While peripheral artery disease symptoms are most common in upright positions, it’s possible for more severe cases to cause leg pain at night.

The most commonly reported symptom of peripheral artery disease (PAD) is leg pain. This is especially noticeable during physical activity, and it can make your legs feel achy and cramp up.

While not as common, pain from PAD may also occur during times of rest. This can make it difficult to fall asleep at night or cause you to experience insomnia or other sleep issues. Research suggests that PAD can accompany sleep disorders in some people.

To prevent sleep problems due to PAD, it’s important to take steps to not only help manage this condition but also to address your sleep environment. Here’s what you need to know about the best sleeping positions for PAD, as well as other tips you may consider discussing with a doctor if leg pain is keeping you awake at night.

First, the best sleep position for peripheral artery disease (PAD) is one that will help increase comfort for mild pain and numbness in your legs that might keep you awake.

You’ll also need to consider any other sleep problems. For example, sleep apnea is a condition common in people with PAD. You may need to sleep in a position that can help both conditions.

Sleep on back with head elevated

Sleeping on your back with your head elevated and your legs in a natural position may help decrease pain in your legs because it encourages blood flow downward. However, this sleep position is not recommended if you have sleep apnea.

Sleep on your side if you have both PAD and sleep apnea

According to a 2017 study, sleep apnea is common in people who also have PAD, and the severity of both conditions is linked. In other words, if you have severe sleep apnea, your risk of having severe PAD is greater, too.

When sleeping on your side, place a pillow between your knees to help improve spinal alignment and prevent back pain.

While the above sleeping positions can help PAD, they should also be avoided in some cases. This can depend on where you’re experiencing pain and whether you have sleep apnea.

For example, sleeping on your back may help relieve leg pain, but it could also worsen symptoms of obstructive sleep apnea. Researchers believe that sleeping on your back causes your tongue to slide back toward your throat, worsening breathing pauses and snoring.

You also may consider avoiding sleeping on your side if you’re experiencing pain in your upper extremities. While not as common as leg pain, PAD may cause symptoms in your arms and hands. This occurs in about 10% of people with PAD.

Sleeping on your stomach is generally not recommended. While you might find this position comfortable, it can create or worsen neck pain.

PAD treatment can also help reduce the symptoms that keep you awake at night. Additionally, consider discussing with a doctor the following tips that may help manage PAD:

Keeping to a sleep schedule, even on weekends, may also help you get better rest with PAD. One 2023 study found that sleeping less than 5 hours at a time was associated with a higher chance of PAD development, while PAD also increased the chance of not getting enough sleep.

In addition to improved symptoms and potentially better sleep, managing PAD can also help reduce your chance of associated complications, such as heart attack, high blood pressure, and stroke. Management may include medications for PAD, such as statins or anti-platelet drugs.

Increased leg pain during rest could also indicate more severe PAD. A doctor might recommend surgery or angioplasty in such cases.

When considering nighttime leg pain associated with PAD, you may want to discuss the following information with a doctor to help you determine how to get better sleep.

Does sleeping in compression socks help peripheral artery disease?

Your doctor may recommend compression socks or stockings to help reduce swelling and improve circulation in certain conditions, such as varicose veins. However, these aren’t typically used for PAD because the way they apply pressure to your legs isn’t helpful with this condition.

If a doctor recommends you wear compression socks for another condition, wear compression socks only during the day and take them off before going to sleep. Wearing traditional socks is considered a good way to help protect your feet with PAD.

Can sleeping in a certain position reverse peripheral artery disease?

As most cases of PAD are related to atherosclerosis, it’s not possible for any particular sleeping position to reverse this condition.

Can sleeping with legs raised or lowered improve blood circulation in people with PAD?

While elevating your legs can improve blood circulation and may be recommended for varicose veins, it’s not clear whether this helps with PAD.

Older research found that people often find relief from ischemia-related leg pain by dangling their legs off of the bed. Unless a doctor recommends otherwise, you may find it more comfortable to sleep with your legs lowered.

What pillow is best for sleeping with peripheral artery disease?

In general, the best type of pillow for sleeping with PAD is one that you find comfortable. A firm pillow, as well as a firm mattress, is often preferable, but you might consider a posture-correcting pillow if a traditional version isn’t for you.

Elevating your head is also helpful in managing sleep apnea. In this case, you might consider a thicker pillow.

If you experience leg pain that doesn’t go away with rest, see a doctor. While PAD can sometimes cause leg pain during rest, classic symptoms such as pain, leg cramps, and aches are more common during physical activity.

Also, consider speaking with a doctor if you are experiencing other symptoms of PAD that contribute to insomnia. These include:

Medical emergency

Go to the nearest emergency room if you experience the following signs of acute limb ischemia, a medical emergency caused by a sudden decrease in blood flow to the affected leg.

  • severe leg pain
  • numbness,
  • pale or blue skin that occurs during rest

Adjusting your sleeping position may help manage PAD at night. Speak with a doctor about your overall treatment plan, and whether you have accompanying health conditions like sleep apnea.