If lower back pain is keeping you up at night, you’re not alone: about one in three adults in the U.S. are affected by such aching, which often results in poor sleep. Western wellness influencers suggest that reclining on the floor could help. But is there any evidence to support the accolades given to floor sleeping?
The practice has a long history. For ages before ancient civilizations such as the Mesopotamians got the grand idea to rest on raised mattresses stuffed with reeds, humans got their Z’s while sprawled on the ground.
Some of us still sleep this way—or close to it. Ayurveda, a holistic healing philosophy from India, extols floor sleeping as central to well-being, and many Japanese people sleep on a thin tatami mat on the ground.
It turns out that resting on the floor may offer advantages for certain people in certain scenarios. Some physiotherapists say that lying flat on your back in a star shape (with your arms and legs extending out and away from your torso) or with your knees up takes pressure off the back and can stretch it out. In addition, cooler temperatures near the floor may improve sleep quality and overall comfort, some experts say. Others agree that lying on the floor could have positive effects.
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At least part of the benefit may be psychological. People sometimes learn to associate their bed with both insomnia and pain, says Deirdre Conroy, a clinical professor of psychiatry and clinical director of the Behavioral Sleep Medicine Clinic at the University of Michigan. At the clinic, Conroy has seen insomnia patients who would sleep better when they left their bed for other locations, including the floor. “The relief could be psychological,” she says.
The floor may feel especially good if you have an old box spring and saggy mattress. In these beds the pelvis sinks lower than the back because the pelvis area typically weighs more, bending the spine out of alignment. Compared with an overly soft mattress, “the floor could provide better support,” says Peter G. Whang, a professor in the department of orthopedics and rehabilitation at the Yale School of Medicine, who routinely treats patients with back pain.
But most experts today agree that sleeping on the floor isn’t necessarily the best option for any type of back ailment, Whang says. The main reason is that the shape of the human spine differs significantly from that of the floor; our spine isn’t board-straight. “We have physiologic curves,” Whang says. One such curve leaves space between the lower back and the floor. Lacking support, this curve flattens out over time, which can result in back pain. Another problem with the floor: without cushioning to absorb the shoulders, the upper back is often propped up too high, which can lead to joint stiffness.
A hard floor also creates pressure points in places such as your hips, buttocks and heels, says Bert Jacobson, a kinesiology professor at Oklahoma State University. This can restrict blood flow to those areas and potentially damage soft tissue.
So how did our ancestors maintain healthy backs while dreaming on the dirt for so many millennia? It’s true that “we did not evolve to sleep on soft, comfortable surfaces,” says Daniel Lieberman, a Harvard University professor, who studies evolutionary biology. But hunter-gatherers slept on the ground from early childhood and may have built up a tolerance to its ill effects, unlike present-day people who try it for the first time as adults. Another difference is that ancient people got more physical activity throughout the day, a lifestyle that may have helped prevent pain despite ground sleeping. And we should scrutinize arguments based only on what is natural, Lieberman warns, noting many examples of beneficial technologies that were unknown to our ancestors.
Modern-day mattresses that provide new levels of support and comfort are one such example. In particular, across ages and body types, “medium-firm” mattresses tend to strike the right balance between hard floors and older, softer mattresses. Medium-firm mattresses work best to support the spine’s shape and to prevent back pain and resolve it, according to a review study published in 2021.
If your back is giving you nightmares, the real solution could be replacing your worn-out mattress instead of descending to the floor. The average American’s bed is 10 years old, equating to about three years of sleep time. “No furniture in the world will sustain that type of weight and abuse,” Jacobson says. In one of his studies, a new, firmer mattress reduced back pain by 47 to 63 percent.
But here’s the catch: scientists haven’t agreed on an objective standard for measuring firmness. Most sleep studies ask people to judge it subjectively, and you’ll have to do the same thing when looking for an ideal surface. One individual’s “medium-firm” may vary from another’s, partly because people who weigh more need a stiffer mattress to support them. “For a heavier person, their version of medium-firm will be firmer,” Jacobson says. For the same reason, they may even find the floor more comfortable than a petite person.
More firmness could also benefit people who sleep on their side and stomach—although side sleeping on a firmer mattress may cause the lower spine to curve to the side in some cases, according to Jacobson. These firmer mattresses may not be ideal for back sleepers because their hips and upper torso will be raised higher than other parts of the body. Research is needed to confirm these hypotheses, Jacobson says. For the most comfort while lying on your back, the sleep surface should enable a position that resembles proper standing posture, something that is difficult to achieve on the floor.
If you’re not ready for a new mattress, a memory foam topper could help. “It really conforms to the spinal curve and keeps it aligned, regardless of your sleep position,” Jacobson says. This observation tracks with Whang’s experience at his clinic. “I’ve had many patients who really appreciate the memory foam mattress,” he says, adding that “mats and pillows composed of this material can be very good for the spine.”
Finding the right sleeping surface, Whang points out, is just one piece of the puzzle for solving back pain. Other important factors include maintaining core strength, flexibility and a healthy weight. “We focus on prevention, not just the material you sleep on,” he says.
