The short answer
Sleep on your side with your knees slightly bent and a firm pillow between them, or on your back with a pillow under your knees. Both keep the lower back and pelvis in line and take pressure off the irritated nerve. Use ice for the first two or three days of a flare and heat after that, stay gently active during the day rather than resting in bed, and see a clinician if pain wakes you at night.
Positions that usually help
On your side, with a pillow between your knees
Lie on the side that hurts less, bend your knees slightly and put a firm pillow between them. The pillow keeps your top leg from pulling your pelvis and lower back out of line. A small pillow or rolled towel at your waist can help if there’s a gap.
On your back, with a pillow under your knees
A pillow under your knees takes pressure off the lower back. Some people prefer a thicker cushion or a wedge.
Stomach sleeping
This tends to arch the lower back. If it’s the only way you can sleep, a thin pillow under your hips may make it more comfortable.
Your mattress
Research on the best mattress for sciatica is limited. One review of back pain studies found medium-firm mattresses improved sleep quality. Overall the advice is to choose one that keeps your spine level and supports your hips.
Before bed and during the day
- Ice, then heat. Ice during the first two or three days of a flare, then heat.
- Keep moving. Bed rest isn’t recommended. Short walks and light activity during the day often mean less stiffness at night.
- Gentle stretches. Simple lower-back and hamstring stretches before bed, if they don’t increase the leg pain.
- Getting up. Roll onto your side, drop your legs over the edge and push up with your arms rather than sitting straight up.
- Pain relievers. Short-term over-the-counter pain relievers can help; ask your clinician which are safe for you.
When night pain is a warning sign
Pain that’s worse when you lie down, or that wakes you at night, should be checked by a clinician soon, especially with a fever, weight loss you can’t explain, or a history of cancer.
When to book a visit
If sciatica keeps you from sleeping for more than a couple of weeks, or keeps coming back, an exam can find out why and what to do about it. Treatment often starts with physical therapy, and our pain management physicians can add options such as an epidural injection when needed. See sciatica and back pain.
Care for this at Specialty Medical Center
This article is general information. It doesn’t diagnose your problem or replace advice from your own clinician.
Sources
- Sleep Foundation (medically reviewed by Abhinav Singh, MD): Sciatic nerve pain relief at night
- MedlinePlus Medical Encyclopedia: Sciatica
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