Living with ankylosing spondylitis (AS) presents many daily challenges — one of the most frustrating being sleep disturbances.

Due to inflammation, spinal stiffness, and joint pain, many individuals with AS struggle to find a comfortable sleeping position, stay asleep throughout the night, or wake up feeling rested.

However, good sleep isn’t a luxury — it’s a critical part of managing this chronic inflammatory condition.

In this guide, we’ll walk through practical, medically informed strategies to help you sleep more soundly with AS.

How to Sleep with Ankylosing Spondylitis?

1. Choose the Right Mattress and Pillow

A good night’s sleep begins with a proper sleep surface.

For people with ankylosing spondylitis, choosing the right mattress is especially important.

A medium-firm mattress is often recommended because it provides enough support to maintain spinal alignment while also cushioning the pressure points.

Just as important as the mattress is your pillow.

The goal is to keep your head in line with your spine, avoiding unnatural angles that can create neck and upper back pain. If you sleep on your back, a thin pillow or a cervical roll is ideal.

Side sleepers should opt for a firmer, thicker pillow that fills the space between the head and shoulder to maintain alignment.

Avoid stacking multiple pillows under your head, as this can force your neck into a forward position and disrupt spinal neutrality — a critical concern for AS sufferers.

2. Optimize Your Sleeping Position

The way you sleep has a direct impact on your spine and joints — especially when dealing with AS.

The best sleeping position for most people with ankylosing spondylitis is lying flat on your back with a small pillow placed under your knees.

This position promotes a neutral spinal curve, eases pressure on the lower back, and encourages healthy posture, which is essential in preventing the spinal fusion commonly associated with advanced AS.

Side sleeping can also be acceptable, particularly if you use a supportive pillow between your knees to keep your hips aligned.

This can reduce strain on your sacroiliac joints and help prevent your spine from twisting during the night.

However, try to avoid curling into a fetal position — while it may feel comfortable initially, over time it may promote forward spinal curvature, which can be problematic for individuals at risk of kyphosis.

The least recommended position is stomach sleeping, as it forces the neck to twist unnaturally and flattens the spine, placing unnecessary pressure on the lumbar region.

3. Establish a Gentle Bedtime Stretching Routine

Incorporating gentle stretching into your nightly routine can go a long way in reducing stiffness and making sleep more comfortable. Ankylosing spondylitis causes your joints and muscles to stiffen, especially after periods of inactivity like sleep.

A short session of light yoga or targeted stretches before bed can loosen tight areas, ease discomfort, and prepare your body for rest.

Some particularly beneficial stretches for AS include the knee-to-chest stretch, which helps relieve lower back tension; the cat-cow pose, which increases spinal flexibility; child’s pose, which gently elongates the spine; and pelvic tilts, which engage your core and improve lumbar mobility.

Always perform stretches slowly and gently — you’re aiming for relaxation, not exertion.

Avoid bouncing or pushing your body into positions that feel painful. Over time, these gentle movements can contribute to improved posture, reduced pain, and better sleep quality.

4. Apply Heat Therapy Before Bed

Heat therapy is a simple yet effective way to relax stiff muscles and reduce pain before sleep. Heat increases blood flow, decreases muscle tension, and helps the body transition into a more restful state.

Applying warmth to the affected areas before bed can significantly reduce inflammation-related discomfort that tends to worsen at night.

Consider taking a warm bath or shower about an hour before bed — not only does the heat help soothe your muscles, but the post-bath drop in body temperature can also signal your body to prepare for sleep.

Alternatively, use a heating pad on the lower back or neck for about 15-20 minutes before lying down.

Some individuals also benefit from heated mattress pads or blankets, but it’s important to use these with timers or auto shut-off functions to avoid overheating or injury during sleep.

Always consult your doctor before using heat therapy regularly, especially if you have other health conditions like diabetes or neuropathy.

5. Stick to a Consistent Sleep Schedule

Your body thrives on routine, and this is especially true when you’re managing a chronic illness.

Maintaining a consistent sleep schedule — going to bed and waking up at the same time every day — helps regulate your circadian rhythm and improve your overall sleep quality. Even on weekends or during flare-ups, try not to stray too far from your set bedtime and wake-up time.

To support your sleep schedule, create a calming pre-sleep routine. This might include reading a physical book, listening to soft music, meditating, or doing deep breathing exercises.

Avoid screens (phones, tablets, TVs) for at least an hour before bed, as the blue light emitted from these devices can suppress melatonin, a hormone essential for sleep.

Instead, dim the lights and engage in activities that signal to your brain that it’s time to wind down. This consistency can help your body fall asleep faster and reduce nighttime awakenings.

6. Use Anti-Inflammatory Strategies

Inflammation is at the root of ankylosing spondylitis, and managing it effectively can lead to better sleep. Lifestyle habits that support an anti-inflammatory state can play a big role in controlling symptoms and enhancing your sleep quality.

For starters, regular physical activity helps keep your joints mobile and reduces inflammation. Low-impact exercises like swimming, walking, tai chi, or yoga are excellent choices for people with AS.

The diet also matters. Incorporate anti-inflammatory foods into your meals — think omega-3-rich fatty fish (like salmon and mackerel), leafy greens, turmeric, ginger, berries, and nuts.

Avoid processed foods, sugar, and excessive red meat, which may promote inflammation.

Hydration is another overlooked factor; drink plenty of water and avoid caffeine, especially in the evening.

Additionally, take your prescribed medications — such as NSAIDs, TNF inhibitors, or biologics — exactly as directed by your physician. When inflammation is under control, the body can rest more easily at night.

7. Consider Sleep Aids — But Use Caution

If you’ve tried natural methods and still struggle to sleep due to pain or anxiety, certain sleep aids may offer temporary relief.

Melatonin supplements are a popular choice for resetting circadian rhythms and improving sleep onset, especially if your schedule has been irregular.

In some cases, doctors may prescribe low-dose tricyclic antidepressants, which not only help with sleep but also have pain-modulating properties.

Over-the-counter sleep aids, like antihistamines (diphenhydramine), are another option, but they can cause grogginess or dependency if used long-term. Always consult your doctor before using any sleep medication — prescription or not.

It’s also important to monitor how these medications interact with other treatments you may be receiving for AS.

Sleep aids should be seen as a temporary tool, not a permanent solution, and should always be paired with efforts to address the root causes of poor sleep.

8. Talk to a Rheumatologist or Physical Therapist

If you’re doing everything right and still struggling to sleep well, it may be time to consult a professional.

Your rheumatologist can assess whether your ankylosing spondylitis is adequately managed and may adjust your medications or treatment plan accordingly. Sometimes poor sleep is a sign that your current approach to managing inflammation isn’t working optimally.

Additionally, a physical therapist with experience in AS can be invaluable. They can help you develop a personalized stretching and strengthening routine, improve posture, and suggest ergonomic changes for your sleep setup.

They may also identify postural imbalances or muscle weaknesses that contribute to nighttime pain.

Working closely with your healthcare team ensures you’re not just managing symptoms but taking steps toward long-term improvement in sleep and daily functioning.

How Mattresses Impact Sleep for Individuals with Ankylosing Spondylitis?

For individuals living with Ankylosing Spondylitis (AS), the quality of your mattress can significantly influence how well you sleep — and how you feel when you wake up.

AS is a type of inflammatory arthritis that primarily affects the spine and sacroiliac joints, often causing pain, stiffness, and reduced mobility.

These symptoms can become more pronounced at night, especially if you’re lying on a mattress that fails to properly support your spine or relieve pressure from sensitive joints.

A mattress that doesn’t align your body correctly can aggravate inflammation, disrupt your sleep, and lead to worse stiffness in the morning.

1. Spinal Support and Alignment

For individuals with ankylosing spondylitis (AS), spinal inflammation leads to chronic stiffness, limited mobility, and significant discomfort—especially after prolonged periods of rest.

A mattress with proper spinal support helps reduce this pain by maintaining a neutral alignment of the spine throughout the night.

The right level of support prevents excessive curvature in the lumbar and thoracic regions, where AS-related inflammation tends to concentrate.

If the mattress is too soft or has begun to sag, it allows the pelvis or shoulders to sink too deeply, forcing the spine into unnatural angles and increasing strain on already inflamed areas.

In contrast, a mattress with zoned support—firm in the center and softer under the shoulders and legs—can keep the spine level, reduce joint stress, and promote more restorative sleep.

Supportive materials like high-density foam, pocketed coils, or adaptive latex are ideal for delivering this kind of spinal precision and contouring.

2. Pressure Relief for Pain Points

Ankylosing spondylitis often causes localized tenderness and joint soreness, particularly around the hips, shoulders, and lower back. Without adequate pressure relief, these areas can become aggravated during sleep, leading to disrupted rest and heightened pain in the morning.

Pressure-relieving mattresses are designed to distribute body weight evenly, cushioning sensitive areas without letting the body sink too deeply.

Memory foam, especially in multi-layered constructions, conforms closely to the body’s shape and reduces sharp pressure points.

Similarly, natural latex offers a more responsive, buoyant feel that still cradles joints gently. This is especially important for side sleepers, who place more pressure on the hips and shoulders—common problem zones for AS sufferers.

The best mattresses for pressure relief will often include comfort layers that gradually transition from soft to firm, allowing for gentle contouring without sacrificing underlying support.

3. Firmness Balance for Mobility and Comfort

Finding the right mattress firmness is one of the most important—and most difficult—considerations for individuals with AS.

Too soft, and the mattress won’t support the spine adequately; too firm, and it can feel like sleeping on a board, causing muscles and joints to lock up even further.

Most people with ankylosing spondylitis benefit from a medium-firm mattress that blends support and pressure relief.

This level of firmness provides enough structure to keep the spine aligned while offering some cushioning to ease joint stress. Additionally, a medium-firm surface allows for better movement in bed.

AS can limit the range of motion, so being able to turn over, shift positions, or rise from the mattress without resistance is crucial. Firmer edges and minimal sinkage help with this mobility, allowing individuals to get in and out of bed without putting undue stress on their back or hips.

4. Temperature Regulation

Individuals with ankylosing spondylitis may be more prone to sleep disturbances related to temperature sensitivity, especially if they experience inflammation flare-ups during the night.

A mattress that traps heat can intensify discomfort, disrupt deep sleep, and leave you feeling fatigued and overheated. Therefore, temperature regulation becomes a major consideration.

Breathable mattress materials like latex, gel-infused foams, and hybrid designs with open coil systems help promote airflow and dissipate body heat.

Some advanced memory foam mattresses now incorporate graphite, copper, or phase-change materials designed to draw heat away from the body and keep the sleep surface cool.

Additionally, covers made from natural fabrics like organic cotton or bamboo tend to wick away moisture and feel cooler against the skin. A cooler sleep environment not only enhances comfort but may also reduce inflammation levels and improve the body’s ability to enter restorative sleep stages.

5. Ease of Repositioning

Because AS reduces spinal flexibility, getting comfortable in bed or changing positions during the night can become physically taxing.

A mattress that is too soft or slow to respond can exacerbate this issue, making it feel like you’re sinking into quicksand with every movement.

That “stuck” feeling is especially common with traditional memory foam, which may not recover quickly enough when you shift positions. Instead, mattresses made from responsive materials—like latex or hybrid designs with innerspring support—allow for easier repositioning and promote better sleep ergonomics.

These mattresses offer a quicker rebound and a bit of “pushback” that helps users move more freely, whether turning from side to side or rising from the bed.

This increased mobility can prevent nighttime awakenings caused by stiffness and make it easier to adjust during periods of discomfort.

6. Durability and Long-Term Performance

Given that ankylosing spondylitis is a chronic condition, individuals often rely on their mattresses for consistent pain relief and spinal support over many years.

A mattress that loses its structure prematurely can quickly turn into a liability, aggravating symptoms and disrupting sleep quality.

Durability is therefore a non-negotiable factor. High-density foam, natural latex, and reinforced coil systems tend to outperform cheaper materials over time, maintaining their shape and support even with nightly use.

It’s also wise to look for mattresses with strong warranties—ideally 10 years or more—as these can offer peace of mind that your investment is protected.

Durable edge support and long-lasting comfort layers help ensure that the mattress performs well across all areas, even if you tend to sleep in one position or section of the bed more than others.

7. Adjustability for Changing Needs

Ankylosing spondylitis is a progressive disease, and symptom intensity can vary from night to night or flare up unexpectedly.

A mattress paired with an adjustable base offers the flexibility to adapt to these changing needs.

Elevating the head can ease pressure on the lower back and promote better breathing while raising the legs can relieve stress on the hips and reduce swelling.

This personalized positioning can be especially helpful during painful flare-ups or for individuals with co-occurring issues like sciatica or sleep apnea. Many modern mattresses, especially those with memory foam or latex cores, are designed to be compatible with adjustable beds.

Some high-end models even offer split-adjustability for couples, massage features for muscle relaxation, or lumbar lift functions that further enhance comfort.

This customization empowers users to take control of their sleep posture and comfort based on how they’re feeling each night.

Comparing Mattress Types for Ankylosing Spondylitis

1. Memory Foam Mattresses

Pros:

• Excellent contouring to relieve pressure on joints
• Even weight distribution reduces stress on the spine
• Good motion isolation — ideal if you share the bed

Cons:

• May retain heat unless infused with cooling gel
• Some models feel too soft and may lack edge support

Verdict:

Memory foam is a popular choice for AS sufferers, especially if you want a mattress that molds closely to your body and cushions every point of contact. Just be sure to choose a medium-firm model with cooling properties if you tend to sleep hot.

2. Latex Mattresses (Natural or Synthetic)

Pros:

• Supportive yet buoyant — doesn’t let you sink too deeply
• Naturally hypoallergenic and resistant to dust mites
• Sleeps cooler than memory foam

Cons:

• Can be heavy and difficult to move
• Often more expensive than other types

Verdict:

Latex mattresses offer a responsive, firmer feel than memory foam, making them a good option for those who need support without feeling “stuck” in the bed. Natural latex is especially beneficial for individuals with allergies or sensitivities.

When to Replace Your Mattress?

Even the best mattress loses support over time. If your mattress is more than 7 to 10 years old, or if you consistently wake up in more pain than you had the night before, it may be time for a replacement.

Signs like visible sagging, creaking springs, or feeling more pain after lying down are strong indicators that your current mattress is working against your condition, not for it.

Final Thoughts

Sleeping well with ankylosing spondylitis isn’t always easy, but it’s absolutely achievable. The key is creating the right combination of supportive sleep environments, therapeutic routines, and medical care.

While it might take time to find the perfect mix of strategies that work for your body, consistent effort can lead to meaningful improvement in both sleep quality and overall well-being.

Remember, good sleep is not a luxury when you have AS — it’s part of your treatment. Prioritize it, protect it, and give your body the rest it needs to fight inflammation and recover.