Pain during the night or immediately after waking up is a very common problem, and often this is caused or exacerbated by something people rarely think to apply the concept of ergonomics to: sleeping position. Depending on what position you’re naturally inclined to sleep in, you may be more prone to low back pain, hip pain, brachial plexus compression (a common cause of numbness, tingling, and pain radiating down the arm and hand), neck pain, or other problems.
Fortunately, there are several simple steps that can be taken to alleviate these complaints by supporting your natural sleep posture. In my clinical experience, while many people can change the way they naturally sleep, this is often a challenge, as the body will often instinctively shift back to its habitual position while you’re unconscious and unable to recognize and stop it. As a result, I encourage most of my patients to focus on supporting and accommodating their natural sleeping position first, and only trying to change it significantly if this approach is ineffective.
Some simple steps that you can take at home, based on your preferred sleeping position, include:
Side Sleeper
Side sleepers tend to be more prone to neck pain, hip pain, and low back pain caused by the uneven pull of gravity on the head, top-side arm, and top-side leg. This can result in the shoulders and/or pelvis being pulled into a twisting position, putting asymmetrical stress on the body. Additionally, many side sleepers do not have an adequately thick or supportive pillow to prevent their head from sagging downward as they sleep, pulling their neck to one side and causing muscle tension and/or undue pressure on the nerves of the brachial plexus, which resides in a narrow space between the collarbone, the first rib, and the shoulder blade and feeds the nerves which run down the arm and hand. To best support this sleep position, side sleepers can try the following:
Low back/hip pain: Place a pillow between your knees, or if you sleep with one leg curled up and the other straight, place a pillow beneath your top-side knee to support it. This prevents the weight of the leg from pulling the pelvis down toward the bed and stressing the pelvis, SI joints, and lumbar spine.
Neck pain: Make sure the pillow your head rests on is relatively firm and thick enough to completely fill the gap between neck and shoulder so that your head doesn’t sag toward the mattress. The pillow should be firm enough to ensure that it doesn’t sag over the course of the night, even if it was adequate at the start of the night.
Neck pain/arm pain, numbness, and/or tingling: Place a pillow in front of you and rest your top-side arm across it, ensuring that your elbow and wrist are both supported. You can either let your bottom-side arm rest beneath this pillow, or prop the forearm against it so that your elbow is bent and your wrist is supported.
Back Sleeper
Back sleepers tend to be more prone to low back pain, due to the hyperextension of the lumbar spine that can sometimes result from the pelvis being pulled into an anterior tilt (tipped forward) by the weight of the legs. Back sleeping can also sometimes lead to neck pain if using a pillow that is too thick, as this can tilt the head too far up/forward and put strain on the muscles and joints of the back of the neck. Back sleeping can even contribute to plantar fasciitis in some cases, especially with heavy blankets or blankets tucked in at the foot of the bed, which pulls the feet downward at the ankles. To best support this sleep position, back sleepers can try the following:
Low back pain: Place a pillow beneath your knees, so that they are bent while still remaining supported. (If one pillow isn’t enough, you can even try two stacked on top of each other.)
Neck pain: Make sure the pillow your head rests on is thin and flat, and not tilting your head up/forward as if to bring your chin to your chest. Some back sleepers even do best with no pillow at all.
Plantar fasciitis: Avoid tucking your blankets in at the foot of the bed, and if it doesn’t make your feet too cold to comfortably sleep, pull any heavy blankets or comforters up to the ankles so the feet are not pulled down. This puts the calf muscles (which are attached to the plantar fascia) in a shortened position, which over time causes them to become excessively tight and pull the plantar fascia painfully tight as well.
Stomach Sleeper
Stomach sleepers tend to be most prone to neck pain, due to the way this sleeping position almost always requires turning the head completely to one side for hours at a time. This uneven strain can also translate into pain in the upper back and upper ribs, depending on the individual. In some cases this sleeping position can also lead to low back pain, particularly in people sensitive to lumbar hyperextension, as well as aggravating plantar fasciitis due to the position of the feet. To best support this sleep position, stomach sleepers can try the following:
Neck pain: Instead of a traditional pillow, try using a neck pillow (such as those sold for use on airplanes), laid flat on the mattress so that you can put your face into the gap, allowing you to lie with your neck straight while still being able to breathe. You may need a thicker neck pillow than you would usually use to accomplish this, and may need to also place a pillow under your chest so that your neck is not hyperextended.
Low back pain: Place a thin or mid-size pillow under your pelvis to prevent hyperextension of the lumbar spine.
Low back pain/plantar fasciitis: Place a pillow or rolled-up towel under your ankles to elevate the feet a little, both allowing the ankles to relax into a more natural position (no longer placing the calf muscles in a shortened, overly tight position) and taking stress off the low back.
For All Cases
No matter what your preferred sleeping position, you can be sure that specialized pillows for it exist, and these can indeed be very helpful for many. However, these are often prohibitively expensive, and these “DIY” solutions can relieve the symptoms of many with minimal comparative cost. This is especially true when combined with regular chiropractic care, which can counteract problems resulting from sleep posture, especially if you are struggling to find accommodations or modifications that work for you. Your chiropractor can also discuss with you more specific modifications that can be made, and help you troubleshoot what’s going on if the modifications and accommodations you’re trying aren’t working well for you. Don’t hesitate to bring up questions at your next visit — we’re always happy to help.