Do you often feel restless during the night and wake up with neck, shoulder, back, or hip pain? Do you feel like you can’t find a comfortable position? Have you tried multiple pillows or even a new mattress and still have the same old problems?
Sleeping is critically important to our functioning as human beings. Consistent disturbances in sleep can be the source of many issues, including but not limited to: mood, concentration, and memory issues, weakened immunity, increased risk for heart disease, high blood pressure, or diabetes, and decreased tissue growth and repair. A good night’s sleep is of dire importance for us to stay healthy.
Poor sleep quality can be caused by a number of factors. Emotional or mental stress can cause one to lie awake or toss and turn for hours. A poor sleeping environment such as too much light or noise can prohibit us from feeling rested. But what often gets overlooked is that how we position ourselves in bed can also impact the quality of our sleep. Improper positioning can stress muscles, ligaments, tendons, and other tissues. Furthermore, as humans, our bodies do not like to be in one position for long periods. This is why we often get the urge to stand up and stretch when sitting and why we find ourselves shifting around when we have been standing. However, we do not have much conscious control of our positioning while sleeping. Many times, waking up stiff or tight is a result of subjecting tissues to non-neutral positions all night long.
In general, there are three types of sleepers: back, side, and stomach sleepers. Although you might employ a combination of these, most people have a preferred position. Each position can present its own unique issues, but there are strategies to prevent these issues from having a lasting effect on your body and improve your sleep quality. The following paragraphs will cover what can cause problems in each position, and how you can combat these problems or prevent them from occurring altogether.
Back Sleepers
Ultimately, sleeping on your back with everything in a straight line is the best option if done correctly because all of your joints and muscles are in an anatomically neutral position. But, most people aren’t comfortable sleeping like a corpse, so there are issues that can arise with back sleeping.
Problem #1: You have too much pillow support. Having an extremely fluffy pillow or even more than one pillow can put the neck into excessive flexion, setting you up for tight muscles and possible disc issues. It’s also likely that if you work a desk job, you have been sitting in this position all day–so you’re living your entire life in this position, which will almost undoubtedly lead to neck pain.
Solution #1: Get a flatter pillow or remove excess pillows. This will reverse the excess flexion in the neck and optimize cervical muscle length.
Problem #2: You have too much extension in your lower back. Lying with your legs out straight often creates a significant amount of arch in your lower back, which over time stresses the joints of the spine and cause shortening of spinal musculature. This can lead to low back pain or stiffness.
Solution #2: Put a pillow or a wedge under your knees. This will reduce the arch in your back, keeping it in a more neutral position all night.
Problem #3: Your sheets are tucked too tightly over your body. This will force your feet into a point all night long, leading to tightness in the calves — which may predispose you to things like plantar fasciitis or cramping.
Solution #3: It might seem obvious, but untuck your sheets at the side and/or the bottom. This will reduce the pressure on your feet and allow them more room to move around under the covers.
Side Sleepers
Many people, including myself, prefer to sleep on their side. This position is usually fine as long as you have a supportive mattress and pillow, but there are still problems that can arise when sleeping on your side.
Problem #1: You do not have enough pillow support. In contrast to having too much when on your back, many people do not use enough support when on their side. This is especially true for people with broad shoulders, as the relatively larger distance from the mattress to their head is larger. Without proper pillow support, the neck will be forced into a side bend towards the pillow, and prolonged positioning like this is very likely to lead to some neck stiffness down the road.
Solution #1: Increase your pillow support by doubling up your current pillow, adding a second pillow, or buying a more supportive pillow so that your neck is as neutral as possible.
Problem #2: You sleep with your bottom hand under your head. Cradling your head in your hand may feel nice at the time, but this puts your shoulder in relative internal rotation all night long. This problem is compounded by the fact that most of us sit with our shoulders rounded forward much of our day, so sleeping this way ensures we rarely move out of this position. In addition to the internal rotation, this can also produce compression through the shoulder joint, and these two in combination can cause issues like impingement.
Solution #2: Put your arm under the pillow instead of under your head. This is a compromise in which you still get the cradling feeling but decrease the internal rotation of your shoulder. Also consider rolling back slightly to decrease some of the compression directly through the shoulder joint.
Problem #3: You sleep curled up in the fetal position, causing increased hip flexion and internal rotation. If you sit a lot at your job, this excessive hip flexion is likely one that you spend too much time in every day. This increases tightness in the hip flexors and stresses the gluteal muscles, which can ultimately lead to back pain, bursitis, or gluteal tendonitis.
Solution #3: Bring your knees down and sleep with a pillow between your knees. This will decrease the amount of hip flexion and bring your hips into a more neutral position.
Stomach Sleepers
This is typically not a position I recommend people sleep in because of the effect on the neck and the lower back. But, if you must, please consider the following potential problems and their solutions.
Problem #1: Your head is in excessive rotation. Because suffocating yourself in the pillow clearly isn’t an option, you have to rotate your head to almost its end range when sleeping on your stomach in order to breathe. Imagine sitting like this all day and how stiff and sore you would get. This position places a tremendous amount of stress on the joints and muscles in the neck, and can often lead to soreness or a crick in the neck.
Solution #1: Place a pillow under the arm towards which you are turned. This creates a decrease in the relative rotation of the neck by rotating the rest of the trunk towards that side as well.
Problem #2: If you like to sleep with your hands under your head, then your shoulders are in excessive elevation and internal rotation. This shortens muscle groups that are already tight in most people and can lead to stiffness of the neck and pain in the shoulders.
Solution #2: Unfortunately, there isn’t a great solution to this problem if you want to stay on your stomach. If you’re willing to compromise, then you can flip onto your back and sleep with your hands under your head. This will put your shoulders in more external rotation and also take the excessive rotation out of your neck as well.
Problem #3: You have too much extension in your lower back. This occurs because of the elevation of your head and neck on a pillow relative to the rest of your body. This excessive extension causes prolonged compression of the lumbar vertebral joints and shortening of the paraspinal muscles, which can lead to back pain.
Solution #3: Remove the pillow and sleep without support. This will reduce the amount of extension in both the lower back and the neck and decrease the pressure on the vertebral joints. Conversely, you can place a pillow under your hips to better align your lower back with your neck.
I bet you didn’t know there were so many ways to sleep incorrectly, did you? I often find with my clients that if they are having trouble progressing as quickly as they would like to in their recovery, how they sleep can be a missing piece of the puzzle. Since we spend so much time in bed and many people are not aware of their positioning during this time, it is always worth a look to assess and improve your positioning throughout the night. This can help you achieve a better night’s sleep and feel better throughout your day.
