How to Sleep With Piriformis Syndrome

Understanding how to sleep with piriformis syndrome can help you ease pain and get a good night's rest. The key to sleeping better if you have piriformis syndrome is supporting your spine and hips, which you can do by sleeping on a medium-firm mattress, positioning yourself on your back or side, and adding support pillows under or between your knees. Stretching exercises during the day can also be beneficial.

This article will go over some tips for sleeping if you have piriformis syndrome, including how some treatment and management strategies for the condition can help.

Pillow Types, Shapes, and Positions for Piriformis Syndrome

Verywell / Jessica Olah

What Is Piriformis Syndrome?

Piriformis syndrome is a condition in which the sciatic nerve is irritated by the piriformis muscle (located behind the hip joint in the buttocks). Piriformis syndrome can cause pain, tingling, and numbness along the back of the leg and down to the foot.

While the sciatic nerve is involved, piriformis syndrome is not the same as having sciatica. In people with sciatica, the pain signals run along the nerve. In people with piriformis syndrome, the pain is muscular in origin. 

In many cases, the cause of piriformis syndrome is not known. Some recognized causes of piriformis syndrome include:

  • Irritation in the piriformis muscle itself or a nearby structure (e.g., sacroiliac joint or hip)
  • Injury
  • Abnormal development or location of the piriformis muscle or sciatic nerve
  • Abnormal spine alignment (e.g., scoliosis)
  • Leg length discrepancy
  • Prior hip surgery
  • Foot problems (e.g., Morton's neuroma)

Sleeping Better With Piriformis Syndrome

The pain from piriformis syndrome can make it hard to go about your activities during the day and can also interfere with your sleep at night. Here are a few things you can do to help ease the pain and get a better night's sleep if you have the condition.

Get the Right Mattress 

Adequate sleep is important for managing pain levels with piriformis syndrome—and it all begins with your bed. 

There is no one mattress that will work for everyone with piriformis syndrome, but sleeping on the wrong mattress can cause or exacerbate lower back pain by reinforcing poor sleeping posture, straining muscles, and not keeping the spine in alignment. The right mattress for you can help reduce spinal pain and improve your spinal alignment and sleep quality.

Research suggests that the ideal mattress for promoting sleep comfort, quality, and spinal alignment is medium-firm and custom-inflated (self-adjusted). You should also consider the two elements that impact mattress quality: support and padding/comfort.

When it comes to supporting your back, think about the inner making of the mattress. The perfect amount of support depends upon a few factors, including your preference, height and weight, and sleeping style.

Choose Back-Saving Sleep Positions

Your sleeping position can also help with your lower back pain problems. The best and worst sleeping positions if you have neck or back pain are:

  • Back sleeping: Unless you are pregnant, lying on your back is the ideal position for spinal alignment and support. However, many people find it difficult to sleep in this position. The right pillows in the right position can help.
  • Side sleeping: This is the second-best option for avoiding sleep-related back pain and joint soreness. It's also an excellent choice for people with sleep apnea or snoring because it helps keep the airways open. Pregnant people will find this position is the best for back support. Remember to keep your legs straight or only slightly bent. Fully bent knees promote an uneven distribution of weight. Tucking your chin into your neck is also recommended to help with spinal support.
  • Reclined position: If you have pain that feels worse when standing up straight and better when bending forward, sleeping in a reclined position is recommended. This means sleeping in a reclining chair or adjustable bed. You can also find comfort and support from the use of a wedge pillow.

Why You Should Never Sleep On Your Stomach

Sleeping on your stomach is the worst choice for your spine health because it puts pressure on your joints and muscles and requires you to turn your head to one side. This position puts pressure on your neck and spine.

If you are having trouble switching your sleeping position, the Sleep Foundation suggests using a thin pillow under your head and placing a more supportive pillow under your hips and abdomen to reduce pressure.

Find the Right Pillow

Your pillow choice also plays a big role in back pain. The right pillow can help keep your upper spine aligned and relieve pressure on your body.

An orthopedic pillow is better for people with back pain over other options like memory foam, goose down, or feather-filled. There are many options for orthopedic pillows. The best one for you will depend on your sleeping style, height, and weight. Different contour designs also change the comfort and support level of the pillow.

Here are the best types of pillows for each sleeping position:

  • Back sleepers: Choose a medium-thin pillow and place it under your head. Add a cervical pillow and one or two pillows under your knees for ultimate support and even weight distribution.
  • Side sleepers: Choose a medium-thick pillow for under your head, and add a pillow between your knees to help encourage a neutral spine alignment. Side sleepers can also find comfort and support from body pillows.
  • Reclining sleepers: Choose pillows like wedge cushions that keep your head and knees elevated and reduce pressure on your lower back.
  • Stomach sleepers: Either use no pillow or a very thin pillow under your head. Try to transition away from this sleeping style because it strains the neck and spine. Add a pillow under your abdomen to prevent your spine from being in a U-shape.

Try Stretching Exercises

The American Council on Exercise recognizes stretching as an effective way to reduce lower back pain, decrease muscle stiffness, and keep your back in alignment.

Regular, gentle stretching can also prepare your body for sleep. One small study showed that just four months of stretching can improve symptoms of chronic insomnia.

Another study found that gentle stretching was effective for promoting sleep health. Results were better than when the participants performed more strenuous exercises, such as aerobics.

When to See a Healthcare Provider

While back pain can be a normal occurrence that resolves on its own, in other cases you will need medical attention. You should see your provider if:

  • The pain began with a specific injury
  • The pain continues or worsens for more than a few days
  • The pain is debilitating
  • The pain radiates to the legs or other parts of the body
  • You experience weakness or numbness in your lower body
  • There are signs of infection like redness, warmth, swelling, or fever
  • You have a personal history of cancer
  • You have other unexplained health changes like weight loss or urinary problems

If you notice new signs and symptoms of back pain after a period of remission (symptom-free status), contact your healthcare provider.

Treatment for Piriformis Syndrome

Your provider may talk to you about other treatment options and management strategies for piriformis syndrome that may help improve your sleep.

Treating and managing piriformis syndrome can include:

  • Resting and avoiding strenuous activity (like exercise) until symptoms get better
  • Using ice and heat therapy
  • Taking non-steroidal anti-inflammatory drugs (NSAIDs) for pain
  • Using non-pharmaceutical pain management techniques like a TENs machine
  • Improving posture when sitting and standing
  • Trying alternative treatments like acupuncture
  • Having steroid, local anesthetic, or Botox injections
  • Taking prescription medications for pain and/or inflammation and to relax muscles
  • Having surgery if the pain does not improve with other treatments

Summary

The pain from piriformis syndrome can make it hard to sleep. There are some strategies you can use to improve your sleep, such as using the right pillows, sleeping on your back or side, and making sure you have a supportive mattress. You should also talk to your provider about other treatment and management strategies for piriformis syndrome, as well as ways to prevent it.

A Word From Verywell

Any kind of back pain can make it hard to go about your day and interfere with your sleep. There are some steps you can take to make your sleep environment more supportive, which can help ease the discomfort of muscle and nerve irritation. If these strategies don't work or you feel like your pain is getting worse, make sure to let your provider know.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Harvard Health Publishing. Ask Dr. Rob about piriformis syndrome.

  2. Spine Health. Choosing the Right Mattress for Lower Back Pain.

  3. Radwan A, Fess P, James D et al. Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials. Sleep Health. 2015;1(4):257-267. doi:10.1016/j.sleh.2015.08.001.x 

  4. Keck Medicine of USC. The Best - and Worst - Sleep Positions for Back Pain.

  5. Spine Health. Mattresses and Sleep Positions for Each Back Pain Diagnoses.

  6. The Sleep Foundation. How to Sleep with Lower Back Pain.

  7. Spine Health. Pillow Support and Comfort.

  8. The American Council on Exercise. Top 10 Benefits of Stretching.

  9. D'Aurea CVR, Poyares D, Passos GS, et al. Effects of resistance exercise training and stretching on chronic insomnia. Braz J Psychiatry. 2019;41(1):51-57. doi:10.1590/1516-4446-2018-0030.x

  10. Pa J, Goodson W, Bloch A, King AC, Yaffe K, Barnes DE. Effect of exercise and cognitive activity on self-reported sleep quality in community-dwelling older adults with cognitive complaints: a randomized controlled trial. J Am Geriatr Soc. 2014;62(12):2319-2326. doi:10.1111/jgs.13158.x

  11. Vij N, Kiernan H, Bisht R, et al. Surgical and non-surgical treatment options for piriformis syndrome: A literature reviewAnesth Pain Med. 2021;11(1):e112825. Published 2021 Feb 2. doi:10.5812/aapm.112825

By Michelle Pugle
Michelle Pugle, BA, MA, is an expert health writer with nearly a decade of contributing accurate and accessible health news and information to authority websites and print magazines. Her work focuses on lifestyle management, chronic illness, and mental health. Michelle is the author of Ana, Mia & Me: A Memoir From an Anorexic Teen Mind.