How to Sleep for Those Who Don't Want to Change Sleep Positions

Author

Dr Brooke Munion | Chiropractor Carlingford NSW

Bottom Line:

Have you ever woken up in the morning with back pain? You just slept for 6-8 hours (hopefully). How is there back pain? You haven't even done anything strenuous! Fear not: it could be how you're sleeping. As a rule of thumb, there are generally 3 sleeping positions: on your back/supine, side, and stomach/prone sleeping. Factors we need to consider are head position and spinal curve pressure. To ensure they have the least pressure, we consider pillow height, mattress type, and leg support. Although there is no "wrong way" to sleep, there sure are some ways that are better than others!

In a perfect world, most people would be sleeping on their back—Sleeping Beauty style with no co-morbidities or conditions to worry about, but that's not the case for everyone. I get it. I say most people because there are caveats to this including, but not limited to: if you have sleep apnea, acid reflux, or are pregnant. However, that's another article within itself, so back on track. Why should you sleep on your back? Sleeping on your back has the least amount of tension on the natural curves of the spine and therefore your joints. Your neck is supported by the "right" size pillow and leg support. The "right size" pillow and where to place the leg support will be discussed in detail later.

Contrastingly, when you sleep on your side, just from gravity, your weight, and pressure on joints, one side is "squished" for the entirety of the night. Muscles "react" to the new side position to support and protect the spine. The lack of movement throughout the night just solidifies the muscles either lengthening or tightening to provide that protection. You might notice in the morning one side feels tighter and the other looser. Ringing any bells for anyone yet?

It's not all doom and gloom for side sleepers, though, as this position is preferred over back/supine sleeping for people with untreated sleep apnea, pregnancies, and acid reflux. If you are a side sleeper, you can make a few quick changes to take pressure off your spine. Start by having the "right" size pillow. Next, ensure "correct" leg supports.

Similarly, when you sleep on your stomach: first of all, the head is going to turn to one side—otherwise, how are you meant to breathe? That's putting pressure through one side of the neck. Secondly, the low back curve is meant to curve in naturally, but now there is extra pressure going through it from gravity and your body weight, so in the morning, the lower back is going to be achy from excess pressure. The quick fix? You guessed it! Have the "right" pillow height and leg support.

Why it Matters? The way you're sleeping could be placing more pressure on the natural curves of the back. What you thought was disastrous is actually a relatively easy fix. It can explain why some back pain is chronic. It might not even be what you're doing throughout the day, but rather what you're unknowingly doing every single night. I'll reiterate: there are no wrong sleeping positions, but there are steps you can take regardless of what way you sleep to ensure that you wake up feeling refreshed and back pain-free!

Things to consider are the "right" pillow height, mattress thickness, and leg support. Let's break it down first with pillow height. The way that you tell the "right" size pillow for you is based on what position you sleep in. If you are a side or back sleeper, you are looking for a pillow thickness that goes from the top of your shoulder to the bottom of your ear. To take this measurement, stand with your head facing forward, do not bend the neck. The pillow height should then be taken. If your pillow is too low, you could be unknowingly jamming your joints the whole night! The muscles "react" to protect the spine, so when there is pressure (from jamming), the muscles will either elongate or tighten accordingly, which is why sometimes in the morning you might feel a bit sore, stiff, achy on one side more so than the other. If you are a stomach sleeper, then you want to find a nice flat pillow—the flatter, the better. If you have a high pillow, you are going to be putting a lot of pressure through the neck on the "breathing" side. The low pillow ensures that there is a neutral spinal curve, and you're not jamming the joints due to the height, which puts your head into extension and excess rotation from turning to the breathing side.

Next, let's talk about mattress thickness. Despite what the mattress companies claim and pretend—that their mattresses are "orthopedic mattresses" with "therapeutic properties," their claims are not supported by enough evidence. So which one are you meant to use? In a double-blind trial conducted by (Kovacs et al.), he found that subjects reported a higher level of improvement both in terms of pain and disability with a medium-firm mattress, as opposed to a box spring mattress (Kovacs et al.). Similarly, Jacobson et al. conducted a study comparing back pain and other common aches in volunteers who had been usually sleeping on commercial spring mattresses and rested for 28 days on medium-firm mattresses. Jacobson et al. observed that benefits were observed as a result of using a medium-firm mattress, independently from age, weight, height, and body mass index (BMI). All in all, it can be claimed that medium-firm mattresses offer more advantages to subjects with non-specific low back pain and are therefore recommended.

Last, but not least, let's talk about leg support. According to Dr. Elizabeth Yu of the Ohio State University Wexler Medical Center, she states, "A neutral (sleeping) position minimizes certain pressure points along the spine that don't need to be under stress. When those pressure points are under stress, it may create pain when you wake up in the morning." She goes on to discuss the use of leg supports and where to place them to ensure a neutral spine. For back/supine sleepers, the lower back can be supported by placing pillows under the knees to keep your pelvis in a neutral position. Ideally, you want your knees above your hips, so just ensure the pillow height is enough to clear them. If you are a side sleeper, you can place a pillow between your knees to keep the pelvis neutral and absorb any pressure that would be going through your knees and subsequently your hips. Lastly, if you are a stomach/prone sleeper, place a pillow underneath your hips. This is going to place the pelvis in a neutral position and will take pressure off of your lower back. It may not be an issue for you now, but imagine what that extra pressure through the back will be like on your back in 10, 20, or even 30 years from now?!

Next Steps: To help navigate the sometimes confusing and frustrating internal questions: Is this even the right pillow/mattress?! Ask one of the chiropractors at Back Space Chiropractic in Carlingford to help. We understand it's not a one-size-fits-all for pillows and would love to offer tips and suggestions to ensure you

Resources

https://www.mayoclinic.org/diseases-conditions/back-pain/in-depth/sleeping-positions/art-20546852 (pictures)

1. Cary D, Briffa K, McKenna L. Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ Open. 2019 Jun 28;9(6):e027633. doi: 10.1136/bmjopen-2018-027633. PMID: 31256029; PMCID: PMC6609073. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609073/

2. Kovacs FM, Abraira V, Peña A, et al. Effect of firmness of mattress on chronic nonspecific low-back pain: randomized, double-blind, controlled, multicentre trial. Lancet. 2003;362(9396):1599–1604. [PubMed] [Google Scholar]

 3. Jacobson B, Wallace T, Gemmell H. Subjective rating of perceived back pain, stiffness and sleep quality following introduction of medium-firm bedding systems. J Chiropr Med. 2006;5(4):128–134. [PMC free article] [PubMed] [Google Scholar]

4. Caggiari G, Talesa GR, Toro G, Jannelli E, Monteleone G, Puddu L. What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature. J Orthop Traumatol. 2021 Dec 8;22(1):51. doi: 10.1186/s10195-021-00616-5. PMID: 34878594; PMCID: PMC8655046. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655046/#CR5

5. Yu E. What sleep positions are best for your back? The Ohio State University Wexner Medical Center. 2018 Oct 04 (1). https://wexnermedical.osu.edu/blog/what-sleep-positions-are-best-for-your-back