Sleep Tips for Piriformis Syndrome: Mattress, Position, and More


Pain from piriformis syndrome can affect your sleep quality, but there are steps you can take that will improve both. Understanding how the way you sleep can affect spinal support and how it contributes to back pain can help you make the necessary modifications to your mattress type, sleep position, and pillow use and get a good night’s rest. Additional measures like engaging in regular stretching exercises can also be of benefit to people struggling to get quality sleep with this condition. 


What Is Piriformis Syndrome?

Piriformis syndrome is a condition in which the 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. This is not the same as having sciatica.

In people with sciatica, the pain signals run along the nerve, while in people with piriformis syndrome, the pain is muscular in origin. 

The cause is not identified in many cases. Recognized causes of piriformis syndrome include:

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

The Right Mattress 

Getting 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 is custom-inflated (self-adjusted). You should also consider the two elements that impact mattress quality: support and padding/comfort.

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

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, and is also an excellent choice for those with sleep apnea or who snore because it helps to 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 can promote an uneven distribution of weight. Tucking your chin into your neck is also advised 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 advised. 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 adds additional pressure on your neck and spine. If you are having trouble switching your sleeping position, the Sleep Foundation suggests using only a thin pillow under your head and placing a more supportive pillow under your hips and abdomen to reduce pressure.

Pillows Types, Shapes, and Positions

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 and goose down or feather-filled. However, orthopedic pillows come in many options, and the best type varies depending on sleeping style, height, and weight. Different contour designs also change the comfort and support level. 

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 to two pillows under the knees for ultimate support and even weight distribution 
  • Side sleepers: Choose a medium-thick pillow under your head, and add a pillow in 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 to keep your head and knees elevated and reduce pressure on the lower back
  • Stomach sleepers: Choose no pillow or a very thin pillow under the head, but try to transition away from this sleeping style since it strains the neck and spine. Add a pillow under the abdomen to prevent the spine from creating a U-shape


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 shows that just four months of stretching can improve symptoms of chronic insomnia. Another study found gentle stretching effective for promoting sleep health and 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, including:

  • The pain began with a specific injury
  • Pain continues or worsens for more than a few days
  • Pain is debilitating
  • 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.

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