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Sleeping
Recommendations for Sleeping Positions
By Carol K. Sheats, PT, OCS
Whether you are in pain or pain-free, your body tolerates sleeping on your back or sides much better than lying on your stomach. This in no way means that you should always avoid being on your stomach, in fact, if someone tells me they cannot lie on their stomach, I always question why and try to have them learn to tolerate the position of being on their stomach for short periods of 10-20 minutes without causing harm, but it becomes a concern when someone sleeps on his or her stomach all night long, night after night, year after year. This can contribute to arthritic conditions in the neck and low back, and interfere with normal blood flow to the brain if the neck is severely rotated.
For someone pain-free, sleeping on his or her back or side with one pillow (that supports the head in a neutral position) should be sufficient. In general, I recommend a feather pillow or a feather-type pillow (if one is allergic to feathers) because you can punch it and conform it to your particular body type. I normally recommend rolling the pillow just under your neck some (in essence a cervical roll) to support the natural curve of your neck during the night. When lying on your back, your head could be level with your body or slightly tilted up. People can bring on or aggravate painful conditions when they sleep with their head propped up too high, such as when reading a book or watching television. Also, the pillow does not belong under the shoulders as that would round the upper back; the pillow should be just under the head and neck (Fig 1).
When sleeping on your side, your spine should be in a neutral position. Also, your back should not be twisted. When sleeping on the side, hips and knees should be in a moderately flexed position, but not in a fetal position. When sleeping on your side, a feather pillow can easily be punched to a thicker position required to fill in the space between the head and the sleeping surface so that your head remains in a neutral position, neither too high nor too low (Fig. 2).
Please note on some television shows or in magazines, you may see pictures of people sleeping on multiple pillows or sleeping on their stomach. Such pictures may even accommodate articles recommending suggestions for improving sleeping. Just because these pictures are often seen in the media, does not mean that they are good for us. Understand the principle of aligning your spine, including the neck, for long periods of time. For more information, read Living Posture by Carol K. Sheats, PT, OCS (livngposture.com).
For painful conditions, extra pillows can be used. For example, when lying on your back, you can place 2 pillows under your knees, bringing one of the pillows close to your buttocks. This is usually enough support for most people to feel comfortable (Fig. 3). In rare cases, one may need a very small support under the low back area.
If you have low back pain when sleeping on your side, you can place two pillows between the legs: one pillow should be brought up as far as you can between the thighs, and the other pillow should be between the ankles. These two pillows will overlap somewhat at the knees and nicely fill in the space between the two legs. The advantage of this positioning is that the pillows unload the weight of the upper leg, keeping it from pulling on the low back (Fig. 4).
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Figure 1 Good alignment when
sleeping on your back.
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Figure 3 Use pillows if needed for
comfort when sleeping on your back.
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Figure 2 Good alignment when
sleeping on your side.
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Figure 4 Use pillows if needed for
comfort when sleeping on your side.
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Once in this position with two pillows between the legs in side lying (and with hips and knees moderately flexed), you can “fine tune” your position by slightly bringing the legs forward or backward. This will alter the position of your low back between flexion and extension allowing you to find a mid-range “neutral” position of comfort. If you still feel uncomfortable, you may put something small, soft, and compressible under your waist. Since this is a small area to “fill in the space”, I have found even something as small as a sock can frequently give you the relief you need.
When first lying in bed, it does not really matter what position you are in, so if you have a habit of sleeping in an asymmetrical sleeping position (Fig. 5 - 6) or one that you now understand is unhealthy, feel free to get in your usual comfortable position when you first get in bed and enjoy your familiar position for a brief period. When you feel yourself dozing off, try to change to one of the recommended sleeping positions and in time you should adjust to a new sleeping position. After all, it is not what position you are in for a few minutes, but what position you are in for hours at a time that will promote either good spinal alignment or poor spinal alignment.
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Figure 5 This is an example of a poor sleeping position because of the asymmetry of alignment, especially if always pulling up the same leg.
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Figure 6 Here are 3 examples of poor sleeping positions that should be avoided for lengthy periods of time due to poor alignment: head severely turned, shoulders rounded, arm under head.
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Mattress
If you have pain and it is worse in the morning, pay attention to your sleeping positions (see above), as well as your mattress. If your mattress is old, you may want to purchase a new one. Start with a good brand name and a moderately firm mattress. A memory foam mattress may also be a good choice and should be considered.
Reference: Gregory S. Johnson, PT, FFCFMT and Vicky Johnson, PT, FFCFMT
Back Education and Training (BET)
livingposture.com
09/27/06
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