How to Sleep with Sciatica: Tips and Exercises from Physical Therapists

If you have sciatica — pain, numbness, and weakness that travels along your sciatic nerve from your lower spine all the way down to your feet and toes — you know how challenging it can be to get a good night’s rest. In fact, nearly 60% of people with chronic low back pain, including sciatica, report sleep problems.

But sleep is one of the best tools your body has to fight sciatica discomfort, stresses Dorian Logan, PT, DPT, a physical therapist at Hinge Health. “One reason why sciatica pain is often worse at night and interferes with sleep is because, during rest, there’s less blood flow,” she explains. “But your nerves need three simple things to stay calm and happy: space, movement, and blood flow. By addressing these needs during the day, your sciatica can settle down, making it easier to get the restorative rest your body needs.”

Read on to learn about the strategies Hinge Health physical therapists recommend, including targeted exercises, to help you reduce discomfort, support your nerve health, and get the sleep you need to feel your best.

What Causes Sciatica Pain?

Sciatica is caused by irritation or injury to the sciatic nerve — the longest and thickest nerve in your body. It’s a bundle of nerve roots branching off from the base of your spine that travels through your lower back, buttocks, and down the back of each leg into your feet and toes. “Your sciatic nerve needs an unobstructed path, so any condition that puts pressure on it can trigger sciatica,” explains Dr. Logan. Common triggers include:

• Disc changes. Age-related changes to the intervertebral discs that cushion your spinal bones can lead to sciatica. “Conditions like herniated discs, degenerative disc disease, spinal stenosis, and bone spurs can narrow the space at the base of your spine where the sciatic nerve branches off,” says Dr. Logan.

• Tight buttock muscles. Tightness or inflammation of the piriformis muscle, a small band-like muscle at the top of your buttocks, can press against the sciatic nerve and cause pain. 

• Sitting on something. Carrying a wallet or phone in your back pocket can put pressure on the sciatic nerve when you sit. 

• Spondylolisthesis. This condition occurs when one spinal bone slips out of place and presses on the bone below it. “The resulting compression can pinch the sciatic nerve and cause pain,” says Dr. Logan.

• Pregnancy. Changes in the pelvis during pregnancy can increase pressure on the sacroiliac joint, which connects your spine to your pelvis. “This can irritate the sciatic nerve and trigger or worsen sciatica,” explains Dr. Logan.

Understanding Sciatica Pain When Sleeping

Nighttime is when your body should be at rest — so why does sciatica often feel worse at night? According to Dr. Logan, there are three main reasons. 

• Sleeping position. “Certain sleeping positions can tighten your back or buttock muscles, which may compress the sciatic nerve,” explains Dr. Logan.

• Lack of movement. While lying down, blood flow decreases, and there’s less circulation to help soothe the irritated sciatic nerve.

• Fewer distractions. During the day, your brain and body are occupied, making sciatica symptoms less noticeable. At night, when your mind and body finally rest, discomfort often feels more pronounced, says Dr. Logan.

Best Way to Sleep With Sciatica Pain: 7 Tips From PTs 

Addressing both your daytime and nighttime habits can make a big difference in managing sciatica and improving sleep quality. Small adjustments can help you sleep better, reduce pain, and break the pain-sleep cycle. Here’s how to sleep with sciatica, according to Hinge Health physical therapists. 

1. Do exercise therapy. Focus on stretches and strengthening exercises that support your spine, recommends Dr. Logan. The four exercises listed below are a great starting point. A physical therapist can also design a personalized routine to address your specific pain and teach you movements that won’t aggravate your sciatica. Research shows that starting physical therapy early can significantly reduce sciatica discomfort.

2. Reduce sitting time. Prolonged sitting can worsen sciatica by increasing pressure on the sciatic nerve. If you have a desk job, take frequent movement breaks throughout the day. “It’s also worth removing your wallet or phone from your back pocket before sitting to see if that makes a difference,” adds Dr. Logan.

3. Practice good sleep hygiene. While good sleep habits won’t eliminate sciatica pain, they can make it easier to fall asleep. Here are a few tips Dr. Logan suggests:

   • Set a regular sleep schedule so you go to bed and wake up at the same time each day.

   • Avoid stimulants late in the day, such as caffeine after lunch and alcohol near bedtime.

   • Create a calming sleep environment. Use blackout shades, keep the room quiet, and try using a fan or white noise machine to reduce distractions.

   • Limit screen time for two hours before bed. Televisions, smartphones, laptops and tablets emit blue light, which makes it harder to fall asleep.

   • Avoid eating within two hours of bedtime.

4. Try relaxation techniques. Relaxation techniques can distract you from pain and help you fall asleep faster. Guided meditation, deep breathing, or mindfulness exercises have been shown to improve sciatica pain, according to a 2024 study in Pain Reports. 

5. Soak in a warm bath before bed. A warm bath or shower before bed can encourage blood flow, relieve muscle tightness, and ease sciatica pain. 

6. Try an evening massage. Research shows massage can reduce pain and improve mobility in people with sciatica. Dr. Logan suggests a DIY approach with a foam roller or tennis ball. Roll it gently along your affected leg to loosen tight muscles.

7. Experiment with sleeping positions. There’s no one-size-fits-all sleeping position for sciatica, but it may help to make adjustments to your preferred style to find some pain relief. Here are some tweaks to consider making: 

   • Back sleepers: Place a supportive pillow under your knees to reduce pressure on your lower back.

   • Side sleepers: Use a pillow between your knees to keep your spine in a more neutral position, which may be more comfortable. There are even specially designed sciatica pillows, which tend to hold their shape better than regular ones, adds Dr. Logan.

   • Stomach sleepers: Place a pillow under your pelvis to create more space in your lower back joints, suggests Dr. Logan.

The above exercises for sciatica pain are recommended by Hinge Health physical therapists. These movements stretch out tight muscles to provide you with pain relief before you go to sleep.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Get Outdoors and Move It 

Aim for 30 minutes of moderate-to-vigorous exercise most days of the week, recommends Dr. Logan. “Exercise has been shown to improve sleep quality,” she explains. A 2023 review in the journal Cureus found that regular physical activity helps with insomnia and leads to better overall sleep. Whenever possible, try exercising outdoors to get natural sunlight, which can help regulate your circadian rhythm. Just try to schedule your workouts earlier in the day — at least two hours before bedtime. “Exercising too close to bedtime can make it harder for some people to fall asleep,” adds Dr. Logan.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here. 

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Alsaadi, S. M., McAuley, J. H., Hush, J. M., & Maher, C. G. (2010). Prevalence of sleep disturbance in patients with low back pain. European Spine Journal, 20(5), 737–743. doi:10.1007/s00586-010-1661-x

2. Fritz, J. M., Lane, E., McFadden, M., Brennan, G., Magel, J. S., Thackeray, A., Minick, K., Meier, W., & Greene, T. (2021). Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica. Annals of Internal Medicine, 174(1), 8–17. doi:10.7326/m20-4187

3. Wexler, R. S., Fox, D. J., ZuZero, D., Bollen, M., Parikshak, A., Edmond, H., Lemau, J., Montenegro, D., Ramirez, J., Kwin, S., Thompson, A. R., Carlson, H. L., Marshall, L. M., Kern, T., Mist, S. D., Bradley, R., Hanes, D. A., Zwickey, H., & Pickworth, C. K. (2024). Virtually delivered Mindfulness-Oriented Recovery Enhancement (MORE) reduces daily pain intensity in patients with lumbosacral radiculopathy: a randomized controlled trial. PAIN Reports, 9(2), e1132. doi:10.1097/PR9.0000000000001132

4. Bell, J. (2008). Massage therapy helps to increase range of motion, decrease pain and assist in healing a client with low back pain and sciatica symptoms. Journal of Bodywork and Movement Therapies, 12(3), 281–289. doi:10.1016/j.jbmt.2008.01.006

5. Alnawwar, M. A., Alraddadi, M. I., Algethmi, R. A., Salem, G. A., Salem, M. A., & Alharbi, A. A. (2023). The effect of physical activity on sleep quality and sleep disorder: A systematic review. Cureus, 15(8). doi:10.7759/cureus.43595