The gentle and moderate facet-sleeping position can help increase the space between the joints in the lower back. The position that many people sleep in, curled up in a fetal position, is a very common and comfortable position. Even though this position is comfortable, it is not the best position to sleep in if you have back pain. It is not in the best interest of your neck and lower back. On the other hand, sleeping directly on your back puts a lot of extra strain on your spine and this is not a good position for back pain either. However, could we put a positive spin on sleeping in your back position? You got it, sleeping with support under your lower back using a pillow or pillows can help reduce back pain significantly. So why is the side-sleeping position better?
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Your neck is made up of seven vertebrae where the spinal cord is situated. Underneath the spinal cord are nerve roots that transmit quite a distance down your arm. The cervical spine is quite vulnerable because it is capable of moving in many directions. Unfortunately, the gentle movements during the night while in an unsupportive position can be quite detrimental to the cervical spine and vertebrae. If you consider that the average person spends 6-8 hours per day sleeping, assuming that only 7 hours is spent sleeping a night, this would mean that the average person is spending about 2500 hours in one year! Assuming that we only live until 60, this person would have spent 175,000 hours sleeping. If a certain sleeping position has been used for many years, then it becomes quite difficult to correct, even with conscientious efforts. This is why it is important to find out the best sleeping positions for neck pain so that the time that is spent sleeping can be used to help the healing process, in place of making it worse.
Indeed, sleeping on the stomach translates to poor sleep since it may increase the frequency and severity of neck pain and it can also cause other health problems. That’s because stomach sleepers must twist their necks to the side in order to breathe. Unfortunately, there are no pillows that can adequately support this position. A pillow for the head should be very flat, while a second pillow under the stomach may help keep the spine in line. Unfortunately this position may put a lot of strain on the lower back. Both of these positions can also affect the lower back because the pelvis is tilted, causing compression in the lumbar spine. Low back pain in the morning is something experienced by many and can be partially attributed to the sleeping position. Side sleeping is a common and comfortable position, however it is a very asymmetrical one which can lead to some undesired effects over time. If a person can’t help but sleep on their side, it is best to use a pillow to fill the space between the ear and shoulder. This should keep the neck in a neutral position and alleviate any possible neck strain. Using a body pillow or something similar to prevent rotation back onto the back would be ideal. Step one of side sleepers with scoliosis is finding out which side is convex and which is concave. The concave side is where it is harder to maintain the space between the shoulder and neck, meanwhile on the other side it can be difficult to keep from tipping in the direction of the concavity. Positional training devices are available for scoliotics to help maintain a certain position, however this may be overdoing it for the average person.
It is very appropriate to find out the reason why the best sleeping positions for neck pain are so important in helping the body to cure and prevent the pain in the cervical neck. In order to neutralize the position of the neck, we also need to learn how bad sleeping positions can affect your neck in a negative way. It has been known for so long that the main function of our neck is supporting the weight of the head. On a normal ten to twelve pound head, the neck moves and maintains the position of the head under control at a time. This requires strength and endurance from the neck. The neck is strong and can sustain this sort of activity over a long term. The head should be in line with the body, not too far forwards and not leaning to one side. This is the ideal support that our neck can provide to our head, and we should always consider maintaining and preventing anything lesser than this it may cause neck pain. The neutral position of the cervical spine is that position in which the cervical spine is in its natural curvature. The natural curvature of the cervical spine is a lordosis at the C1-7 levels. The neutral position is significant because that is when the cervical spine is the least loaded. This is because when the head is positioned in a neutral position, the weight of the head (about 10-12 lbs) is aligned with the center of the cervical spine. This is balance, and maximal load is not placed on the cervical spine muscles, tendons, ligaments, or discs. This means that when the cervical spine is not in a neutral position, the loading on the cervical spine is increased and predisposes it to mechanical neck pain and acceleration of the degenerative process. This is because the weight of the head is not ideally aligned with the cervical spine. When the head is in a forward posture, the loading of the head is greater and increases with the degree of flexion of the cervical spine. This puts the cervical spine in a high load situation and is at risk of sustaining an injury that might cause neck pain.
If supporting your neck in the above positions fails to improve your neck pain in a night or two, you may want to use a little extra help. Of course, the best type of additional help is a cervical pillow, regardless of which position you sleep in. A cervical pillow serves to give your neck that extra bit of support while you sleep. However, they can be expensive, and it is not always practical to go out and buy one right away. A cheaper alternative is using a rolled-up towel.
Using additional support, such as a rolled-up towel or a cervical pillow
If you find yourself turning over onto your side during the night, do not worry. It may be helpful to place a body pillow or something similar to prevent you from turning all the way over onto your stomach, which is not a recommended position for neck pain. This can often be easier than the next option.
Start by lying flat on your back. Gently tuck in your chin while keeping the base of your skull on the pillow. If you feel any discomfort at first, use another pillow that does not lift your head as much. This will give your neck time to adjust to this new healthier position. Try to stay on your back as much as possible throughout the night, using a cervical pillow to give your neck extra support.
While you can try to go without a pillow or use a flat one, this is not usually helpful and can often times affect your neck even more. Therefore, it is important to use a cervical pillow to help support the natural curve in your neck.
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It can be a difficult transition to change your sleeping posture, but the use of pillows and a natural sleeping position for the spine make it easier and more comfortable. This kind of support will greatly reduce the probability of waking up with back pain and stiffness. By doing so, you actually create the right conditions during the sleeping hours for your body to heal itself and reverse the damage done to muscles and other tissues, whose daily job is to support the body in various activities.
Maintaining a good posture is just as important sleeping as it is when you are awake. Pulling in your chin and keeping your head aligned with your neck and spine helps achieve this. It also helps to keep the rest of your body in line, not sprawling in different directions. The use of supporting pillows to maintain this position will train your body to fall asleep in a desirable posture and hopefully carry on through the night. This technique is beneficial as the body is evenly distributed throughout the bed and no one area has more stress and strain than another.
If you sleep on your back, a small pillow under the back of your knees and a rolled towel under your neck will support the natural curve of your spine. The pillow for your head should support your head, the natural curve of your neck, and your shoulders. This will keep your neck straight and not bent forward or backward. The pillow will prevent any unnecessary or additional strains on your neck muscles and allow them to rest through the night. This is a great way to prevent back and neck pain.
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You may find placing a winged pillow under your body (in line with your back) can promote you to stay on your side during the night. This serves as a physical reminder if you are trying to break the habit of being a stomach sleeper.
Cervical pillows are becoming increasingly more popular in mitigating neck pain, and there seems to be growing evidence in their use. These pillows are intended to give support for the curve in your neck and are effective in keeping your neck in line with your spine.
In a redraft, I might use a similar style; however, I would focus on ensuring I’m getting the point across a bit clearer. The diagram in this chapter is a great example of how the spine and neck should be aligned. This is an important part of the initial step of setting up a correct way to sleep on your side. Using a good quality pillow is important in ensuring that your neck is not sitting too high above your shoulders or too low. The ideal pillow height should maintain a contour that follows the curve in your neck when standing.
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Sleeping on your stomach might seem cozy, even though it may not be the optimal choice for your neck’s health. When you lie face down in this position, your head tilts to the side and your neck twists creating a strain.
While some find this position comforting, it can have adverse effects. The pressure on your neck can result in discomfort, stiffness or pain. Interestingly, stomach sleeping isn’t entirely bad. It’s fine occasionally, but not ideal as a routine. If you find it hard to sleep in any position, try using a pillow or no pillow at all to reduce the strain.
Choosing the pillow plays a role in ensuring a pain free neck. Your pillow works hard to provide support for your head and neck every night particularly when dealing with neck discomfort.
The ideal pillow choice depends on how you sleep. Back sleepers benefit from a pillow that maintains the curve of their neck. Side sleepers, on the hand, should opt for a firmer pillow to fill the gap between their ear and the mattress.
For those who prefer sleeping on their stomachs, a pillow or none all is recommended to allow the neck to rest naturally.
Don’t overlook the importance of the pillow material—whether it’s memory foam, feathers or something else. Selecting the material is akin to choosing fabric for your cozy sweater. Your comfort is essential so choose what works best for you.
Create a restful routine. Allow yourself to wind down in the hour or so before bed. Try reading, stretching, soothing music, or soaking in a hot bath. Try to get into a regular and calming routine before bed. Avoid caffeine, nicotine, and eating right before bed. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening later in the night. Limit liquid intake before bed to prevent nighttime awakening to use the bathroom. An adult bladder can only hold about 2 cups, approximately 16 ounces of liquid. If you regularly awaken in the night from a full bladder, avoid drinking liquids after dinner. If frequent bathroom visits are for other reasons such as an enlarged prostate, urinary problems, or menopausal or perimenopausal hot flashes, a visit to a physician may provide treatment for these issues, improving sleep duration and quality.
Create a comfortable conducive sleep environment. A bedroom should be inviting and comfortable. It should be free from noise that can disturb sleep. A television or reading materials that may stimulate wakefulness should be kept out of the bedroom. Ensure that the bed is comfortable. It may be time for a new mattress and check for supportive pillows. Your pillow should be comfortable and supportive. If you sleep on your side, use a contoured pillow to support the natural curve of your neck, with a flatter pillow cushioning your head. If you sleep on your back, a contoured pillow should support the natural curve of your neck, with a flatter pillow cushioning your head. Using too many pillows or an overly soft mattress may lead to poor support of the neck and worsening pain. Keep your sleep posture in mind. The most comfortable and pain-free position is highly individual. Try out various positions with a supportive pillow or rolled towel to find what is most comfortable and supportive for you. You may not be aware of the position or movements that you make during the night that may contribute to neck strain and pain.
Some people find it helpful to use a hot water bottle or a cold pack to reduce any pain, but most of us won’t use them properly. Not compressing a hot water bottle properly to contour the shape of the neck, or placing a cold pack directly on the skin without a towel or pillowcase is likely to cause more pain from local burns. Another potential problem is falling asleep with a cold pack, in which case you may wake up later with increased muscle tension because it has lost its anesthetic effect due to continued exposure, and you have curled up around it, possibly in an unusual or poor posture. If you do use them, make sure you read the usage instructions. Traction, in which the head is pulled up with a device, has sometimes been recommended for neck pain, and is based on the idea that decompressing the disc space is a good thing. However, the reasoning is flawed, and evidence it can achieve this effect is very limited. A recent review identified only one low-quality study which showed it to be effective for neck pain in the immediate term, but the long-term effects are unknown. Many people find that turning over to sleep on their front relieves their pain, which is understandable since this is a way of escaping over-supportive pillows or partners who snore! But it does not help healthy alignment of the neck. So this is not a recommended way to improve your neck pain in the long term.
Effects of conservative or surgical treatment in cases of radiculopathy have also been assessed showing improvement in physical function and sleepiness following operations compared to non-significant static change in those treated conservatively, 8,9 but the non-specific comparisons of these investigations limit recommendations to sleep affected by neck pain as a whole.
Cognitive behavior therapy targeting sleep thoughts and beliefs has been recommended for management of insomnia complaints, 6 its effects in comparison to standard neck pain treatments in a primary care setting have shown modest improvements in sleep quality (0.51 QOL points) coinciding with decreased neck pain intensity.
Changes in neck pain symptom intensity and sleep-induced factors were evaluated at Hospital Pain Clinic utilizing a treatment regimen consisting of trigger point injections and physical therapy in comparison to tricyclic antidepressants and placebo injections. Maintenance of patient’s pattern of sleep was a treatment goal, one investigation showing that 6 patients reporting improvement in their sense of well-being despite no change in neck pain and sleep problems.
One approach to the management of neck pain exacerbating or resulting from poor sleep quality is to seek professional medical help. Recognizing the strong relationship between neck pain and sleep, several investigations have evaluated the symptoms of neck pain and sleep quality following treatment aimed at reducing neck pain.
At the Orthopaedic & Pain Practice, our team is dedicated to addressing your neck pain concerns. We offer a variety of treatments aimed at easing discomfort and improving your quality of life. Our aim is not to alleviate pain but to enhance mobility ensuring that you can easily participate in daily activities. Through a combination of expertise and a patient centered approach we strive to empower individuals to live without pain while promoting a renewed sense of movement. Your journey towards a healthier and more active lifestyle starts with us at the Orthopaedic & Pain Practice.
The best sleeping position for alleviating neck pain is typically on your back or side. Back sleeping helps keep the spine aligned, while side sleeping can be comfortable if you use a supportive pillow to fill the gap between your ear and shoulder, maintaining a neutral neck position.
When sleeping on your back, use a pillow that supports the natural curve of your neck. A rolled towel under your neck can also provide additional support. Additionally, placing a small pillow under your knees can help maintain spinal alignment.
Yes, side sleeping is generally recommended, but it’s essential to use a firmer pillow that fills the space between your ear and the mattress to keep your neck aligned and reduce strain.
Stomach sleeping is not recommended as it often requires twisting the neck, which can lead to increased strain and discomfort. If you must sleep in this position, consider using a very thin pillow or no pillow at all to minimize neck twisting.
Yes, cervical pillows are designed to support the natural curve of your neck and can be beneficial in reducing neck pain. If a cervical pillow is not available, a rolled towel can serve as an alternative.
A worn-out mattress may contribute to poor spinal alignment and exacerbate neck pain. It’s advisable to invest in a supportive mattress that maintains proper alignment during sleep.
Remember to maintain good posture and use proper lumbar support when sitting. Also, consider using a wedge pillow when reading or working in bed to reduce neck pain.
Yes, screens emit blue light that can disrupt your sleep patterns. Treat your screens like a chatty friend, and give them a break at least an hour before bedtime to promote better sleep quality.
Dr Yong Ren graduated from the National University of Singapore’s Medical faculty and embarked on his orthopaedic career soon after. Upon completion of his training locally, he served briefly as an orthopaedic trauma surgeon in Khoo Teck Puat hospital before embarking on sub-specialty training in Switzerland at the famed Inselspital in Bern.
He underwent sub-specialty training in pelvic and spinal surgery, and upon his return to Singapore served as head of the orthopaedic trauma team till 2019. He continues to serve as Visiting Consultant to Khoo Teck Puat Hospital.
Well versed in a variety of orthopaedic surgeries, he also served as a member of the country council for the local branch of the Arbeitsgemeinschaft für Osteosynthesefragen (Trauma) in Singapore. He was also involved in the training of many of the young doctors in Singapore and was appointed as an Assistant Professor by the Yong Loo Lin School of Medicine. Prior to his entry into the private sector, he also served as core faculty for orthopaedic resident training by the National Healthcare Group.
Dr Yong Ren brings to the table his years of experience as a teacher and trainer in orthopaedic surgery. With his expertise in minimally invasive fracture surgery, pelvic reconstructive surgery, hip and knee surgery as well as spinal surgery, he is uniquely equipped with the tools and expertise necessary to help you on your road to recovery.
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