How to Sleep with Piriformis Syndrome

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Written by: Alex Savy
Read 13 minLast updated June 1, 2021

Piriformis syndrome can really mess up one’s sleep, as this condition typically goes hand in hand with painful symptoms.

And it’s not that common either, which means there’s more to learn about this condition.

However, what we know for sure is that dealing with piriformis syndrome does not necessarily mean that you have to suffer from poor sleep. There are a couple of tricks up our sleeve that we would love to share with you. Chances are, some of them will help you sleep with piriformis syndrome peacefully and soundly.

Curious to find out more? Then keep reading!

Understanding Piriformis Syndrome and How It Can Affect Sleep

Sleeping with piriformis syndrome can seem like an impossible task (if we’re talking about restful sleep and not tossing and turning all night). And that’s understandable: this condition can have really unpleasant symptoms. However, if we understand them better, there’s a chance we will be able to deal with them effectively.  So, what is piriformis syndrome, and how exactly does it ruin one’s sleep? This disorder is rare and occurs when the piriformis muscle (hence, the name) irritates or compresses the sciatic nerve (1). The sciatic nerve is the largest one in the body. It starts at the lower spine, passes through the buttocks, and goes all the way down through the thighs and to the feet (2). The Piriformis  muscle extends across the sciatic nerve across the front part of the sacrum (3). This muscle participates in the hip movement, and when it experiences strain, tension, or spasm, it can put pressure on the sciatic nerve. Understanding Piriformis Syndrome and How It Can Affect Sleep

Source: https://www.spineuniverse.com/conditions/sciatica/how-tell-if-your-sciatica-actually-piriformis-syndrome

One of the main symptoms of piriformis syndrome is pain (as you have probably guessed). It can involve shooting pain in the hip and down the leg (4). Buttocks often become affected, too: you can experience tingling, numbness, or muscle tenderness in that part of the body (4). In many cases, piriformis syndrome makes it difficult for patients to sit comfortably. Pain often worsens while sitting for extended periods or, on the contrary, being too active.

And the condition is sneaky, too, as it’s often confused with back pain or sciatica (with the latter being very similar). For example, research suggests that the prevalence of piriformis syndrome is about 17% among the people suffering from lower back pain (5). 

Now, knowing the risk factors of piriformis syndrome might help you prevent it in the future. So, the most common causes of this condition include:

  • vigorous exercise;
  • unhealthy spinal alignment and curvatures (like scoliosis, for example);
  • sitting for long periods;
  • injuries;
  • lifting heavy objects;
  • running;
  • bad falls;
  • car accidents;
  • prior hip surgery (6).

Naturally, when dealing with such a condition, it can be hard to sleep soundly. Pain often causes sleepers to toss and turn during the night, trying to find a comfortable position. This can affect one’s overall sleep quality and, consequently, health (7). Just like that, poor sleep can lead to greater piriformis syndrome pain (8), which means it’s easy to get stuck in this vicious cycle of sleep problems and pain (and their mutual influence).

Here’s the good news, though:

Dealing with piriformis syndrome does not necessarily mean that you can forget about restful slumber. There are little tricks you can turn to that may help you feel more comfortable (and less in pain) during the night. So, let’s take a closer look at some of them.

What Sleep Position Is the Best for Piriformis Syndrome Sufferers?

While choosing a proper sleep position is not a panacea for piriformis syndrome, it can help you find pain relief, which is one of the biggest steps towards restful sleep when dealing with this condition. After all, sleep position is one of the biggest contributing factors to the pain levels you are going to experience during the night.

So, here are a few ideas you might want to explore further and test the next night:

  • If you sleep on your back, you may want to elevate your knees a little. This will help reduce pressure from the hips and the lower back, which may come in handy if your piriformis syndrome is usually accompanied by hip pain at night. You can place a pillow or a rolled towel under your knees, or even use a wedge pillow if that’s more comfortable for you. If you experience lower back pain when lying on your back, you can also try and add a smaller, thinner pillow right under the lumbar curve of the spine to give it more support and, again, to reduce tension in those painful areas.
  • When sleeping on your side, you need to make sure that your hips receive enough cradling, especially if they are tender because of piriformis syndrome. In some cases, it’s better to get a new mattress for hip pain that could gently hug the protruding parts of your body when you sleep on one side. Plus, you can add a pillow between the knees. This will help align the hips and the pelvis. As a result, your sciatica nerve might experience less pressure, which should help alleviate the pain. Plus, this will prevent you from sleeping with a slightly twisted spine, as your top leg will be supported by the pillow instead of falling down onto the mattress or the other leg. Therefore, your spine will remain in a proper alignment during the night, which might reduce back pain (if you are suffering from it).
  • If you are a stomach sleeper, you might want to rethink your choice. The thing is, when lying on your stomach all night, you put too much strain on the spine. It curves much more than needed, which can lead to more pain. Plus, with your head turned to the side (because I doubt you can breathe through your pillow), you keep your neck twisted during sleep. It makes the whole spine fall into misalignment and can create tension build-up in some parts of the back. And as you can probably guess, pressure accumulation often leads to increased pain levels. So, if you can, try to sleep in a different position. If you can’t teach yourself to sleep in a different way, at least put a thin pillow under your abdomen. This will help you kind of balance out the excessive curve of the back and might keep your spine in a more neutral, healthier position.

Note: if you can, try sleeping in a reclined position. It’s often effective when it comes to sciatica pain (9), which means it may help with piriformis syndrome as well. If you have a recliner chair or an adjustable bed base, that’s great news. If not, you can try a larger wedge pillow designed for sleeping reclined.

How to Sleep with Piriformis Syndrome Better: Extra Tips and Tricks

Sometimes, changing your sleep position might not be enough. After all, each situation is different, and you may have to go through a period of trial and error to start enjoying your restful slumber. 

Hopefully, some of these tips and tricks can help you deal with piriformis syndrome pain and, thus, sleep better:

  • Consult your doctor. Naturally, this should be your number one step. However, many people prefer to do everything on their own, including diagnosing (with Google’s help) and treating their pain. However, only a professional will be able to tell what you are dealing with exactly. Plus, your physician can share some pain-alleviating methods based on your specific case (which means they should be much more effective). And let’s not forget that some cases of piriformis syndrome have to be treated more seriously (with pain killers, physical therapy, or sometimes even surgery). 
  • Consider gentle stretching, especially before bed. Certain stretching exercises (10) can help relax the piriformis muscle that’s putting pressure on your sciatica nerve. When the piriformis muscle is more relaxed, you will be likely to experience less pain and, thus, might sleep better. Remember to keep it gentle. Too much stretching can further aggravate these muscles, causing increased pain.
  • Get a new mattress. The best thing you can do for your restful sleep is get rid of your old mattress (if it doesn’t feel comfortable anymore). Your mattress plays a crucial role when it comes to piriformis syndrome, which means it can either save you from pain or make it worse. Check out mattresses recommended by chiropractors that promote proper spinal alignment and can prevent pressure build-up (here are a few examples of quality models). 
  • Take a warm shower before sleep. Warm water can help your muscles relax, including the piriformis muscle that might be pressing into the sciatica nerve and causing pain. Plus, taking a warm shower can be a part of your relaxing nighttime ritual. It may help you wind down after a long day and, thus, fall asleep easier.
  • Apply cold packs. Pain means there’s inflammation in your body, and the best way to deal with inflammation is by applying cold packs to the sore spots. Gel ice packs are probably the most convenient ones, but you can take pretty much any frozen food from your fridge, wrap it in a towel, and place it gently on your sore body parts. 
  • Try yoga or self-massage. Both can help you relax the tense muscles and potentially alleviate the pain. Make sure that you are super gentle, though. You don’t need to be too vigorous with your massage or try challenging poses when doing yoga. Focus on your thighs and try to open them gently to relax the piriformis muscle (11).
  • Get the right pillow. Just like the mattress, your pillow plays an important role when it comes to proper spinal alignment and tension alleviation. Now, if you are a back sleeper, you need a pillow with a medium loft. Your head shouldn’t be tilted or bent backward. Just make sure it’s in the same line with the back (approximately). If you sleep on your side, it’s better to use a loftier, firmer pillow. It has to support your head properly while filling in all the space between the mattress surface and your head. And if you are a stomach sleeper, your pillow has to be thin and soft. It shouldn’t support your head that much, as this can create an unhealthy curve in your neck.

Want Makes a Good Mattress for Piriformis Syndrome (And How You Can Make Your Mattress More Comfortable)

For fast pain relief when trying to sleep with piriformis syndrome, you need to find a comfortable and healthy position. And if comfort is pretty easy to understand, a healthy position is something we aren’t always able to achieve.

A healthy sleep position implies your body is properly aligned, with zero to minimal tension and no painful pressure points. To achieve that, you need a suitable mattress (and you can check some of the most comfortable ones here). It has to allow for just the right amount of sinkage to maintain the natural curves of your spine while supporting your body and keeping it in a relatively straight line.

In many cases, medium-firm mattresses work the best when it comes to sleeping with pain (12). However, you should also factor your sleep position in. For instance, side sleepers require a bit more cushioning, so they are typically advised to choose softer mattresses (medium if you are heavier than 230 pounds). Back sleepers need minimal sinkage for their hips and buttocks, so medium or medium-firm mattresses usually work the best for this type of sleepers. As for stomach sleepers, they are recommended to pick firm mattresses (extra-firm if you are heavier than average). The thing is, this sleep position requires firmer support to avoid creating a curve in one’s back.

Now, I would also suggest you look at the mattresses that have temperature-regulating properties. It’s hard to sleep peacefully when you’re in pain, but if you’re also sweating all over, the task becomes nearly impossible. For cooler sleep, check breathable hybrid or temperature-neutral latex mattresses. As for foam models, give your preference to the ones using gel particles or an open-cell design for cooler sleep.

Now, if your current mattress isn’t that bad but doesn’t feel 100% comfortable, you can adjust its feel a little with the help of a mattress topper. For instance, if your mattress is too firm for you and results in painful pressure points, you can add a thick foam topper to enjoy more cushioning. If your mattress is overly soft and feels too hugging, you can add a firm latex topper. It will make your mattress feel more resilient and supportive.

Also read: How to Choose the Best Mattress for Sciatica Pain Relief and TOP 5 picks

FAQ

What is the best sleeping position for piriformis syndrome?

The best sleep position for piriformis syndrome is on one’s back, preferably with slightly elevated knees. This position creates the most suitable conditions for proper spinal alignment, which, in turn, can lead to reduced pressure and pain alleviation.

Can my mattress make piriformis syndrome pain worse?

Yes, your mattress can make your piriformis syndrome pain worse if it can’t keep your body in a neutral alignment. This can happen if you sleep on an overly firm/soft mattress. It might also happen if your mattress is old, saggy, or lumpy.

Can changing my sleeping position help with piriformis syndrome pain?

In most cases, changing your current sleep position or adjusting it slightly can help you alleviate the pain caused by piriformis syndrome.

Summary

Trying to sleep with pain caused by piriformis syndrome doesn’t have to turn into a nightmare

Just try some of the tricks mentioned above, and you might get your restful, healthy slumber back. And don’t forget to talk to your doctor to make sure you’re doing the best for your body.

How long have you been dealing with piriformis syndrome? And what changes do you think might help you start sleeping better? Share your thoughts in the comments!

References:

  1. National Institute of Neurological Disorders and Stroke (March 27, 2019). Piriformis Syndrome Information Page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Piriformis-Syndrome-Information-Page 
  2. Steven Yeomans (June 07, 2019). Sciatic Nerve and Sciatica. Retrieved from https://www.spine-health.com/conditions/sciatica/sciatic-nerve-and-sciatica
  3. James Roland (September 18, 2018). Retrieved from https://www.healthline.com/health/piriformis-syndrome
  4. Brandon L. Hicks, Jason C. Lam, Matthew Varacallo (December 07, 2020). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448172/
  5. Chee Kean Chen, Abd J. Nizar (April 2013). Prevalence of piriformis syndrome in chronic low back pain patients. A clinical diagnosis with modified FAIR test. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22863240/
  6. Robert H. Shmerling (November 2017). Ask Dr. Rob about piriformis syndrome. Retrieved from https://www.health.harvard.edu/back-pain/ask-dr-rob-about-piriformis-syndrome
  7. National Health Service (May 30, 2018). Why lack of sleep is bad for your health. Retrieved from https://www.nhs.uk/live-well/sleep-and-tiredness/why-lack-of-sleep-is-bad-for-your-health/
  8. Nicole K. Y. Tang (September 2008). Insomnia Co-Occurring with Chronic Pain: Clinical Features, Interaction, Assessments and Possible Interventions. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589931/
  9. Richard Staehler (October 25, 2017). Mattresses and Sleep Positions for Each Back Pain Diagnosis. Retrieved from https://www.spine-health.com/wellness/sleep/mattresses-and-sleep-positions-each-back-pain-diagnosis
  10. David Heitz (February 20, 2020). 5 Things to Know About the Piriformis Stretch. Retrieved from https://www.healthline.com/health/things-to-know-about-the-piriformis-stretch
  11. Jennilee Toner (n.d.). The piriformis the little muscle causing trouble. Retrieved from https://www.ekhartyoga.com/articles/anatomy/the-piriformis-the-little-muscle-causing-trouble
  12. Ahmed Radwan, Philip Fess, Darcy James, John Murphy, Joseph Myer, Michelle Rooney, Jason Taylor, and Alissa Torii (December 2015). 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. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29073401/

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