A question I frequently hear is what is the best position to sleep? I thought I would guide you through some of what I consider the best sleeping positions to decrease pain and promote a neutral posture and give you a few new ideas.
Sleeping on your back or side is okay. Some say that sleeping on your side increases wrinkles, but that doesn’t increase pain physically! Sleeping on your stomach is one position I would strongly recommend avoiding. To turn the head completely to the right or left for extended periods can constrict arterial blood flow to the brain. Paraphrasing Dr. Stanley Paris, the founder of the manual certification program where I graduated, joked that perhaps people who could only sleep on their stomachs were giving themselves a stroke every night to pass out!
Sleeping on your back
The first photo shows sleeping on the back with a pillow supporting the knees. Many individuals have tight hip flexors, the muscles in the front of our hips, that can cause the back to arch if they are too tight. It is important to let the low back relax into the bed. The bed needs to be firm enough to support the body, but not so soft that it causes the entire spine to totally sink in. This varies by individual. The second picture shows the pillow further under the buttocks. Sometimes the only way to allow the lumbar spine to relax is to bring the pillow higher under the hips.
The head should be supported on a pillow and fairly even with the body. In this photo, the pillow is a little high, but for those of us who like to sleep on our back and side, I find it better to err on the high side. That way, when turned on the side the head can be in a neutral position. More on that in a minute. Even though his head is a little above his body, it is parallel to the body and bed. The top of the head should not be elevated, nor should it drop down, raising the chin. These will both create strain on the neck and even headaches.
The arms can lie at the side or on the abdomen. If at the side, I would prefer the palms or thumbs face upwards, putting the shoulder in a more neutral position. If the shoulders are popping forward creating shoulder pain, putting a small pillow or towel roll under the elbows can be helpful. This will allow the shoulders to fall back into the mattress. I like to think of tucking my shoulder blades under me to open my chest.
Sleeping on your side
To sleep on your side again involves aligning your entire spine, neck, hips and shoulder. In the first photo, the pillow is moved to between the legs and a second pillow is placed under the arm either in front of you or at your side. You will notice the pillow between the legs, supports the entire leg, not just the knees. This decreases rotation in the legs and keeps the hips and knees in neutral. If the knee dives into the bed, the hip and pelvis would be rotated, creating a rotation into the spine. Some of you like to sleep with one leg straight and one one bent. This is possible if you place two pillows under the bent knee or enough to make it even with the hips. Having the shoulder off the body improves the blood supply to the shoulder. It also helps keep you out of a fetal position. In a fetal position, your chest space closes, your top arm is rotated against your body compromising nerve and blood supply and straining the neck. The bottom shoulder joint is compressed also irritating the rotator cuff tendons. The pillow under your arm or in front of you can help keep your arms more neutral and joints, muscles, blood and nerves more relaxed. Nerves don’t immediately complain when compressed, but you may wake with tingling or numbness in the arms or hands. Letting your hands stay relaxed, rather than fisted and your elbow less bent will help decrease nerve compression as well. Also, keeping your elbow below shoulder level is recommended for the same reasons.
An alternative side position is shown above. Instead of putting the pillow in front of you, wedge it behind your entire back. That way you may rotate back into the pillow. This is a great way to take pressure off the bottom shoulder and hip, which is a common complaint sleeping. Make sure the entire spine rotates back into the pillow so you are not creating increased rotation, causing torquing in the spine. The top arm can rest on this pillow or your side. A down or fluffy pillow, such as My Pillow© works well.
In either position, the head should be in line with the body. I Iike to look at the nose to see it is parallel to the bed. Or, you can check from behind and see if the top of the head is tipping up or down. This will be determined by the width of your shoulders and how soft or hard your bed is. In a softer bed your shoulders will sink deeper allowing a narrower pillow to be used. Conversely, in a firmer bed you may need a thicker pillow.
Supporting the lower curve of the neck is very beneficial to keep the cervical spine in line and not compress the discs, facets and nerves. The cervical spine has a curve and is not a straight line, therefore, it needs more cushioning in the lower area and less at the top and head. Too much cushioning at the lower neck can increase the compression and cause the head to tip down. The head tipping upward compresses the other side. Just like Goldilocks and the Three Bears, it needs to be “Just Right”. Pillows that react with heat can sink in further during the night, so if you are waking with pain in your neck during the night, you might check to see if your pillow is keeping you supported.
One thing that has worked well for me in finding a pillow is having someone take a photo of my head position on the pillow on my side and back. This allows me to really see how supported my head is and if the pillow is going to work. Finding a pillow that fits you is no easy matter and one pillow does not fit all. Check out my December blogpost and you can see my personal favorite, https://www.transformative-pt.com/2019/12/14/gift-ideas/
One last comment on sleeping is for those with an hourglass figure. If you have a thin waist and wider hips your lumbar spine might be sagging into the bed. This can be corrected and the spine supported with a rolled up towel placed just at your waist. It only takes a small roll and can allow the lumbar spine to stay supported. A towel roll or pillow under a pregnant belly will work the same way if the baby is causing the spine to drop toward the bed.
I hope you find at least one of these suggestions helpful. As we all know, sleeping is very important for healing and restoration of the body. Getting a good night’s sleep with pain makes it even more difficult. So, I hope I haven’t put you to sleep already. If I have, read this before going to bed! Otherwise, I hope these simple solutions give you sweet dreams! As always, I welcome your questions and comments.
Judy
Great info!