An Osteopath’s insight into sleeping positions and back pain, by Resident Practitioner at Shine, Stoke Newington Church Street, Andrew Doody.
A good night’s sleep is essential to your health, and an important part of your overall well-being. Back pain can significantly affect a person’s ability to get the quality and amount of sleep they need. Furthermore, poor bed posture can worsen or even be the cause of backache in the first place. This is because certain positions can place unnecessary pressure on the neck, hips, and back.
Here are some pointers of how to maximise the quality of sleep you get if you are suffering from back pain.
Experiment with sleeping positions.
Finding the best sleeping positions can help ease your back pain, so make sure you have found one or two that are comfortable for you. (Having more than one helps so that you are not stuck in the same position for hours on end).
Everyone sleeps differently so there is not one perfect position, but a good place to start is by making sure the head, shoulders, and hips are in alignment. The best way to do this is usually by sleeping on the back or side.
Lying on the back is probably the best all round sleeping position for a healthy back. It ensures good spinal alignment from the head and cervical vertebrae, through the thoracic and lumbar, all the way down to the pelvis. Because the back is the body’s largest area, weight is most widely distributed in this position, minimising pressure hot spots.
However if you have any lumbar spinal issues, you may feel more comfortable with a pillow placed under your knees. This is because many areas that cause backache in the lumbar spine are at the back, the facet joints and nerve roots. Placing a pillow under the knees allows the lumbar spine to gently flex and gap posteriorly, taking the pressure off these joints and nerves.
Many people naturally end up slightly flexing their spine for the same reason, by lying on their side with their knees towards their chest a little, the so-called foetal position. This may work well if your issue is more disc related.
Side-lying like this is often the position people find most comfortable. It can however twist the spine a little and put it out of alignment.
To correct this, if you prefer sleeping on your side, you can place a firm pillow between your knees. This stops the upper leg falling forward and raises it, which restores the alignment of the spine, hips and pelvis.
Try to avoid sleeping on your stomach if you can, because it puts a lot of strain on your back by over-extending it. Unfortunately for a lot of people, it’s the only position they can fall asleep in, or any other position makes them snore. If you’re one of them, try putting a pillow under your stomach to take some of the pressure off your back.
If you’re someone who falls asleep on their back or side, then rolls over in their sleep and wakes up on their stomach, try hugging a large pillow against your chest and stomach to keep you in position.
Another reason sleeping on the front is considered bad is because the head is usually turned to one side. This twists the spine and places additional stress on the neck, shoulders, and back.
To avoid this, you can try lying face down. Place a small firm pillow or tightly rolled-up towel under the forehead, or better still a face pillow, allowing room to breathe. In this position you should still place a pillow under the stomach.
If all else fails you can try sleeping in a reclined position. People with spondylolisthesis for instance may resort to this after finding it comfortable falling asleep in a reclined chair. There are beds available that can be sat up slightly, so this is worth investigating.
Invest in a good mattress
It’s worth it, you spend about a third of your life on your mattress, spend a little more money on the mattress and a little less on the car! You really do get what you pay for.
People generally find slightly firmer mattresses work well for lumbar spine problems. This is probably due to what we discussed earlier, in which the lumbar curve is allowed to extend a little, taking the pressure off the facet joints and nerve roots. This only really follows if you sleep on your back though.
People that prefer to side-lie may well find a slightly softer mattress allows your hips and shoulders to sink in a little therefore helping to maintain spinal alignment. this is particularly important if your hips are wider than your waist.
For people suffering with upper back issues, too firm a mattress may put unnecessary pressure on the ribcage and therefore upper spine in any position. Perhaps a good compromise here is a ‘pillow top” mattress. This is a good supportive mattress with a softer layer on top.
By all means try different kinds of mattresses, but remember, one night is not enough to really judge. People often sleep on a hotel bed and find it comfortable so decide to buy it. Those mattresses are often designed for short term comfort, not long term support.
Instinctively I would prefer the mattress to do the supporting, firm, medium, or even soft, so prefer a platform base, however some mattresses do seem to combine well with a slightly sprung base if they have been designed to do so. If you find the mattress more comfortable on a sprung base, perhaps it’s worth trying a slightly softer mattress on a platform base.
Be ‘Bed Fit”
The healthier and stronger your back is, the better night’s sleep you will get, and the better your back will be when you get up in the morning.
Core strengthening exercises will help support the back during the night and prevent back spasms. Gentle stretching before bed can increase flexibility and help to relax the body and reduce stress.
Take care getting in, and especially out, of bed. Take your time. When you wake up in a morning, allow a few minutes to get your muscles and joints moving fully instead of leaping out of bed at the alarm. Roll onto your side then use your arms to push you upright while your legs drop over the side, then sit there for a minute, moving gently before slowly standing up.
Perhaps most importantly, if you do have a back or musculoskeletal issue, get it checked. A health professional can assess why you’re suffering and help treat the symptoms. They can suggest the correct investigations, treatment and exercises, as well as further helping you to choose that all important correct mattress.