How to sleep with sciatica – top tips

So you’d like to know how to sleep with sciatica? As an Edinburgh osteopath for nearly 30 years, I have a few tips below which can make a big difference.  Full disclosure, the below is lifted almost in its entirety from the Active X book on lower back pain.  But the principles are as relevant for sciatica.  I also link to an article at the bottom on how to get your socks on with pain!

Why sleeping with sciatica can be so difficult

Pain is often worse at night.  Sleeping is really very important if you’re in pain. It helps you to regenerate damaged tissue.  And it helps to calm an alarmed nervous system. If you’re lacking in good quality sleep you tend to experience more pain.

Pain is often worse at night for a number of reasons:

  • There are no other distractions; total lack of input into your other senses means your brain “notices” alarm sensations more easily. Leading to you stressing about it, leading to more pain.
  • Movement helps to block the alarm messages in your spinal cord; lack of movement=more pain.
  • Lack of movement allows inflammation to build up.
  • Discs absorb fluid over night, so if you have a disc prolapse or bulge, it’ll probably get bigger the longer you stay lying down.  And irritate the nerve more (if that’s happening at all).

How to sleep with sciatica – my top tips

  • Do some gentle mobilising/relieving exercises before lights-out.
  • Try ice or heat packs.
  • Use pain-relieving medication
  • Use mindfulness meditation to help with the pain and to help get to sleep.
  • When you turn over, brace your abdominal muscles first.
  • Do some mobilising exercises during the night.
  • Sleep on your own – stressing about whether your tossing and turning is keeping your partner awake will only make your pain worse.
  • Get the right support from your mattress and pillow (see below).
  • Use a pillow between your knees if side-lying.
  • Use a pillow under your knees if lying on your back.
  • Lie in whichever position is most comfortable (or least uncomfortable) – there is not one position that is best for everyone.
  • Different size people – particularly a couple who are very different weights – may very likely need different mattresses. Try a split mattress.

Good lying down posture for sciatica at night

Lying still – especially if you aren’t optimally supported – creates a Sustained Load on part of your back (and other bits of you). When lying down, you should be able to rest without exerting any increase in force on any part of your body.  Lying on a firm but supportive surface makes this more easily achievable. If the surface is too hard (e.g. the floor), your body has to adapt to the flat surface – your body isn’t flat, so it’s going to have to compromise instead of relaxing. If you lie on an overly soft surface, the heavier parts of your body will sag towards the floor.  This increases the strain on tissues over many hours; ideal conditions to cause stretching of tissues such as muscles and ligaments.

Mattresses and positions of comfort for sciatica

In order to achieve this firm but supportive surface, you may have to spend more money. Generally speaking the more money you spend, the better the mattress will age too. It’s not uncommon for people (particularly women) to have mattresses that are too hard. The top of your mattress needs to be soft enough to adapt to your curves. You may find putting a layer of memory foam on top of a too-hard mattress makes life a lot more comfortable.

Supine means lying on your back. This is often painful for sciatica sufferers. However, be guided by the pain; if it’s not sore, then it’s perfectly all right to lie on your back. If it is sore, then try side-lying.

When lying on your back, your lower back should not be curved down towards the floor. And if you try to put your hand between your low back and the mattress there should be no gap. The mattress should hold your spine in its natural alignment.

Side-Lying is often a position of more comfort in someone with sciatica (but you may be the exception).  Sometimes it’s lying on the painful side with your knees tucked up.  Sometimes it’s lying with the painful side upper-most.  Try bending the bottom knee up and straightening the top leg down.  Or try putting a pillow between your knees.

Getting your socks on in the morning

Also, remember I mentioned earlier that your discs absorb fluid over-night (it’s why you’re tallest first thing in the morning).  Consequently, disc-related sciatica pain is usually worst first thing in the morning and takes an hour or so to settle, meaning socks are beyond reach. But inflammation also builds up when you’re lying still so this can contribute to morning pain too.  Here’s an article on how to get socks on with lower back pain – it applies to how to sleep with sciatica too.

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