Dr. Clint Woo, DPT, PT
What To Consider For Pain When Sleeping
Sleeping can be hurting you! OK maybe that's a bit dramatic, but depending on a combination of your sleeping habits, mattress/pillow type, etc.... making adjustments could help a lot with pain and getting better sleep!
Let's start from the top: The pillow. Often times you will hear people recommend several different heights of pillows and firmness to them and this has some truth to it! If you have neck issues, consider starting off with a pillow height that allow for your neck to be in a "neutral" position (where the neck is aligned with the rest of your spine). If after several days this doesn't seem to help, then we may need to accept that your neck specifically wants a different height other than neutral (this is what you may not hear enough of)! Consider trialing different heights in 1 inch increments for a few days at a time to find your ideal height. I have learned over time that my spouse likes their pillows at double the height of mine! We can also consider the contents of the pillow. A more rigid, foam type of pillow may allow your head and neck to be slowly cradled into place. If you sleep in multiple positions, then a softer, more malleable pillow may be better so you can adjust it to accommodate your needs (side lying would require a higher build up which you can achieve by bunching the pillow up).
Now lets talk about the mattress. There are several different types of mattresses each with its pros and disadvantages. The two very popular types are memory foam and inner spring. Memory foam is useful for those who like to sleep on their side as it sinks and forms to you while supporting your shoulders (decrease pressure for shoulder impingement) and hips (decreased pressure for hip/trochanteric bursitis). Memory foam is also nice in that it reduces motion transfer (less likely to wake up the partner) and doesn't need to be flipped as often. Be warned that memory foam can get hot though and is heavy. Innerspring (coils) mattresses can give you a more recoil which some people may like rather than a literal sinking feeling of foam. Also it may be beneficial for those who like to constantly switch their sleeping position as they won't be "stuck" in place. Some report that the coils are more cool to the touch due to air circulation. The springs do wear out faster than foam construction and you have to flip the mattress more often.
Now let's talk about different sleeping positions and what to consider for each one.
As a side sleeper, I can attest to how much the body doesn't seem to enjoy this position. Our sides are not as "meaty" as our backs and so there are a lot of things to consider. The shoulders and hips in particular are sensitive to having your entire body weight on them. The shoulder gets compressed and leas to what we alluded earlier to as impingement. Thus I would suggest pulling the shoulder out in front of you as if you are reaching for something with the arm your are lying on. This makes it so that the pressure is more on your scapula than the tip of your shoulder! For the hip, there is a fat pad at your hip that gets irritated when there is constant pressure on it, thus my best recommendations are to make sure you are sleeping on a surface that "gives" under weight nicely. Our back actually twists when one of your knees passes midline (even when the top leg is on lying directly on the bottom leg) so I would suggest using a pillow between the knees. If your back feels like it is collapsing, then try a small pillow or towel roll underneath your spine. Finally consider that your head is at a higher height when side lying vs on our back. Thus your need a higher pillow when side sleeping to keep you neck in natural!
Sleeping on your back presents the least amount of problems. As mentioned earlier, the first thing to consider here is the pillow height and finding out what your neck likes! Next look at how much your back feels supported by your mattress. If the curve of your low back feels like it is being cranked in an upwards motion too much, consider a pillow underneath your knees (have to be careful for elderly individuals as to not shorten your hamstrings or increase pressure on the heels though for those who have more sensation)! If the lumbar feels like it is collapsing, then consider a small pillow or even a towel roll to support it.
Stomach (prone) sleeping can be rough. Unless you sleep on a massage table where there is a hole in the table, you most likely have to sleep with your neck turned. This places incredible amount of stress on the spine! Plus, your neck and lumbar are cranked back into extension for an extended period of time. There have been a surge of pillows with holes in the middle so if using these, then I would suggest using a pillow underneath your trunk as well so as to avoid your back being sacrificed.
Try to make the little tweaks before jumping straight to replacing your mattress as the pillow adjustments are a much more affordable option (especially for the neck pain individuals)!
This is not intended to be professional advice. Please speak with a physician or physical therapist. Invest in yourself by bring the physical rehab to your home! We at Woo Physical Therapy and Wellness are proud to serve the Anne Arundel, Howard, and Prince George's counties in-home and online anywhere in the U.S.A. for wellness!!