Sacroiliac joint pain: 12 correct sleeping positions to help relieve aches

If you often experience sacroiliac joint pain, and each time you lie down, you feel a sharp pain in your lower back, buttocks, or hip, causing you to toss and turn all night, you are not alone. According to statistics, about 15–30% of chronic lower back pain cases are related to the sacroiliac (SI) joint. The pain often increases when changing sleeping positions for back pain sufferers inappropriately or when lying on one side for too long, even causing hip pain when sleeping, disrupting sleep and affecting daily activities.

In this article, Tiptory will guide you through 12 ways to improve sleep when experiencing sacroiliac joint pain based on simple, easy-to-apply medical recommendations. You will learn how to choose the right sleeping positions for back pain sufferers, use support pillows correctly, and establish pre-sleep habits to reduce pressure on the sacroiliac joint, thereby sleeping better and reducing the recurrence of pain at night.

How to relieve sacroiliac joint pain before sleep

Use pillows to reduce pressure on the sacroiliac joint

• When lying on your side, place a medium-sized pillow between your thighs, knees, and lower legs.
• This pillow placement helps keep your spine, pelvis, and hips aligned, thereby reducing pressure on sacroiliac joint pain and limiting pain radiating down to the lower back or buttocks.
• If you frequently experience hip pain when sleeping or back pain when turning over, this is one of the sleeping positions for back pain sufferers recommended by many physical therapy experts.
• Choose a pillow of moderate thickness to keep your legs parallel, avoiding excessive rotation or tilting of the pelvis.

Perform gentle stretching exercises before bedtime

• Dedicate about 5–10 minutes to exercises that help relax the lower back and sacroiliac joint.
• You can choose movements such as:
  • Torso twists to stretch the lumbar spine.
  • Knee-to-chest stretch while lying on your back.
  • Gentle mobilization exercises to increase hip and pelvic flexibility.
• These exercises help reduce muscle tension, improve range of motion, and support relief from sacroiliac joint pain before bedtime.
• Only exercise within a pain-free range. If the pain is severe or persistent, consult a doctor or physical therapist.

Apply cold compress before bed to reduce inflammation and pain

• Applying a cold pack to the sacroiliac joint area for about 20 minutes before sleep can help reduce inflammation, swelling, and pain.
• Always wrap the ice pack in a thin towel before applying it to protect the skin and avoid placing ice directly on the body.
• This method is particularly helpful when sacroiliac joint pain flares up after a day of strenuous activity or after standing or sitting for a long time.
• After cold therapy, combine it with an appropriate sleeping position for back pain sufferers to maintain pain relief and improve sleep quality.

Method 1: Side sleeping correctly to reduce pain

Switch to side sleeping position

• If you are experiencing sacroiliac joint pain, prioritize sleeping on the side you feel most comfortable on. This is one of the sleeping positions for back pain sufferers that helps reduce pressure on the spine, pelvis, and hip area.
• Slightly bend your knees towards your chest, avoiding bending them too close to your abdomen as this can increase muscle tension in the hip and lower back areas.
• Place a regular pillow between your thighs, knees, and lower legs to keep your legs aligned. This pillow placement helps stabilize the pelvis, reduce spinal torsion, and minimize hip pain when sleeping.
• If you frequently toss and turn or find it difficult to maintain the correct position throughout the night, you can use a body pillow. A body pillow provides better support for the entire leg and hip, maintaining a stable side-sleeping position, thereby helping to reduce sacroiliac joint pain and promote more comfortable sleep.
• Adjust the thickness of the pillow so that your hips and spine remain in a neutral position. If you still feel increased pain upon waking, try changing the pillow's height or switching to a pillow with suitable firmness.

Method 2: Proper pillow placement when sleeping on your back

Place a pillow under your knees to reduce back pressure

• If you habitually sleep on your back, place one pillow under your head and another just below your knees. This helps maintain the natural curve of the spine, reducing pressure on the lower back and sacroiliac joint pain.
• When your knees are slightly elevated, the muscles in your lower back and hips will be less tense, contributing to improved pain and helping you fall asleep more easily.
• If you still feel a large gap between your lower back and the mattress surface, roll a soft towel and place it under your lower back for added support. However, only place enough to allow your spine to maintain a natural position, without excessively arching your back.
• This is one of the sleeping positions for back pain sufferers recommended by many experts as it helps distribute body weight evenly and effectively supports reduction of hip pain when sleeping in some individuals.
• If sleeping on your back increases pain or causes prolonged discomfort, switch to side sleeping with a pillow between your legs to reduce pressure on the sacroiliac joint and hip area.

Method 3: Proper pillow placement when sleeping on your stomach

Reduce back pressure when stomach sleeping is necessary

• Individuals with sacroiliac joint pain or back pain are generally not encouraged to sleep on their stomach because this position tends to arch the lumbar spine and increase pressure on the sacroiliac joint. However, if you can only sleep well on your stomach, adjustments can be made to reduce pain.
• Place a thin pillow under your hips and lower abdomen. This pillow placement helps limit excessive arching of the lower back, reducing pressure on the spine, hips, and sacroiliac joint area.
• If your neck or back still feels uncomfortable, try sleeping on your stomach without a pillow under your head. This helps your neck and spine maintain a more natural position, while also reducing muscle tension in the neck and shoulders.
• If, upon waking, hip pain when sleeping or lower back pain becomes more severe, you should switch to sleeping positions for back pain sufferers such as side sleeping with a pillow between your legs or back sleeping with a pillow under your knees to reduce pressure on the spine and sacroiliac joint.
• If the pain persists for several days or frequently disrupts sleep, consult a medical facility for assessment of the cause and guidance on appropriate treatment methods.

Method 4: Choose the right pillow to reduce pain

Prioritize pillows that provide good head and neck support

• A suitable pillow can help maintain alignment between the head, neck, and spine, thereby reducing pressure on sacroiliac joint pain and improving sleep quality.
• Avoid using pillows that are too high or too firm, as this can cause the neck to bend, disrupt spinal alignment, and indirectly increase pressure on the lower back, hips, and sacroiliac joint.
• Choose a pillow with moderate softness and elasticity to support the entire head and neck while keeping the spine in a natural position. This is an important factor when selecting effective sleeping positions for back pain sufferers.
• Memory foam or feather pillows are highly rated by many people for their ability to conform to the curves of the head and neck, helping to distribute pressure better throughout sleep.
• In addition to material, you should also choose a pillow height appropriate for your sleeping position. Side sleepers often need a higher pillow than back sleepers to keep their head and neck aligned, thereby helping to reduce hip pain when sleeping and minimize back pain upon waking.

Method 5: Choose a mattress with moderate firmness

Use a mattress that supports the spine and sacroiliac joint

• A mattress that is sagging, worn, or has lost its elasticity can prevent proper spinal support, increasing pressure on sacroiliac joint pain, lower back, and hip areas throughout the night.
• If your mattress has been used for many years and frequently causes you to wake up with back pain or stiff joints, consider replacing it with a medium-firm mattress. Many studies show that this type of mattress can help reduce lower back pain and improve sleep quality for many people.
• A medium-firm mattress helps distribute body weight more evenly, keeps the spine in a natural position, and effectively supports the use of sleeping positions for back pain sufferers.
• However, no single mattress type is suitable for everyone. The ideal firmness also depends on individual weight, body shape, preferred sleeping position, and the extent of hip pain when sleeping or sacroiliac joint pain.
• When choosing a new mattress, prioritize trying it out in person or selecting a product with a trial period. A suitable mattress is one that helps you maintain a comfortable sleeping position, reduces pain upon waking, and supports deeper sleep.

Method 6: Establish a scientific sleep routine

Create a sleep environment that reduces pain and promotes deeper sleep

• Maintain a consistent bedtime and wake-up time every day to stabilize your biological clock. This routine helps the body fall asleep more easily, even if you are experiencing sacroiliac joint pain.
• Turn your bedroom into a quiet, dark, and comfortable space. Turn off lights and minimize noise from TVs or electronic devices to reduce brain stimulation before sleep.
• Adjust the room temperature to a comfortable level. A room that is too hot or too cold can cause you to wake up frequently, making hip pain when sleeping more uncomfortable.
• Avoid using phones, tablets, or devices that emit blue light for about 30–60 minutes before bedtime, as they can slow down the production of melatonin – a hormone that aids sleep.
• Do not drink coffee, strong tea, energy drinks, or other caffeinated beverages in the evening. Also, limit alcohol consumption close to bedtime, as while they may initially make you drowsy, they can reduce sleep quality and cause you to wake up easily in the middle of the night.
• Combining an ideal sleep environment with appropriate sleeping positions for back pain sufferers and a supportive mattress will help reduce pressure on the sacroiliac joint, improve sleep quality, and support long-term relief from sacroiliac joint pain.

Method 7: Stretch before bed

Perform stretching exercises to relieve sacroiliac joint pain

• Spending about 5–10 minutes before bed to perform gentle stretching exercises can help relax the back, hip, and pelvic muscles. Proper movement also helps reduce joint stiffness, improve mobility, and support relief from sacroiliac joint pain, thereby helping you sleep better.
• Practice slowly, controlling each movement, and stop if the pain increases.

Side plank exercise for the lower back

• Lay a yoga mat or soft towel on the floor and lie on your side.
• Prop yourself up on your forearm, while bending both knees at approximately 45 degrees.
• Place your free hand on your upper hip to stabilize your body.
• Keep your knees and lower legs in contact with the floor, then slowly lift your hips off the ground and lower them back down.

Supine Knee Lift Exercise

• Lie on your back on a flat surface, with both knees bent and feet flat on the floor.
• Gently engage your abdominal muscles, imagining pulling your navel towards your rib cage to keep your spine in a neutral position.
• Keep your knee bent at about a 90-degree angle, then slowly lift one leg.
• Continue to lift the other leg to a similar bent angle.
• Hold the position for about 5–10 seconds, then slowly lower each leg one at a time.
• You can perform up to 5 sets, each lasting about 1 minute, with a 4-second rest between repetitions.
• This exercise helps strengthen abdominal and hip muscles, improves pelvic stability, thereby reducing hip joint pain when sleeping and alleviating pressure on the sacroiliac joint.

Exercise Precautions

• Only perform exercises within a range that does not cause significant pain.
• Breathe evenly and avoid holding your breath throughout the exercise.
• If sacroiliac joint pain persists, radiates down the leg, or you experience numbness or weakness in the lower limbs, stop exercising and consult a doctor or physical therapist for appropriate guidance.

Method 8: Cold compress before bedtime

Cold compress for 20 minutes to reduce pain and inflammation

• If sacroiliac joint pain makes it difficult for you to fall asleep, apply a cold compress to the painful area for about 20 minutes before getting into bed. This is a simple method to reduce inflammation, swelling, and temporarily relieve pain.
• Place the cold pack on your lower back or the area just above your buttocks – the location that often corresponds to the sacroiliac joint. Always wrap the ice pack in a thin towel before applying it to avoid damage or frostbite to the skin.
• In addition to before bed, you can also apply cold compresses 2–3 times a day if pain occurs after physical activity or prolonged sitting or standing. Allow your skin to rest for at least a few hours between applications.
• If you don't have a specialized cold pack, you can use a bag of frozen vegetables or a homemade ice pack. Regardless of what you use, ensure there is a protective layer of cloth between the cold pack and your skin.
• Cold compresses are often effective in the acute phase of sacroiliac joint pain or when there are signs of inflammation in the joint area. If the pain persists for several weeks, you should combine it with sleeping positions for back pain sufferers, rehabilitation exercises, and treatment guidance from a doctor for long-term improvement.
• Stop applying a cold compress if your skin experiences prolonged numbness, unusual discoloration, or you feel too cold, especially if you have circulatory disorders or conditions that reduce skin sensation.

Method 9: Warm compress to relax muscles

Use warm heat to relieve muscle tension around the sacroiliac joint

• A warm compress can help relax stiff muscles around the sacroiliac joint pain, thereby reducing pain and making the body more comfortable before sleep.
• Place a heating pad or warm compress at a low temperature on your lower back or sacroiliac joint area for about 20 minutes. Moderate temperature helps increase blood circulation and soothe tense muscles without irritating the skin.
• Do not use excessively hot temperatures or apply compresses for too long, as this can cause skin burns, especially in people with sensitive skin or reduced sensation.
• After applying the compress, turn off and unplug the heating pad before going to sleep. Do not sleep overnight with the heating pad on to avoid the risk of burns or safety hazards.
• For many people, alternating between cold and warm compresses can provide better pain relief. Cold compresses are usually suitable when the joint area is swollen or inflamed, while warm compresses help relax muscles and reduce joint stiffness after the inflammation has subsided.
• To improve long-term effectiveness, combine warm compresses with sleeping positions for back pain sufferers, choosing appropriate mattresses and pillows, and maintaining exercises to strengthen hip and core muscles. These measures also contribute to reducing hip joint pain when sleeping and improving sleep quality.

Method 10: Deep breathing to relieve pain

Practice deep breathing to relieve pain and relax before sleep

• When sacroiliac joint pain occurs, many people tend to breathe quickly and shallowly due to stress or as a reaction to pain. However, this type of breathing can make the body more tense, anxious, and make the pain more pronounced.
• Instead, try to breathe slowly and deeply. Studies show that controlled breathing techniques can help relax the nervous system, reduce muscle tension, and assist in pain management, thereby helping you fall asleep more easily.

Perform diaphragmatic breathing exercise

• Lie or sit in a comfortable position.
• Place one hand on your chest and the other on your abdomen.
• Inhale slowly through your nose, feeling your abdomen expand while your chest moves very little.
• Exhale slowly through your mouth, pursing your lips gently and letting your abdomen contract.
• Repeat the movement at least 3–5 times or until your body feels relaxed.
• This technique helps reduce muscle tension in the back and hips, supporting the improvement of sacroiliac joint pain before sleep.

Apply the 4-7-8 breathing technique

• Place one hand on your chest and one hand on your abdomen.
• Inhale through your nose for 4 seconds.
• Hold your breath for 7 seconds.
• Exhale slowly through your mouth for 8 seconds.
• Perform 4–7 cycles or stop if you feel dizzy.
• This method helps calm the nervous system, reduce stress, and improve sleep quality for many people.

Combine breathing with appropriate sleeping positions

• After completing breathing exercises, lie in an appropriate sleeping position for back pain sufferers, such as lying on your side with a pillow between your knees or on your back with a pillow under your knees.
• Combining relaxation through breathing, correct sleeping posture, and a quiet sleep environment will help reduce pressure on the sacroiliac joint, limit hip joint pain when sleeping, and naturally improve sleep quality.

Notes when practicing breathing

• Perform exercises in a quiet space and with a natural breathing rhythm, without straining to hold your breath.
• If you experience dizziness, shortness of breath, or chest pain during the exercise, stop immediately and rest. If symptoms persist, you should seek medical attention for examination.

Method 11: Use painkillers correctly

Use over-the-counter pain relievers when necessary

• If sacroiliac joint pain makes it difficult for you to sleep or frequently wakes you up at night, over-the-counter pain relievers can help control symptoms in the short term.
• Some long-acting medications, such as naproxen, can help maintain pain relief throughout the night. However, the choice of medication should be based on your health condition and the guidance of a doctor or pharmacist.
• Medications only provide temporary symptom relief and do not treat the underlying cause of pain. Therefore, you should still combine them with sleeping positions for back pain sufferers, rehabilitation exercises, and lifestyle adjustments for long-term improvement.

Some commonly used over-the-counter pain relievers

• Paracetamol (Acetaminophen):
  • Can help relieve mild to moderate pain.
  • Adults should generally not take more than 1,000 mg per dose and not exceed 4,000 mg in 24 hours. High or prolonged doses can increase the risk of liver damage.
• Ibuprofen:
  • Belongs to the non-steroidal anti-inflammatory drug (NSAID) group, which helps reduce pain and inflammation.
  • Should only be used as directed on the label or as prescribed by a healthcare professional. Prolonged use or high doses can increase the risk of stomach ulcers, gastrointestinal bleeding, and kidney dysfunction.
• Aspirin:
  • Has pain-relieving and anti-inflammatory effects, but is not suitable for everyone.
  • People with a history of stomach ulcers, bleeding disorders, or those taking anticoagulants should consult a doctor before use.
• Naproxen:
  • An NSAID with a longer duration of action, which may be suitable for people with sacroiliac joint pain that lasts through the night.
  • It is important to follow the recommended dosage on the label or as directed by a doctor to reduce the risk of side effects.

Notes on using pain relievers

• Take medication at the correct dosage and at the correct intervals between uses as directed by the manufacturer or healthcare professional. Do not arbitrarily increase the dose or combine multiple pain relievers without medical advice.
• Be cautious if you are pregnant, have liver disease, kidney disease, cardiovascular disease, hypertension, or a history of stomach ulcers, as some pain relievers may not be suitable.
• If hip joint pain when sleeping or sacroiliac joint pain lasts for more than a few weeks, recurs frequently, or does not improve after taking medication, seek medical attention for diagnosis and treatment of the cause instead of relying solely on pain relievers.

Method 12: Ask your doctor about sacroiliac joint injections

Consider injections if sacroiliac joint pain persists

• If you are diagnosed with sacroiliac joint pain due to inflammation and methods such as rest, rehabilitation exercises, medication, or adjusting sleeping positions for back pain sufferers do not provide relief, your doctor may consider prescribing injections into the sacroiliac joint.
• This method usually involves corticosteroids combined with an anesthetic, injected directly into the joint under imaging guidance to increase accuracy.
• The goal of joint injections is to reduce inflammation, alleviate pain, and improve mobility, helping patients with daily activities and better sleep.

The effectiveness of corticosteroid injections is limited

• Corticosteroid injections can help relieve pain for several weeks to several months in some people, but the effectiveness varies among patients.
• Because corticosteroids can affect tendons, cartilage, and bone density if used repeatedly, doctors usually limit the number of injections per year and only prescribe them when absolutely necessary.
• You should not request repeated injections without a thorough evaluation by a specialist doctor.

Discuss other treatment methods with your doctor

• If sacroiliac joint pain is persistent, recurrent, or severely affects quality of life, your doctor may recommend more specialized treatments, such as:
  • Radiofrequency ablation to reduce pain signals.
  • Neuromodulation with an electrical device in certain appropriate cases.
  • Surgery to stabilize or fuse the sacroiliac joint when conservative treatments are no longer effective and there is a clear indication.

Combine treatments for long-term effectiveness

• Joint injections do not replace rehabilitation. To control hip pain when sleeping and improve mobility, you should still maintain exercises to strengthen your hip and core muscles, manage your weight, choose an appropriate sleeping position for back pain, and follow up with your doctor as scheduled.
• If the pain radiates down your leg, accompanied by numbness, muscle weakness, or urinary incontinence, seek immediate medical attention for evaluation and timely treatment.

References

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Content editor: Ashley Wright Nguyen.

Information consulted and verified by expert: Charlotte Davis.