowdown on lumbar support and sleep

The human spine naturally curves in an S shape. “A lot of times when people think of curvatures, they think of scoliosis, but these curves are normal and healthy,” says Jason Queiros, licensed chiropractor at Norwalk Sports and Spine in Connecticut. The lumbar spine, in the area of your lower back, curves in toward your belly and then back out toward the sacrum.

The purpose of these curves, Queiros explains, is proper weight distribution. The lower vertebrae of your lumbar spine support the weight of your entire torso. Because of that, he says, they are prone to stress. For example, the soft discs between your lower vertebrae can start to bulge after years of wear and tear, putting pressure on the nerves surrounding them. That can lead to symptoms including numbness, tingling, pain, and weakness.

That’s why it’s essential to protect your back while you sleep. “If you don’t have proper lumbar support, your hips and shoulders will sink in and your natural curves will be flattened out,” Queiros says. “Sleeping on a couch or a bad mattress for one night isn’t the end of the world—our bodies are resilient—but doing so on a nightly basis can lead to lower back pain as well as early onset arthritis or other symptoms like pain, numbness, tingling, and weakness.”

The best mattress for lumbar support

The purpose of lumbar support in a mattress is to keep your spine in neutral alignment while you sleep. A mattress that is too soft, or one that’s too firm, will cause your spine to bow unnaturally. That being said, it’s best to err on the side of firmness, Queiros notes—although what’s firm for one person might not be firm for another. “If you’re a small woman and you have a heavyset spouse, your firmness is going to be different than their firmness,” he points out. “The point is you always want a firmness that supports your back in its natural position.”

A medium-firm mattress is a good starting point. According to Harvard Health Publishing, a survey of 268 people with low back pain found that those who slept on very firm mattresses had the worst sleep quality, while there was no difference in sleep quality between those who slept on medium-firm or firm beds.

An adjustable bed may also ease lower back pain, says Queiros. Adjustable bases allow you to raise your head and legs separately, taking the pressure off your lower back. Raising your head is also good if you snore or have acid reflux. (Here are some more tips for sleeping with back pain.)

Beyond finding the right mattress, how you sleep matters too. “Ideally, you should sleep on your back,” says Queiros. Lying on your back helps evenly distribute your weight, resulting in less pressure on your back as well as better spinal alignment. “If you can’t sleep on your back, the second best sleep position is on your side,” he adds.

Stomach-sleepers, you’re out of luck: “This is the worst sleep position for your low back specifically,” says Queiros. That’s because the weight of your hips and belly pulls your lower spine down; a mattress that lacks sufficient support will allow your hips to sink too deeply and leave you with a sore lower back.

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How pillows can help with lumbar support

The right mattress is only part of the lumbar support equation; the choice of pillow can affect how your back feels as well. As with mattresses, the best pillow for your lower back depends on your sleep position.

  • If you’re a back sleeper: Queiros suggests placing a small pillow under your knees to take pressure off your spine and sciatic nerve and a standard-size pillow under your head to keep your spine in a neutral position.
  • If you’re a side sleeper: Opt for a thicker pillow to maintain your head and neck in a neutral position, advises Queiros. Hold a body pillow in front of you while you sleep on your side for shoulder support and a pillow between your knees to keep your hips level.
  • If you’re a stomach sleeper: It’s best to train yourself to snooze in a different position, since this one’s bad for your back—in the meantime, try placing a flat pillow under your stomach and hips to slightly elevate your pelvis to take some pressure off your lower back.

Lumbar support tips for when you’re not sleeping

Don’t just think about lumbar support while you sleep—keeping it in mind during your waking hours is crucial for your back as well. In fact, sitting is basically the worst position for your back. Many of us slouch in our seats, which can put strain on the spine and lead to back pain. It’s also bad for health overall: A sedentary lifestyle has been linked to an increased risk for weight gain, diabetes, and heart disease. But sometimes it can’t be avoided, especially if you work an office job.

To combat some of the negative effects prolonged periods of sitting have on your lower back, it’s best to sit all the way back in your chair to support your lumbar spine, says Queiros. Most chairs have lumbar support, but a lot of people tend to lean forward—away from that support—while seated.

“This rounds the spine like a C shape instead of an S curve,” Queiros says. “Sitting back in your chair forces you to maintain your posture.” In the car, he adds, your head should touch the headrest, and you should adjust your mirrors for that position.

Pillows can also offer lumbar support during your waking hours, as a study published in the journal Chiropractic & Manual Therapies showed. For the study, 28 participants who sat for prolonged periods of time used a lumbar support pillow for 30 minutes. Half of the participants had lower back pain. The researchers noted that the lumbar support pillow helped increase or preserve the natural curve of the lumbar spine in those with and without back pain.

Getting a standing desk is one way to combat sitting all day, says Queiros, and so is what he calls the “water trick.” Get up from your seat to fill up your glass with water every hour—most people don’t drink enough H20 anyway, says Queiros, so this will force you to up your hydration game—plus you’ll also have to get up to go to the bathroom!

For more tips on alleviating back pain overnight, here’s how to keep pain from ruining your sleep.