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Got Back Pain When Sleeping? Here’s How to Fix It (In Pictures)

Back massage

How To Fix Back Pain When Sleeping

Why is it that kids (or people who don’t seem to have back problems) can sleep in the strangest, most bizarre positions, but never seem to have any pain?

How is that they can sleep in totally unnatural positions and still sleep just fine?

And why is it that even when I try to sleep in a perfect position, on a great bed, with tons of pillows,  I can’t sleep. What the heck is going on?

After many years of sleepless nights, I figured out the answer.

Table of Contents:

  1. The Proper Painless Position For Your Spine
  2. Proper Sleep Positions To Prevent Back Pain When Sleeping
  3. Which Position is the Best?
  4. Troubleshooting

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The Proper Painless Position For Your Spine

Alright, so you’re going to have to trust me on this next one – your spine wants to be perfectly aligned all day.

Standing, sitting, walking, sleeping – your spine really only has one optimal position, although it’s obviously built to accommodate flexibility and constant motion.

When you mess up that natural, optimal alignment for too long (like when you sit at work for 8 hours and get terrible lower back pain), pain results. Comprende?

Here’s your normal spine:


Via Wikipedia

Normal posture

Here’s a common misalignment of the spine, where the shoulders are hunched and the head pokes out (computer caveman syndrome anyone?):


And here’s another common spinal misalignment that is frequent in many of us who sit a lot. Tight hip muscles cause the lower back to overly arch:


Via University of Maryland Medical Center


So what do any of these have to do with your sleep?

It’s important to know what proper spinal alignment is versus dysfunctional alignment – so that when you sleep you can quickly remind yourself how to get into a properly aligned position.

The real question is how to keep the natural position of the spine while sleeping.

Proper Sleep Positions To Prevent Back Pain When Sleeping

A. The Fetal Position

Problem #1: The lower back is overly arched

Back Pain When Sleeping - Fetal Position

Depending on how tight your hips are, if your legs are too straight, it will pull the lower back into an arched position. If your legs are too bent, tight hamstrings will pull the lower back into an overly-rounded position.

The key is to find the sweet spot in-between.

Problem #2: The back is overly rounded

Back Pain When Sleeping - Fetal Position

For many of us with tight hamstrings, tucking the legs up too close to the chest will result in an over-rounding of the lower back.

Problem #3: Shoulders are overly hunched and the head is bent down too much.

Back Pain When Sleeping - Fetal Position

For those of you with neck/upper back pain, it’s really important to pay attention to your shoulder and neck alignment.

Problem #4: Head is overly tilted back

Back Pain When Sleeping - Fetal Position

Proper Position When Sleeping On Your Side In Fetal Position

Proper Fetal Position

Proper Fetal Position Pillow

B. On The Back

Common Problems: Lower back is overly arched and in pain

Generally, the main problem that people have with back sleeping is that the lower back starts to ache.

Usually this can be because of tight hip muscles like the hip flexors & psoas. It’s pretty easy to figure out if they’re tight: Just bend your knees to a 90 degree angle – when your legs are pulled up, is there less pain and does your lower back feel less arched? If so, it’s probably tight hips.

The easy fix is to simply add a pillow beneath your knees, which will let the lower back settle a bit.

Laying on The Back

C. On The Stomach

Main Problem: Tight hips cause the lower back to overly arch

The problem here is very similar to the problem that people have with sleeping on their back – but in reverse.

Here, you want to put a pillow or flat towel under your stomach/groin to help push that lower back up into alignment a bit. Usually you can immediately feel the relief.

Laying on Stomach 1

Laying on Stomach 2

So Which Sleep Position is The Best If You Get Back Pain When Sleeping?

If you’re having problems with your back or neck, I highly suggest sleeping on your back.

There are a number of reasons for this: first – just from personal experience, sleeping on your back is generally the easiest way to aggravate the fewest number of things (well, except for snoring ;) ).

When you sleep on your side, you have to worry about your back alignment, neck alignment, your hips twisting, etc. When you sleep on your back there is less than can go wrong and fewer variables to experiment with to get comfortable.

Second, when you sleep on your back, you are naturally laying flat which is letting gravity re-align the body a bit. It’s offsetting the fact that you might have just been sitting in a caveman computer pose for 10 hours (here’s how to fix that back pain).

Also, if you have neck pain, I’ve found that back sleeping is also easier than side sleeping for some people. People with neck pain tend to have protruding necks (in my case – from staring at a computer screen for 10 hours a day). Usually when they go to sleep the neck continues protruding and stays in the poor alignment, reinforcing the pain.

It took me years of waking up to throbbing neck muscles and spasming trapezius muscles, with a crap night of sleep, to realize this.

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At the end of the day, deviation from your body’s natural alignment will cause pain in the long-run. The key is to maintain better alignment throughout the day, and while you’re sleeping.

If you’re at work, make sure to focus on sitting properly to prevent back pain.

If you’re in pain when you’re sleeping (or when you wake up), take the same precautions – for a few weeks, awkwardly force yourself to get into a more aligned position when you sleep.  Missed sleep sucks, and I’ve been there with the back pain. You just need to be patient and experiment.

I also have a free back pain E-course for you in the private insider’s list. Just click here (or click the image to the right) and it’ll bring you there.

– Alex

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52 comments… add one

  1. Thanks very much, I’ve just recently started waking up in the middle of the night with back pain and want to hit it on the head before it gets any worse. I’ve just recently read an article that a memory foam mattress will do the trick but have been reluctant to try it out, but looking at the positions on here hopefully it will support me in the way you’ve recommended.

    1. Hi Beth!

      In my experience, changing mattresses was a short term fix. Have you ever noticed that people with “good backs” can sleep on anything? A wood floor, memory foam, an awkward couch – and they still sleep well. I’ve found the reverse to be true, too. For me, it doesn’t matter how optimal the conditions are, because we need to fix what’s going on with the body first.

      Try it out and keep me posted with how it goes!


  2. Stumbled upon the article while trying to understand the late night back pain. I am the batman in day but soon as I lie down, it pains to even move or shift position. THis has been happening since last week.

    The doctor wants me to hold on for a while till he is assured that this is not any ordinary muscle issue. I can tell straight away I am facing something far serious.

    Will wait and see.

    1. Hi Ashok,

      Where specifically does it hurt?

  3. hey there Alex, I’ve read all your back pain posts and I’ll try my best to incorporate these advices in my life, but I have a question…what about scoliosis (my spine is bent in a S shape) these tricks should help me out for sure, but is there something else I should know?

    Thanks a lot

    1. Hi Laurence,

      I would suggest checking with your doctor first, and avoiding anything that causes pain or discomfort.


  4. Your sleep positions have been really helpful, but I can’t understand why I get severe lower stomach pain when lying on my back. Is it something to do with muscles pulling my stomach down? I have spondylosis (and also think,from your diagrams, that I might have I have an exagerated lumbar curve). My lower stomach only hurts when I sleep on my back. Any ideas would be really appreciated! Thanks

    1. Hi Kate,

      Does it hurt when you do anything else or throughout the day?

      - Alex

      1. Could just be gas. If I eat too close to bedtime (within 2-3 hours), that happens to me. Just lay on your left side for a bit to release the gas. Eating within three hours of bedtime increases the likelihood of digestive pain while sleeping on the back.

  5. Hi Alex,
    Thank you for the sleeping tips. I have been getting lower back pain from sleeping for the last week. I have been on the same mattress for the past 5-7 years and its a pillow top.
    I had back pain a few years ago and added a comforter to the bed which seemed to fix the problem. I felt like my back was sinking in to the bed too much. Now the pain is back again and I’m not sure what to do. I mainly sleep on my sides but have found I am sleeping on my back a lot now. My lower back is really tight. What do you think?


    1. Hey Matt,

      I had similar issues with my back. I’ve noticed that a lot of people try to compensate for back pain by reverting back to sleeping on their back.

      When you sleep on your back it still hurts? Does it hurt your upper back and neck, or just lower back?

      If it’s just your lower back, do a quick experiment: Bend your knees and put your feet flat on your bed (while you’re laying down) – do you still feel back pain? If not, it could be that you have tight hip flexors and psoas muscles which make your back overly arched.

      Try putting a big pilow under your knees while you sleep and see if that fixes the pain a bit.

      - Alex

  6. last night, at 3:00 in the morning i woke up and started feeling strong pains in my neck. I put some arbonne bio-nutria herbal muscle cream on my neck to ease the pain. that stuff pretty much did nothing. Throughout the day today i have kept a hot patch-thing on my neck to make it easier to move around. literally an hour ago i looked in the mirror and noticed something weird. my shoulderline is not exactly horizontal, and is slanted to the left. my head is tilted to the right, and everytime i try to tilt it into a somewhat proper position, it hurts like hell and goes back to the slant. HELP!

    1. Hi,

      Chances are you simply slept wrong and now you’ve got a stiff neck from the muscle strain. Basically all you can do is take it easy for a few days, relax, and maybe massage some pain-relieving cream on your neck. Let me know how it goes!

      - Alex

  7. Hi Alex,
    Am suffering from back pain since 1 year ,but its not consistent…When i tried yoga it gives me temporary releif. Now i get pain in every position if am in that position for a long time…and now i get lower back pain while sleeping sometmes uppre back pain as well….what i need to do ?


    1. Hey Sheetal,

      First check out this article for back pain relief (it usually works right away): http://modernhealthmonk.com/fixing-lower-back-pain/

      And then download this free guide I made (see bottom for back pain guide): http://modernhealthmonk.com/monks-courtyard-subscribed

      Try those out and let me know how it goes!

      Are you sitting throughout the day a lot?


  8. Hi!
    i got this back pain since almost 2 weeks.. i get pain during the night after sleeping on the back. even changing positions is painful. though i get bit relief from changing position for little bit but still the pain will be there and it will radiate to my belly sides.
    The pain is actually where the shoulder plates end.

    1. Hi Mirwais,

      So is it closer to your neck (top?) or is it bottom of the shoulder blade? Or closer to the inside?

      - Alex

      1. It is at the bottom of the shoulder plates.

  9. I have had upper back pain in the middle of night for 1 month plus and my sleep has been disrupted because the pain will wake me up after lying on bed for about 4 hours. I am not able to return to sleep because no position helps to alleviate the pain. It takes 2 – 3 hours of movement in the day and pain will be gone but it returns once I go to bed. The first attack came while sleeping in fetal position and a really numb right arm. Tried sleeping on the back but pain did not go away.

    1. Hi Denise,

      Do your arms usually fall asleep when you’re sleeping? Usually that’s an indicator of poor upper back and shoulder alignment – check out this article to help get you started: http://modernhealthmonk.com/neck-pain-and-shoulder-pain-upper-crossed-syndrome/


      1. Arms don’t go asleep, only that pain will be there when i lay down anytime or sleep at night.

  10. Sorry Alex i thought that reply was for me.

  11. I sleep on my side and have had severe lower back pain at night for months. The pain woke me up after five hours almost every night. I found your website and used your suggestion to sleep with a pillow between my legs. I have been sleeping 7-8 hours every night ever since with little or no lower back pain. I can’t thank you enough for the great suggestion!

    1. Ray,

      Awesome! I’m glad I could help :)


  12. I just wanted to say THANK YOU! I purchased a cheap mattress and have been waking up on it with back pain for over a year now. I’ve been getting used to sleeping in that relaxed side position for the past week and my back pain is practically inexistent. I honestly thought it was just the crappy bed until now! Seriously can’t thank you enough for this information… It all makes sense now!! <3

    1. Melissa, you are very welcome :) I’m glad it helped! Feel free to email me if you ever have any other questions.

      - Alex

  13. Alex, I hear all this talk about lower and upper back pain. What about mid back pain?

    1. Hi Meagan,

      Can you tell me specifically where the pain is? Is it mid shoulder blade?

      - Alex

  14. Hi Alex,

    I have been having severe low back pain when I sleep. I’ve tried putting pillows under my knees when on my back and between my knees when on my sides. I can’t sleep on my left side because it hurts more so I sleep on my right but that doesn’t last long. I also do stretches before bed and after I wake up (knees to chest and alternating). But nothing has been helping. It’s been so bad that I’ve actually had to take Aleve before sleeping. It only helps a little bit but not much. I only get about 3-4 hours of sleep before the pain starts. I don’t know what to do.

    1. Hi Sandy,

      Have you checked with a doc to make sure something more severe isn’t going on?

  15. Hi Alex – I have chronic spasming in my upper trapezius. I had surgery about 2 months ago on the top corner of my scapula, as we thought this may have been the issue. Now the upper trap is spasming more :(. I stumbled across your article here when I was trying to figure out if it was how I was sleeping that was causing all of this. I use one of those tempurpedic neck pillows…which may be artificially raising me up. Can you explain how my neck should be if I’m a back sleeper and trying to get this spasming to stop? You recommend a folded towel? Any idea how high this should be to get my head in alignment? Thanks!

    1. Hi Adrienne,

      Was the trapezius bothering you before the surgery quite a bit?

  16. Hi Alex,

    I have been having severe pain for the last three weeks in the middle part of my back. This pain occurs when I am sleeping at night and during the day it disappears. I am not sure what the cause of my pain is. I bought a new bed last year I do not feel that is the problem. I went to get a x-ray but they did not find any problems. I don’t know what to do any suggestions. I would greatly appreciate this thank you.

    1. Hi Analese,

      Do you mean your upper back, between the shoulder blades?

  17. Hi Alex – For the last 3 months, I have been having lower back pain, while turning sides. I have to be extremely careful while turning sides during night. This disturbs my sleep constantly. Moreover when I wake up, it pains to sit straight on the bed and getting up from the bed, to a standing position. The back is stiff and my walking posture is odd. But within one hour of getting up from bed, the pain disappears and back gets stronger as day passes. I have referred to neuro, Ortho and also have been to massage for a week. They feel muscles are week. Situation has improved but not OK. I have been asked to sleep on hard bed, which makes my turning easier. Soft beds make my turning difficult as resistance to turning is high. Do you have any suggestion

    1. Hi Sunil,

      What position do you usually sleep in?


  18. Hi,
    I have been having upper back pain (in between shoulders) only after 5-6 hours sleep , it is very deep and sharp and makes it difficult to breath in deeply. Lying on front, impossible, side very painful and back only just bearable. I have to get up and walk around for 10 or so minutes for it to subside. Sick of waking at 3:00am to start my day can you help at all.
    I have been seeing a Chiropractor twice a week for 4 weeks and not much change at all.

    1. Hi Charmaine, start with this article: http://modernhealthmonk.com/neck-and-shoulder-pain

      and this article: http://modernhealthmonk.com/neck-pain-and-shoulder-pain-upper-crossed-syndrome/

      Do those and I guarantee it’ll be gone quickly.


  19. Loved this article! I hate nights because I’m constantly waking up in pain and not able to get back to sleep. I have other health issues but my back, neck, and hips are a real pain for me. I’m laying in bed as I write (on my side, lol). I’m going to have to try changing to back sleeping but I hate the thought of it. I’ve always been a side or belly sleeper and can’t sleep well otherwise. Another question about sleeping… What is the best kind of pillow? I have awful neck pains that lead to migraines.

    1. Hi Shy’rell,

      Personally, I have to mostly sleep no my back due to my back and neck pain. I hate back sleeping too but it’s one of the best ways to keep the body properly aligned.

      Regarding pillows – honestly it doesn’t matter as long as your body is properly aligned. That will depend on your body size/shape/curves, etc. So you need to experiment with those.

  20. Hi,

    I am a 28 year old male and about a month ago I had severe back pain right in the middle of my back which built up throughout the night until it was unbearable by the morning time.

    Various sleeping positions and back stretches did not work. Light exercise the day before helped a little.

    However hanging from a bar, arms straight, feet off the floor, for about 30 seconds a day, every day for a week, fixed the problem. (I also did some chin ups while I was at it, but I don’t think this fixed my back).

    No more back ache for me. Just thought I’d share the tip.


    1. Hey Rob,

      Awesome, thanks for sharing! I will definitely pass this along. Sounds like your spine just needed to decompress and stretch out a bit eh?

  21. Hi Alex, Great article. I was wondering if you could help me out. I wake up most mornings with a slight headache( trapped nerve feeling) and its due to the fact that when I am asleep I am tilting my head right back as far as it will go and sleeping like that ( I wake up in that position) which in turn makes my neck stiff in the morning as well as the headache etc. I mostly sleep on my side with my underneath arm stretched out, my knees are bent although my top leg falls forward. I set off to sleep purposely tilting my chin down but I cant control my neck while I’m asleep. I also try to sleep on my back but always wake up on my side. I was thinking maybe a neck brace would help but not sure if that’s wise. Any info or suggestions would be greatly received. Thanks

    1. Hi Deborah,

      I would follow through with this protocol I put together here for neck and shoulder pain – if you have neck alignment issues, that slight headache issue is REALLY common. I had it for years. Read the article here: http://modernhealthmonk.com/neck-and-shoulder-pain

  22. HI

  23. Love this! Sharing on my FB as well – After battling the worst neck/upper back pain the past couple of months, I decided to take to the internet for suggestions on sleeping positions. This is perfect – Love the pictures and the additional information.


    1. Cheers Callie :) Let me know how it goes!

  24. I sleep in my bed and get back pain every night, the pain is in the lower back and sometimes the middle (not between shoulder blades, just middle of back) but the pain is mostly in the lower, bought new beds and still get pain, if I sleep on the couch in a reclined position I wake up fine, any suggestions so I can start sleeping in my bed again.

    1. Hi Denis,

      Start with this article: http://modernhealthmonk.com/fixing-lower-back-pain/

  25. Hi I have arthritis in my neck is there a good pillow u could recommend or sleep position 1 pillow or 2 pillow or flat have tried them all ?

    1. Hi Kaz,

      Honestly, I’ve tried many different pillows and they didn’t make much of a difference for me – I was still in pain. I had to fix the underlying cause first.

  26. Hi there,

    I “must” sleep on my back due to having subluxated shoulders–and have done so for 20 years. I sleep on a firm latex mattress and use a thin latex pillow. I’ve experienced upper back pain while sleeping for the last few months. I wake up and my upper back is super tight right in the spine. I can’t figure out why. I do mild stretching prior to sleep which allows me so sleep for a few hours…

    Cheers :)


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