Is My Sleep Position an Issue?
If you are not getting enough sleep, you could be robbing yourself of your physical therapy rehab potential. Sleep is our body’s way of hitting the reset button with a long list of benefits including restored brain function, improved muscle recovery, and improved athletic performance to name a few. Drawing from clinical experience, most people that I see with acute and chronic pain lack the ability to get a full night of sleep. This can be due to a wide variety of factors, but I often hear that, “I get pain when I lay down at night”, “my pain is worse in the mornings”, or “I just can’t find a comfortable position.” Finding a fully supported sleep position can help with this.
Below you will find a detailed description of supported sleep positions for the back sleeper, side sleeping, and, yes, even the stomach sleeper to help you get into that more comfortable position. These are especially important when you are in acute pain or if you are that person that says they have pain that is worse in the morning.
Ground Rules For Sleep Position
Before we dive into the sleep positioning, I want to lay a few ground rules and expectations:
1. Support yourself in a neutral position from your trunk all the way to the extremities.
2. Support the entire extremity.
3. You should be able to have minimal pain while in these sleep positions and be able to get out of these positions without increasing your pain.
4. Baby bear from Goldilocks had it right. You don’t want too much or too little support, you want it just right.
In terms of sleep position, I often get the comment that, “I move around in my sleep. I can’t stay in this position for the full night.” One theory in terms of why you may readjust and move around a lot in your sleep is that you subconsciously are not comfortable or start to hurt so you seek a new position. These positions should help you maintain your comfort and limit the increase in pain through the night. If, despite the supported sleeping, you do toss and turn, I’d rather have you supported for 2 hours per night than nothing at all.
The amount of support you will need with vary based on your body type and the firmness of your mattress so please take this into account when adding or subtracting pillows/support from your setup position.
Back Sleeping
Most commonly back sleepers will hear the recommendation of, “Sleep with a pillow under your knees to help with your back pain.” This is a good recommendation and will help take some pressure away from the low back, but it violates rule #2 of supporting the entire leg. Try these alterations to help improve your supported sleep position while on your back.
1. Pillow – Select an appropriately sized pillow to support your neck in a neutral position. If the pillow is too thin, your head will be extended through the night and chin pointing up towards the ceiling. Too thick and your neck will be flexed with your chin closer to your chest. The pillow should support the entire neck from the base of the neck, just above the shoulders, to the top of the head.
– Tip – If you are having trouble getting the pillow just right, start with a pillow that is slightly too thin and try a folded towel to help raise the head slightly.
2. Shoulders/Arms – If you notice your shoulders are tipped slightly forward, you can try adding a small, folded towel behind the shoulder or provide a pillow or towel support under the upper part of the arm. Forearms can rest on your belly.
3. Legs – Place one pillow at the bottom of the pelvis just below the crease of your buttocks. Ideally this willow will be wide enough to extend down to your knees. You’ll place another pillow starting at the crease of your knee to support the lower half of the leg. These pillows should overlap slightly.
4. Feet – You may need some additional support under the ankles/feet depending on your height.
Side Sleeping
Most common correction side sleepers get is, “Sleep with a pillow between your knees.” While I do like this recommendation, it once again fails ground rule #2. Try these alterations to provide supported sleep position on your side.
1. Pillow – Again you want a pillow that is just right. Select a pillow that is too thick, and your head will be side bent away from the bed through the night. Too thin and your head is side bent toward the bed. The pillow should support the entire neck from the base of the neck, just above the shoulders, to the top of the head.
– Tip – If you are having trouble getting the pillow just right, start with a pillow that is slightly too thin and try a folded towel to help raise the head slightly.
2. Shoulder/Arm – Place a pillow in front of you to drape your top arm over, resting your forearm on the pillow. Snuggle.
3. Waist – If you have a narrow waist and you notice your trunk is side bent slightly. Try sliding a folded towel underneath your waist (just above the boney part of your pelvis) to help support. This should be a folded towel, not a towel roll. — Tip – If you continue to lose your towel through the night, place it between the mattress and the fitted sheet.
4. Legs – For this part you could use two pillows or a body pillow. If you use two pillows, the first should be brought up as high as you can into the groin region to support the upper leg. The second pillow will go from the knee to the foot/ankle to support the lower leg. The key for this position is the hip, knee, and foot should all be level.
Stomach Sleeping
This is a position I don’t really recommend. It places a lot of strain on the neck with your head turned to breathe through the night. The position also lends itself to promoting lumbar extension through the night which, for some, can be very irritating. Despite these drawbacks, some insist on sleeping on their stomach. For those that argue, I’ll compromise with the following adjustments in order to make it a modified stomach supported sleep position.
1. Pillow/Head Support – Place a support under a portion of the head just outside the eye that will help support a portion of your head to reduce the amount of neck rotation that occurs through the night.
2. Shoulder, Arm, and Trunk – Place another pillow underneath the side of the body opposite the pillow. In the picture below, the pillow is under the right side of my head and the left side of my body. Again, this should help fill in the gaps from the modified position and help support the rotation.
3. Lower Extremity – Place a pillow under the leg on the same side as the pillow support along the upper body to help support the rotation.
The Big Finish
While positioning is important, there is a lot more that goes into the ability to fall asleep and stay asleep. One book I often recommend to most, if not all, of my clients is, “Why We Sleep” by Matthew Walker. I highly recommend buying, and reading, this book if you are having difficulty sleeping. We have also included a sleep health block on our website if you click here.
As always, if you have any questions, feel free to reach out to lawsofmotionpt@gmail.com. Sleep tight.
