By Pamela Norton, DPT

Do you have trouble getting comfortable to rest?  Do you toss and turn all night? Do you get less than the recommended eight hours of quality sleep?  If so, keep reading!

Sleeping is a basic human need, like eating, drinking, and breathing. Like these other needs, sleeping is vital for good health and well-being throughout your lifetime.

According to the Centers for Disease Control and Prevention, “ About 1 in 3 adults in the United States reported not getting enough rest or sleep every day. Sleep deficiency can lead to physical and mental health problems, injuries, loss of productivity, and even a greater likelihood of death”.

There are a lot of factors that influence inability to gain quality sleep: pain, stress, poor nutrition, nighttime distractions, children!  When you add back pain into the mix, sleep can become even harder, but more important to start the cycle of your day in less discomfort. Here, I will focus on how posture and alignment in your bed is one easy way to improve quality sleep!  

Many people who are experiencing back pain describe the inability to get comfortable at night. Even if you do not have discomfort when you sleep, many people make a few inaccurate assumptions about sleep position and posture at night. 

1) It’s OK to sleep on my stomach 

When we sleep on our stomach, naturally our head and neck have to be fully turned to one side in order to breathe. This takes the joints of our neck and brings them to the end range of their movement, similar to turning to look behind you in the car and then keeping your head like that for hours. Your neck will be sore!  A similar phenomenon occurs in the lumbar spine. When our discs and muscles of the spine are near neutral alignment, they become re-hydrated.  Sleeping with a pillow between or under the legs as well as having a pillow supporting the natural curvature of our next allows our discs to not be compressed. 

2) I can sleep anywhere !

I remember in high school and college, I could literally fall asleep anywhere- the floor, a couch, sitting up, on an airplane. I would always feel best after resting in bed, but my body didn’t suffer the consequences of poor alignment. As we age, our tissues naturally become more stiff. When we lack support and our spine is not unloaded, areas of our spine as well as muscles, ligaments, and connective tissues become less hydrated and replenished with nutrients and feel even worse when we go to move and use them. Sleeping with a well aligned and supported spine allows our tissues to be happier. 

3) I only need one pillow 

Yes, you may only need one supportive pillow under your head depending on: a) if you are on your back or side and b) depending on how broad your shoulders are. If you are side-lying you want the thickness of the pillow to match the distance from the side of your face to the edge of your shoulder- this allows the neck to remain in neutral alignment. Pillows too thick can displace your neck into a side-bend on the top side and pillows too thin can displace your neck into a side-bend on the bottom side. In the picture below, the pillow is nicely tucked all the way to my shoulder and neck is in neutral. 

Why do I need more than one pillow?  

The infamous leg pillow!   No, this is not just for pregnant women. When you are on your side using a pillow between your legs helps the hips/pelvis/lumbar and thoracic spines remain in neutral alignment, with the joints in a loose and open position. Without a pillow here, the top leg draws itself across the body and can pull on the hip and spine, creating tension. When you are on your back, placing a pillow under your legs- from buttock to ankle lengthwise allows the lumbar spine to have support to its natural curvature. Without that pillow, extension of the lumbar spine is accentuated and again the joints are left in a more compressed position. 

So how should I align myself? : 

1. Lying on your back (supine) or on your side (side-lying)

2. Using 1 supportive pillow under your head, make sure the material feels supportive and not that it is displacing your head in another direction 

3. Using 1-2 supportive pillows between or under your legs 

• Supine: 1 pillow lengthwise from buttock to ankle, 1 pillow horizontally under knees 

• Side-lying: 1-2 pillows from groin to ankles, the entire length of leg

d.  Optional but recommended : an arm pillow under your top arm- unloads the arm,        

      which can act like a weight on the neck if left unsupported 

According to the American Physical Therapy Association (APTA), "Sleep is a part of human behavior and movement and is essential to life. There are aspects of it that PTs are experts in, such as positioning for prevention and rehabilitative reasons. This position makes it explicit that PTs are involved in and should be mindful and helpful in the area of sleep, which lends naturally to working with, learning from, and sharing our knowledge with sleep professionals.”  

Let’s improve our sleep together!