Sleep positioning to help you fall asleep and stay asleep!

One of the questions I ask every client during their first session is “Do you have a hard time falling asleep or staying asleep?” If the answer is yes, then my follow-up question is, “Is your pain the reason you can’t fall asleep or stay asleep?”  If the answer is yes, then you guessed it, we have to address sleep!

There are many components that we discuss when it comes to sleep.  We could talk about position, the type of pillow they use, their mattress - what type is it?  How old is it?  Do they prefer a firm mattress or a soft mattress?  How do they know which they prefer?  Do they sleep better while away on vacation vs at home?  Is their room dark at night?  Do they watch TV or surf the internet before falling asleep?  Do they have a hard time ‘turning their brain off’?  Have they always had a hard time sleeping? Do they drink alcohol before bedtime?

As you can see, there are so many components to sleep recommendations.

The first two questions above give me very important information however on if I need to address positioning.  If their pain keeps them from falling asleep or staying asleep, we MUST discuss positioning.

Note:  We would also need to discuss the age of their mattress, type of mattress, and the type of pillow they use to sleep.

So let's talk POSITIONING!

There are 3 main positions people primarily sleep - supine (back sleeper), prone (stomach sleeper), or side-lying (side sleeper).  Research has shown sleeping supine has the least amount of stress on the lower back.  Clinically, I have found clients generally have a hard time falling asleep on their back which can make this recommendation difficult for side-sleepers or stomach sleepers to adapt.  With time and commitment, you CAN make this change.  

STOMACH SLEEPING

Generally, If a client is a stomach sleeper, I encourage a change to the side or back.  Stomach sleeping naturally increases the stress on the lower back and neck.  If they absolutely do not want to make this change, I will recommend a modified side sleeping position with the purpose of taking stress off these areas.

I have made a video below to demonstrate how I would position these clients with the appropriate pillows for support.

SIDE SLEEPING

Side sleeping can be the most comfortable position to fall asleep for a lot of people.  Many people can sleep on their side for most of their life without a problem.  It is when a mattress starts to lose its support, your pillow loses its support, or you develop shoulder, neck, back, or hip pain from an injury that it becomes more difficult.

I am a lifelong side sleeper who chronically slept with a pillow that was not supportive enough.  To improve the support, I would straighten my arm up over my head and under my pillow to help support my head better.  Essentially, I would sleep with my head on my arm!  Somehow I thought this was a good idea.

I now have shoulder and neck pain when I sleep on my right side due to years of sleeping with a pillow that was not supportive enough.

When someone has pain with side sleeping, they may benefit from using various pillows for support.  The most important areas for support include appropriate support for the head, trunk, and legs.  There is an experimental component to this set up as you will see in the video.  I will admit, this is the most pillow intensive set up so bare with me on the video.  Take some time to experience the difference with support and without support before you decide against adding the extra pillows!

BACK SLEEPING

As I mentioned earlier in this post, changing from side sleeping or stomach sleep to back sleeping can be very difficult and may take years even!  If you can adopt the ability to sleep through the night on your back, your body will likely thank you.  

Back sleeping requires the least amount of pillow support for your head/neck and legs.  The most important elements generally include not over supporting your head/neck and supporting your legs in a way that takes pressure off your lower back.  There are also some very important do’s and don’t for supporting your legs.  See the video below for more information regarding back sleeping.

To conclude, there are MANY different reasons you may not be sleeping well.   In this post, we addressed positioning options if you cannot fall asleep or stay asleep due to discomfort or pain.  We hope you find this helpful and please share with a friend who may benefit from this information!

Travis Gerrald PT, DPT, CFMT