Sciatic pain can be excruciating enough to cause pain in both the short and long-term. While there are several ways to address the problem with therapy, exercises in mild to moderate cases, severe cases need medical treatment. In either case, your mattress plays an essential role in maintaining your spinal health, especially post-surgery care. Sciatic pain can be challenging to eliminate completely, but the best way to treat sciatica is medical care and therapy and post-surgery care and maintenance.

What is Sciatica?
A sharp pain, often pulsating from the lower back to the back of your legs, is called sciatic pain. The pain arises out of a herniated disc, commonly known as a 'slipped disc.' Because of the compression of the sciatic nerve stuck between the deformed skeletal alignment, the nerve sends a pain signal to our brain. This condition is known as sciatica. The main characteristic of sciatica is that it is connected because of the length of the sciatic nerve. Different conditions can cause Sciatica or sciatic pain in your body. Muscle spasms, sacroiliac joint dysfunction, lumbar degenerative disc disease, among other medically diagnosed issues.

Sciatica can be worse with age, obesity, skeletal degenerative diseases, among other diagnosed conditions. Moreover, sciatica can also be a side effect or result from tumors and skeletal injuries, and internal blood clots. The best way to tell if it's sciatica, muscle pull, or any other issue is to check if it radiates from your lower back to buttocks to either of your legs.

Why does sciatica worsen in bed?
Sciatica is mainly a nervous system issue that is a side effect of issues with your skeletal system. It gets worse in bed because of many factors, the main being improper support or cushioning from your mattress. Incompatible or low-quality mattresses can result in lower back pain and cause your sciatica to worse in bed. It would be best to have a mattress that supports and cushions your lower back, pelvic area, and legs. Moreover, the sleeping position also plays an integral part in taking care of sciatic pain.

Here is how sciatica worsens with sleeping orientations and incompatible or low-quality mattresses:

1. Sleeping orientation:
Sleeping on the side without proper support for your knees and an incompatible mattress can lead to additional stress on the nerve. Once you have figured out the paining leg and part of your body, it is not a good idea to sleep on either side. Sleeping on the side, stomach, or even fetal orientation is a bad idea and can worsen your sciatica. Moreover, it would help if you always used the cushioning support of a pillow in sciatica to help relieve the pain and pressure from your lower back and pelvic region. Pillow support should always be beneath your knees instead of between them sandwiched in a side sleeping orientation.

2. Bad-quality or incompatible mattresses:
If you have been diagnosed with sciatica recently because of an accident and already use a medium-firm mattress, you can continue using it. However, if you have developed sciatica because of issues with internal systems and have been living a sedentary lifestyle ignoring your waking and sleeping health, it is time to switch. You should always consult your doctor for orthopedic or other mattresses that work for your degree of sciatic pain. Suppose you use extra cushioning or soft mattresses in general. In that case, it is a good idea to switch to a medium-firm mattress or a dual comfort mattress if your doctor suggests it is a temporary issue. A medium-firm surface on one side and a firm or extra firm surface on the other side to use when you start feeling better from sciatic pain.

How to sleep with sciatica or use the best positions for sciatic pain:
Sleeping with sciatica needs more than just a change in sleeping orientation and therapy. If you have been diagnosed with short- or long-term sciatic care, it is the best time to invest in an orthopedic mattress. A medium-firm orthopedic mattress or dual comfort mattress is ideal for dealing with sciatica. Moreover, you would also have to sleep differently, ideally on your back with your knees raised.

1. Sleeping orientation changes:
If you love sleeping on the side or in a fetal position, sciatica demands differently. To start on the road to recovery, you would need to change your sleeping pattern, specifically sleeping orientation. Sleeping on either side with or without a knee support pillow sandwiched in between wouldn't work. The best position to try for sciatic pain is to go for a sleeping-on-the-back sleeping lifestyle. Additionally, you would also need sleeping pillow support to place beneath your calves. This sleeping orientation allows the lower back and pelvic to relax and relieve pressure from the upper vertebrae.
Moreover, sleeping with a support pillow to elevate your legs would help either side be free of sciatic pain as neither side would face the pressure from the bed. Sciatic pain needs your lower back and pelvic area to be relaxed and properly aligned with cushioning support. This kind of mattress allows your pelvic area to feel relaxed from the overwhelming or underwhelming support from your body and a soft mattress, respectively.
Sleeping on the side can also be a good idea in case of mild to moderate sciatica and depending on body weight. People with injury based sciatica can go for this choice and sleep on the side without pain. The other side should have adequate support with a knee support pillow just enough to make both legs seem parallel. If this doesn't cause any pain, you can even adopt a sem-fetal position and incline your knees at a 90-degree angle to your body. The knee support should make your paining leg have some relief from the compression of the sciatic nerve.

2. Medium-firm mattress:
You need a medium-firm mattress or dual comfort mattress to help support your pelvic area and back yet not make it uncomfortable. In the case of sciatica, since your entire back doesn't hurt, it is okay to rely on some cushioning support; otherwise, your sleep wouldn't be as comfortable. Moreover, a medium-firm mattress takes the load off your lower vertebrae and supports your back and pelvic area at the same time. The best way to address sciatic pain is with a medium-firm latex foam mattress, dual comfort mattresses, or other configurations as long as you can take care of sleeping on the back orientation.

Worst sleeping positions for sciatic pain:
The worst sleeping positions for sciatic pain are abdominal, fetal without support, or even the side. These orientations are bad depending upon certain factors which influence how your sciatic never relaxes. If you are overweight, side support, fetal or stomach support, would worsen. Sleeping on the back would be the ideal condition for sleeping comfortably with both mild and severe sciatica.

1. Sleeping on the side:
Sleeping on the side is the wrong choice for people with severe or above moderate severity sciatica. This is because not only would your mattress and body weight support the uneven proportions of your body but the mattress too. Moreover, sleeping on the side would further compress your sciatic nerve unless you use knee support in mild to moderate cases. Sleeping on the side would also not give relief from the much needed lower back pain. On a soft mattress sleeping on the side would cause extreme discomfort in your entire back area, including your lumbar region. It may seem like you need more cushioning, but you need support to help the nerve and muscles recover in the sciatic pain area.

2. Fetal position:
Sleeping in the fetal position can cause the already compressed and strained sciatic nerve to face further discomfort. If you have sciatic pain, you know even a mild discomfort in addition to the pulsating pain would make it harder to sleep. However, sciatic pain can stay the same or worsen in the fetal position since it might make you turn more at night and wake up from sleep in excruciating pain.
At best, you could try to hold your knees at a 90-degree angle to the body as mentioned above, that too if the doctor recommends it. The degree, nature, and kind of sciatic pain can differ significantly depending from person to person. As a result, it needs extra care, both medical and post-medical (post-surgery), and some level of physiotherapy as per the doctor's prescription.

3. On the stomach:
Sleeping on the stomach would make your sciatica a lot worse than it would start out to be. This is because:

a. Everyone has different abdominal fat levels, and you need something that supports and relieves your lower back, pelvic region, and the paining leg.
b. Different mattresses can yield different results, and sleeping on cushioned mattresses like memory foam, PU Foam, or extra firm innerspring or rebonded mattresses can strain the spine. Not only would it strain your lower back, but cause uneven pressure on the pelvic area, through which your sciatic nerve passes. These issues would make your sciatic pain much worse and possibly need surgery or advanced medical care.

Best mattresses to avoid sciatic pain:
While there are only medium firm latex foam or pocket coil-based medium-firm mattresses to rely on to relieve sciatic pain, prevention is different. Since sciatica isn't always because of injury, it can be because of a herniated disc, degenerative diseases, and other internal issues. Accordingly, it would need different mattress types to take care of your lower back and pelvic area. The best way to try and avoid sciatic pain is by relying on a medium-firm to firm supportive mattress that helps support your spine.

Here are the mattresses to check if you want to strengthen your core and avoid sciatica as best as possible:

1. Latex foam mattress:
A latex foam mattress is a medium-firm option with a bounce factor to help support your lower back. As you need support for your spine and alignment in both sides and on-the-back sleeping positions, a latex foam mattress can be invaluable for this scenario. Moreover, latex foam mattresses last long and help make your body fitter with their varied use, so if you buy one for your sciatic pain today, it will continue to help even after you are better or cured completely. Moreover, medium-firm mattresses like latex foam are essential as sleeping on the side might be too comfortable to avoid in the recovery stage. People with average body weight can enjoy sleeping on the side or in the 90-degree side inclined fetal position mentioned above. 

2. Orthopedic mattresses: Innerspring mattresses with a flat, firm surface like the Bonnell Coil or pocket coil can be useful in helping support your lower back and sides. Accordingly, you would need better care and have to pay more attention to sleeping positions. You should always follow what the doctor says in matters of therapy, mattresses, and sleeping orientations.
Orthopedic mattresses are usually medium-firm to firm and help support your spine and help strengthen your core. Dual comfort mattresses with one side medium firm and extra firm surfaces would also work. This way, you can have something to look forward to sleep comfortably post-recovery.

Conclusion:
Sciatica is one of many conditions that can arise from a lack of care for your sleep and general health. The best way to address such issues is by taking care of your back and body with the help of a compatible mattress and exercise. Exercise can help keep your body in top shape even in the senior years and avoid issues like sciatica, herniated discs in early age, and sedentary lifestyles too. Moreover, taking care of sciatica can be a short and long term process and needs time and dedicated care to get back on your feet. Even in this condition, you should try and walk as lying on the bed with pain could worsen.