Our earlier blog discussed ‘what causes sciatica’, catchup here if you haven’t already seen it. Unfortunately, sciatica can make even simple daily tasks uncomfortable, and when it comes to sleep, the pain can feel even worse. Poor sleep doesn’t just affect energy levels; it can also heightens pain sensitivity, creating a frustrating cycle. Many patients tell us “sciatica wakes or keeps me up at night”. Try these adjustments to find a sleeping position that reduces irritation and helps you rest more comfortably.

Why Does Sciatica Feel Worse at Night?

Sciatica is caused by irritation or compression of the sciatic nerve, leading to pain that may travel from the lower back into the buttock and down the leg. At night, pain can feel worse because:

• Stillness: Lying still for hours can make stiff joints and irritated nerves more noticeable.
• Positioning: Certain sleep postures may place more pressure on the nerve.
• Sleep disruption: Poor sleep increases pain sensitivity and lowers pain tolerance.

Best Sleeping Positions for Sciatica:

1. On Your Back with a Pillow Under Your Knees

• Lying flat can sometimes increase tension on the sciatic nerve.
• Placing a pillow under your knees gently tilts the pelvis and changes the lower back position.

2. On Your Side with a Pillow Between Your Knees

• Many people find side-sleeping comfortable.
• Keeping a pillow between your knees prevents the top leg from dropping forward and twisting the lower back.
• Try to keep your hips and shoulders stacked to avoid rotation.

3. Foetal Position (for some people)

• Curling up on your side with knees drawn towards your chest can open up the spaces where nerves exit the spine.
• This may provide relief if your sciatica is related to spinal stenosis.

4. Mattress and Pillow Considerations

• Medium-firm mattresses often provide the best support for your body.
• A supportive pillow that keeps your neck in line with your spine may help distribute pressure over your whole body.

Tips for Improving Sleep with Sciatica:

• A warm bath, heat or cold packs: Apply 15–20 minutes before bed to relax muscles and ease pain.
• Gentle stretching: Simple stretches for the lower back, glutes, or hamstrings can reduce tension before lying down. Many of these stretches can be done on your bed, so you don’t even need to wake up for them:
• Knees to chest
• Pelvic tilt
• Knees to opposite shoulder
• Figure 4 stretch

• Movement breaks: If pain wakes you up, try standing, walking, or lightly stretching before returning to bed.
• Consistent routine: Good sleep hygiene with regular bedtime, limiting screen use, and a calm wind-down routine can help improve overall rest quality.
• Medication: Rest is essential and can actually aid in the healing process. If your doctor has prescribed you with pain medications, take them as indicated. If you do not have prescribed medications, discuss appropriate over-the-counter medications with a pharmacist that may help with sleep and pain.

When to Seek Help

If your sciatica pain is persistent, worsening, or accompanied by symptoms such as leg weakness, numbness, or bowel/bladder changes, see a health professional promptly.

As physiotherapists, we help people manage sciatica not only through movement strategies and exercises, but also by finding practical solutions for daily challenges like sleep. By experimenting with different positions and routines, most people can discover a setup that allows for deeper, more restorative sleep.