How to Sleep When You Have Piriformis Syndrome

Piriformis syndrome is rare. It is estimated to be responsible for between 0.3 and 6% of low back pain or sciatica cases.

Sciatica and piriformis syndrome are often confused because they both affect the sciatic nerve, though they have different causes.

Piriformis syndrome is also called pseudo sciatica or wallet syndrome, and it is six times more common among females than males.

People with piriformis syndrome experience pain or discomfort in the lower part of their bodies that can make it difficult to sleep. There is, after all, a well-established link between pain and sleep.

In this article, we’ll go into detail about how you can sleep better if you have piriformis syndrome. We’ll cover the sleeping positions that can alleviate the pain associated with piriformis syndrome, as well as how to choose the best mattress and pillow for your condition.

What is Piriformis Syndrome?

Piriformis syndrome occurs when the piriformis muscle compresses or traps the sciatic nerve that runs under it. It is also possible for the sciatic nerve to pass through the piriformis muscle, which increases the chances of developing piriformis syndrome.

Numbness, pain, or tingling sensations in the buttocks that worsen during activities like sitting, climbing stairs, or running may be an indication of piriformis syndrome.

What causes piriformis syndrome?

Piriformis syndrome can be caused due to your anatomy — this is known as primary piriformis syndrome. In other words, you may be predisposed to developing piriformis syndrome because of one of the following factors:

• A split piriformis muscle
• A split sciatic nerve
• A sciatic nerve path that’s abnormal
• Abnormal spinal alignment

Primary piriformis syndrome is quite uncommon. Most people have secondary piriformis syndrome that is caused by trauma to the piriformis muscle that can occur in one of the following ways:

• Straining the muscle due to overuse or inactivity — for example, strenuous exercise or sitting for long time periods
• Performing repetitive activities, like running
• Lifting or carrying heavy objects
• Climbing the stairs often.
• Hip injuries — especially falls
• Sports injuries
• Vehicle accidents
• Past hip surgeries
• Penetration wounds that affect the piriformis muscle

How do I know if I have piriformis syndrome?

A doctor will be able to diagnose you with piriformis syndrome, but there are some signs you can watch for that may be an indication of the condition. These symptoms include:

• Pain when doing certain activities, like climbing stairs
• Pain after sitting or standing for prolonged periods
• Pain that gets better with exercise or movement
• Pain when getting up from a sitting or squatting position
• Numbness in the feet
• Pain when sleeping or lying down
• Pins and needles/pain in the buttocks that radiates down the thigh

How to Sleep With Piriformis Syndrome

If you are struggling with the pain, discomfort, or numbness caused by piriformis syndrome, it may seem impossible to get a good night’s sleep. Finding pain relief can help you get the rest you need and there are a number of ways this can be done.

Follow our guidelines below to improve your sleep quality if you have piriformis syndrome.

What Are the Best Sleeping Positions for Piriformis Syndrome?

According to The Better Sleep Council, the most common sleeping position among Americans is the fetal position. About 47% of people in the U.S. sleep curled up on the side as they did in infancy.

Stomach sleeping is the second most popular choice, with 17% of study participants preferring this sleeping position.

But if you have piriformis pain, are these positions still recommended? Here’s how to sleep to find pain relief from piriformis syndrome:

On your back

Sleeping on your back will ensure an even distribution of weight and help you maintain spinal alignment during sleep. This is considered the best position for piriformis syndrome, but it can still feel uncomfortable.

Placing a pillow beneath your knees and lower back will give you some extra support and comfort.

On your side

This position may take some getting used to if you’re suffering from piriformis syndrome, but it can be a great way to sleep — especially if you’re pregnant.

To make side sleeping more comfortable, place a pillow between your knees to align your hips and pelvis.

You can also hug an extra pillow to prevent your shoulders from rounding, which can worsen or contribute to back pain.

Reclined position

If sleeping on your back or side doesn’t bring you comfort or help you get to sleep, try a reclined position.

Invest in a wedge pillow or a reading pillow to stay comfortable while sleeping in a reclined position. These special pillows will also help stabilize your body while you sleep.

A reclined position may work for those who have pain when they stand upright, but find relief when they bend forward.

What Sleeping Positions Should I Avoid with Piriformis Syndrome?

Any position that worsens your pain or makes it difficult to rest should be avoided. Give your body some time to adjust to the new sleeping position and use pillows to increase your comfort.

Different positions will work for different people. Some sleep positions will bring certain people relief, while others will feel more discomfort or pain. Listen to your body and alter your sleep position to something that works for you.

There is, however, one position that should be avoided when you have piriformis syndrome.

Stomach sleeping

Even though it’s the second-most popular sleeping position in the U.S., you should avoid it if you’re trying to recover from piriformis syndrome. Spinal alignment is very important when you’re sleeping, but it’s even more crucial for those with piriformis syndrome.

When you sleep on your stomach, you move your head to the side which causes a curve in your spine. Sleeping like this will also cause your shoulders to hunch, increasing the pressure on your spine.

Even under normal circumstances, stomach sleeping is not encouraged. It’s best to sleep in a position that promotes proper spinal alignment, such as side sleeping.

How Do I Choose the Perfect Pillow for Piriformis Syndrome?

It’s not just the position you sleep in that counts when you have piriformis syndrome — it’s also what you sleep on.

Orthopedic pillows

You’ll want a supportive pillow that will help keep your spine aligned while you sleep. An orthopedic pillow is typically a good option as they are designed to promote spine alignment, which in turn can help reduce piriformis pain.

If you’re struggling with back and neck pain, you can also benefit from an orthopedic pillow.

Bed pillows

Although orthopedic pillows are useful, you’ll also want to use other pillows that can be positioned under your lower back or between your knees. Regular bed pillows can work for this.

Just remember to choose supportive pillows and position them in a way that makes it easier for you to sleep.

While most sleepers may prefer a thicker, more sturdy pillow, a thinner pillow may be better suited to stomach sleepers.

Specialized pillows

There are pillows that have been specially designed to offer support and comfort to people who struggle with posture. Some examples of these include:

• Seat cushions or lumbar support pillows
• Body pillows
• Knee pillows
• Wedge pillows
• Reading cushions

Some of these pillows may help to relieve chronic pain and increase your sleep quality, but it’s not always necessary to purchase a special cushion to sleep well.

Be sure to get your doctor’s opinion first or visit the store to see different specialty pillow designs before making your final decision. Sometimes a normal bed pillow can get the job done.

What is the Best Mattress for Piriformis Syndrome?

It may not be necessary to go out and purchase a new bed because you have piriformis syndrome, but the wrong mattress can leave you feeling worse after a long night.

Medium-firm mattresses typically suit most people — they shouldn’t be too soft or too hard.

Test out a few mattresses first and get advice from in-store experts before you buy a new mattress.

How Do I Treat Piriformis Syndrome?

Knowing which sleeping positions, mattresses, and pillows you need to use to get a good night’s rest when you have piriformis syndrome is a great start, but you still need to treat your condition to avoid unpleasant long-term effects.

Piriformis treatment may include one or more of the following options:

• Physical therapy
• Exercises — especially gentle stretching and core exercises
• Warm baths or showers before bedtime
• Practicing good posture throughout the day
• Pain relief medications
• Heat therapy
• Acupuncture
• Massage therapy
• Making adjustments to your gait (the way you walk)
• Decompression surgery (this is usually a last resort)

How long does it take to recover from piriformis syndrome?

This depends on multiple factors, but recovery time for piriformis syndrome can be a few weeks or a few months, depending on how you’re managing the condition, how early it was diagnosed, and also how severe your case is.

If you’re concerned about downtime or not being able to do certain activities, speak to your doctor.

When Should I See a Doctor for Piriformis Syndrome?

If you suspect you have piriformis syndrome, you should consult a doctor as soon as possible. This condition requires a proper diagnosis and treatment plan to ensure you make a full recovery.

Piriformis syndrome that is left untreated can result in permanent damage. Seek medical attention if you have pain or numbness in your buttocks or legs that persists.

Where Can I Learn More about Piriformis Syndrome?

If you’re concerned that all those hours in front of the computer are catching up with you, or that you’ve never quite recovered from that bad fall you had, LifeMD can help.

Board-certified doctors can help you diagnose the condition and find the best treatment plan so you can sleep soundly again.

Head over to LifeMD to make your first appointment, and get ready to meet your doctor on your smartphone or computer. You'll be able to discuss your symptoms and work on next steps.