What comes first: chronic pain…or sleep problems? For many people, the two go hand in hand. And research shows that’s probably no coincidence. A review of 20 research studies, involving more than 200,000 adults, showed robust evidence of an association between sleep-related problems and chronic musculoskeletal (MSK) pain. In fact, the study found them to be “bidirectionally associated,” meaning they appear to feed into one another.
The results suggest that people with sleep problems should take steps to address any MSK pain that is keeping them awake. In addition to addressing pain with a drug-free approach, many doctors of chiropractic offer patients practical lifestyle and ergonomic advice to improve their overall health and wellness – including ways to improve their sleep.
Positions to Reduce Back Pain
“Sleep ergonomics” refers to our postures and positions during sleep–which either help us rest safely and comfortably or stress joints to the point that we wake up with more aches and pains than we fell asleep with. Sleeping positions matter.
It is possible to take strain off your back by making simple changes in your sleeping position. The healthiest sleeping position is on your side. If that is how you sleep, draw your legs up slightly toward your chest and put a pillow between your legs. Some people even use a full-length body pillow to help maintain balance. Try not to put weight on your arms. This causes circulatory problems and a related pins-and-needles sensation. Instead, try crossing them in a braced position. (If tingling persists, talk to your chiropractor about other potential causes and options.)
If you sleep on your back, it is best to place a pillow under your knees to help maintain the normal lower back curvature. You might try placing a small rolled towel under the small of the back for more support.
Be aware that sleeping on your stomach is generally not the best for your back. In this position, the cervical spine undergoes considerable strain, which can cause nerve compression, muscular imbalance and muscle pain. If you can’t sleep any other way, reduce the strain on your back by placing a pillow under your pelvis and lower abdomen. Also place a pillow under your head if it doesn’t cause back strain. Otherwise, try sleeping without a head pillow.
Mattresses and Pillows
Your mattress and pillow should support your body in its natural position, allowing it to rest and recover from the day’s activities.
The best mattresses are designed to conform to the body’s natural curves (shoulders, hips, low back) while keeping the spine in alignment. Beyond that, your mattress choice is highly subjective. You must find the one that works and feels best for you. Look for one that is firm enough to support your spine in a side-lying position, but soft enough that it feels good to the skin. A mattress that is too firm may irritate bony prominences of the hips and shoulders.
Meanwhile, ergonomic pillows are designed to accommodate the user’s sleeping position and to minimize any associated tension that may result from prolonged time spent in one position. Ergonomic pillows are shaped differently from regular pillows. They are often made of foam or similar form-retaining material that offers greater support.
A healthful pillow is designed to keep the spine in natural alignment, which minimizes stress on the body. Most people do not maintain neutral positions while they sleep. This creates tension at problem spots like the neck and the lower back, resulting in pain in either or both of these areas. An ergonomic pillow can often correct such problems.
A pillow of the wrong size can cause or aggravate neck and shoulder problems. When you sleep on your side, the pillow should fill the space between the head and mattress so that the cervical spine (the neck) is in line with, and an extension of, the spine. The pillow should support the head, neck and shoulders and adapt to the contours of these areas. This will optimize your sleeping position throughout the night. A pillow also should be hypoallergenic.
Trouble Falling Asleep at Night?
In addition to a comfortable mattress and the right pillow, there are things you can do to enhance your ability to fall asleep successfully each night. The Centers for Disease Control and Prevention (CDC) offers these suggestions:
- Be consistent. Go to bed at the same time every night and get up at the same time every day, even on weekends and vacations.
- Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature.
- Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom.
- Avoid large meals, caffeine, and alcohol at least two hours before bedtime.
- Be sure to move! Being physically active during the day can help you fall asleep more easily at night.
Reviewed by the ACA Editorial Advisory Board. This information is for educational purposes. It is not a replacement for treatment or consultation with a healthcare professional. If you have specific questions, contact your doctor of chiropractic. To find an ACA chiropractor near you, click here.
Additional Resources
Centers for Disease Control and Prevention, “About Sleep,” https://www.cdc.gov/sleep/about/index.html#cdc_behavioral_basics_steps-what-to-do.
Mayara Santos, Flávia L Gabani, Selma M de Andrade, Bruno Bizzozero-Peroni, Vicente Martínez-Vizcaíno, Alberto D González, Arthur Eumann Mesas, The bidirectional association between chronic musculoskeletal pain and sleep-related problems: a systematic review and meta-analysis, Rheumatology, Volume 62, Issue 9, September 2023, Pages 2951–2962, https://doi.org/10.1093/rheumatology/kead190.
National Heart, Long and Blood Institute, National Institutes of Health, “Healthy Sleep Habits,” https://www.nhlbi.nih.gov/health/sleep-deprivation/healthy-sleep-habits.
