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  • Dr. Donald Littlewood

How your sleep position could be causing (or preventing) pain during the day


How many of who have woken up with an incredibly uncomfortable kink in your neck that affects your whole day?


One question I ask every patient who walks through my office door is “What position do you sleep in?”


The answer is often: “In ________ position, but what is the best?”


Truth be told there is no best sleep position but, spoiler alert, there is a worst.


Sleep and Pain


We know that there is a massive relationship between sleep quality & duration and pain & overall health. There is tons of evidence stating that a bad night’s sleep can cause some pretty intense musculoskeletal pain, especially in the neck and upper back.


The results of a 2002 study done show that 35% of people wake up with neck pain or stiffness at least once a week. Other common complaints from this study were shoulder/arm pain (27%) and headaches (19%).


And in this same study, 53% of people who felt pain in the morning said it lasted into the mid-afternoon, or into the next day.


To me, that leads to the question: what is the best position to sleep in?


Sleep Positions


Most people have a pretty set position they fall asleep in, and if you’re like me, there is only one position I find comfortable enough to sleep in.


Back Sleeper


Generally, sleeping on your back is good for you. It distributes your body weight over a larger surface area so it doesn’t put a lot of stress on any one joint.


But there are a couple of things you need to know.


1. It’s really important to sleep with a firm pillow under your knees. This is going to keep your low back in a more natural, curved position. Your spine will be more stable, and it will thank you for it.


2. You’ll want to use a fairly thin pillow. This will keep your neck in a more neutral posture. Ideally you want your neck to look the same when your laying down as it does when you’re standing with good posture,


Side Sleeper/Fetal Position


In my opinion, this is the best position to sleep in, but that doesn’t mean it is perfect. In this position, you want to make sure that your head & neck are adequately supported.


You want to have a thick pillow (which most people love), and your head should rest in a line right between your shoulder blades.


When your neck is in between your shoulder blades, you’re less likely to be in the ~54% of people who have woken up with neck pain or a headache.


One other key thing to do here is to put a thin pillow in between your legs. This does two things:

  • Knees are bony body parts. Putting a pillow in between them will just be more comfortable.

  • It helps keep your low back in a more neutral position, and your hips won’t be rotated. This reduces a lot of stress in that area and can work wonders in preventing/helping with low back pain.


If you have back pain and it is relieved by flexing forward, you might want to try sleeping in the fetal position and hugging your knees. This could be a very comfortable position for you.


Stomach Sleeper


This is probably the worst position to sleep in, but it is ultra comfortable. There is no way you can sleep with a neutral neck; it will always be turned to one side or the other.


Spending that much time with your head rotated can cause some pretty intense neck pain and headaches. Obviously no one wants that!


It also makes it really easy to throw your arms over your head, which isn’t great for the shoulder joint.


There are a couple of things you can do to make stomach sleeping a little bit healthier for your spine:

  • Try using an ultra-thin pillow or no pillow at all. Even though your neck is rotated to one side, having no pillow will help to stop your neck from being too elevated.

  • Place a pillow under your abdomen or pelvis. Again, this is going to help stabilize your spine and keep your hips in a more neutral position.


Stretch before bed


Stretching your neck before bed is super important, especially if you spend most of your day sitting at a desk.


If you do spend all day at a desk, check here for a blog post I wrote on how to improve your posture.


Levator Scapula Stretch


The levator scapula is a muscle that runs from your neck down to the tip of your shoulder blade. Its action is exactly as it says: it elevates your scapula (or shoulder blade).


The levator scapula is often really tight in those who sit at a desk all day.


The rounded shoulder posture can cause your shoulder blade to naturally move up towards the neck and therefore the muscle gets short.


To stretch this guy, use your left hand to grab the right side of your head right behind the ear. Then you are going to pull your head toward the outside of the left knee.


Hold it there for 45 seconds and then repeat it on the other side.


This is going to loosen up that muscle and help release some tension in the neck and shoulders.


Final Thoughts


Sleep is so important, and it is crucial to not only your spinal health but also your overall health that you get enough sleep and you wake up rested.


Do you often wake up with pain in your neck, shoulder or head? Give me a call, and I would be glad to go over some additional strategies and a care plan to help you get back to your everyday life.

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