Finding the best sleep position for back pain can be challenging for any patient who has a difficult time relaxing in bed at night. Sleep is one of our most important needs and without enough quality rest, we can not possibly ever expect to be healthy, happy or even sane.
Sound sleep is known to be difficult to accomplish for many back pain sufferers. In fact, we receive dozens of questions each month related to sleeping with back and spine problems. We understand the necessity of good sleep and hope that this new guide will help facilitate more satisfying rest time for many of our readers.
This dialog examines the reasons why relaxing sleep is difficult for some patients to achieve. We will also take a look at the variety of possible sleep positions and help patients to determine the ideal fit for their specific needs. Finally, we will address some of the variables that figure into the sleep equation, including mattress and pillow choices, especially as they relate to the chosen sleep position.
Finding comfort when sleeping is one of the major hurdles faced by a great number of back pain victims. Some patients are lucky to enjoy restful sleep and relaxing reclining in bed. Other patients are not so fortunate. In fact, some actually suffer their worst pain while trying to unwind, refresh and get some needed sleep.
Sleep difficulties that are related to back pain take many forms and can include any of the following scenarios:
People with mindbody pain syndromes, like TMS, often suffer exacerbated symptoms when they are in the process of falling asleep or actually sleeping. Since the subconscious takes over during sleep, this is no surprise, as repressed psychological issues might strive for conscious recognition during sleep or during the twilight of consciousness preceding sleep. Pain is the best way to eliminate the possibility of repressed issues coming into conscious light, so it is common for patients to begin to get pain while falling asleep or being awoken with severe pain while sleeping.
Spinal structural problems might suffer positional exacerbation when the body is not properly supported or aligned. While these events are much rarer than some doctors, therapists and chiropractors will have you believe, it is certainly possible to demonstrate particular anatomical deficits that are worsened by particular sleep positions. Likewise, muscular problems might flare-up when the body is placed into certain positions. Some people with chronic back muscle pain develop cramping or soreness when they are horizontal, while others only suffer symptomatic expressions in select sleep postures.
Some circulatory problems can cause pain virtually anywhere in the anatomy when the patient reclines to sleep. Since gravity produces different effects on the horizontal body, as opposed to the vertical, some of these circulatory issues may worsen.
Even people without a history of back pain can suffer symptoms when sleeping on an unfamiliar, worn-out or improperly positioned sleep surface.
There are 3 basic sleep positions that can be performed, with countless subtle variations of each posture being possible:
Back sleeping entails lying on the dorsal surface of the anatomy, with the head supported by a pillow, face up. This is also called the supine position. Back sleeping is the most common sleep posture and is recommended by many doctors. Some people bend their knees while back sleeping and find that this subtle change reduces pressure on the lumbar spine. In order to maintain this position, it is advised to place a small pillow under the backs of the knees. Other patients decide to lie flat and find the best comfort in this posture. If this is the case, it is advised to place small pillows left and right of the hips, so you will not roll in your sleep. Common problems with back sleeping include snoring, sleep apnea and exacerbated pain for many dorsalgia complaints. Many patients find the direct pressure on the spine to be unbearable, forcing them to seek other, more comfortable sleep options.
Side sleeping is the second most popular posture for sleep. Side sleepers, usually keep their arms bent, at approximate 90 degree angles and keep them at head height. Side sleepers also often prefer a fetal positioning, with the knees drawn up and in at 90 degree angles, as well. Some side sleepers prefer to straighten their legs. Many side sleepers like to hold a pillow under their top shoulder, to support the upper body and prevent them from rolling. Additionally, placing a pillow between the knees often affords the most comfort and also provides better skeletal support and alignment of the lower body. Common problems suffered by side sleepers include unilateral symptoms from stress being placed unevenly on the spine. Since side posturing places stress side-to-side on the spinal column, particular structural issues may suffer escalation of symptoms. Many patients complain of neck stiffness or pain due to side sleep posturing.
Stomach sleeping is the least common posture for sleep and is not advised for most people. This is also called the prone position. Stomach sleeping usually entails using a flat pillow or no pillow at all. Arms may be placed bent above the head or straight at the sides. Legs are usually uneven, with one straight and the other bent upwards into an approximate 90 degree angle. Common problems for facedown sleepers include snoring, neck strain and lower back pain. Some patients report poor circulation in this position, often waking to find numbness in their arms or legs.
The best choice of mattress and pillows can make big differences to the comfort level of any sleep posture for back pain. Below, we detail our research experience combining a preferred sleep posture with a selection of mattress and pillow variables:
Back sleepers generally do best with a slightly firmer mattress and a thin pillow. Soft mattresses allow the body to sink, providing inadequate support for the spine and possibly being the direct cause of pain. Pillows that are too thick can cause neck or upper thoracic pain, since the neck is being cranked forward for hours during sleep. Our recommendation is to use a firm mattress, a thin primary pillow and secondary pillows at the hips to prevent rolling.
Side sleepers benefit from a softer mattress, such as a pillow top or one with a dedicated topper made of a softer material, such as memory foam. Since the side of the anatomy has less surface area than the back, the body will sink more. Being that side sleeping involves pressure on the shoulder and hip, which are bony protrusions, the mattress surface must accommodate these regions comfortably or painful pressure points will develop. Over time, side sleeping on a very firm mattress may exacerbate hip or shoulder issues or cause degeneration of the joints. It is important to use a primary pillow that accommodates the gap between the bed and the head. This means finding one the same width as the distance between the side of the head and the edge of the shoulder. We also recommend a fetal position for side sleepers, with limbs bent comfortably. A pillow between the knees and another cradled by the top arm will support the body, prevent rolling and align the spine.
Stomach sleeping is not advised. We find it to be the least beneficial position and is often fraught with painful issues that are difficult to overcome. If you insist of stomach sleeping, we recommend utilizing a very firm mattress and using no primary pillow at all. Using a pillow will crank the neck backwards creating strain and possible injury over time. Meanwhile utilizing a soft mattress allows the trunk of the body to sink, preventing spinal alignment and possibly contributing to circulatory problems in the limbs.
Sleep comfort is a highly individualized concern. No one solution will fit every patient. However, following the guide above has been proven to provide great results for the majority of readers.
Sleep should be a time to relax, allowing the body to recuperate from a long day of activity. It is part of our natural design to find comfort when reclining and for specific sleep-related back pain, there is often a mindbody cause, rather than a purely physical source. A great way to test this theory is to see if you can comfortably recline in your preferred position when you are fully awake. If the answer is yes, then the pillow, mattress and posture combination is likely to be fine. If symptoms only come on just prior to sleep, or during sleep itself, the chances of the problem being psychogenic increase exponentially. This is a logical and clinically proven conclusion that we have seen in tens of thousands of patients studied over the past 12 years.