Common Sleeping Postures

There are many different ways people choose to sleep, not all of them are bad, but there are ways to improve whatever position it is you prefer. Take a look at the specific position of your neck while you sleep. Depending on the position you sleep in, the height and density of your pillow will differ for the most comfort. Poor pillow support can also cause narrowing of the air pipe, resulting in obstructed breathing, and sometimes snoring, which can hinder sleep.

The Spine and Sleep

The spine is broken down into several different components: the cervical, thoracic, lumbar and sacral spine. Between each vertebra, there is an intervertebral disc that requires nutrients and space to recover from the days actions. Each segment designates areas of different curves, but they all come together to function as a unit to absorb shock, support the weight of the body and head, and allow movement in many planes. During sleep, your spine should maintain a neutral position to allow the intervertebral discs the opportunity to re-hydrate and decompress. Research has shown that we are around 1 cm or 1/2 inch taller in the morning due to changes in disc height.

Improve Your Sleep Posture

The key to a better night’s sleep is simple. By modifying the position you already sleep most comfortably, you can rest easy knowing that your body is resting peacefully as well. The best lying or sleeping position may vary, depending on your symptoms. No matter what position you lie in, the pillow should be under your head, but not your shoulders, and should be a thickness that allows your head to be in a normal position. Follow these guidelines for body pillow placements according to your sleep posture.

• Side sleepers: Foetus, Log, & Yearner.
  1. Your pillow should rest comfortably taking up the space between your shoulder, neck, head and the bed. When your pillow is the right size, your head should rest comfortably allowing your neck muscles to fully relax. Your cervical spine will thank you if there is no rotation or lateral shearing happening in your neck from having a pillow that is too flat or too fluffy.
  2. To keep your lower back happy, place a pillow between your knees, aiming to keep your knees about hip distance apart and slightly bent. The best would be to have a pillow that supported your ankles as well to keep neutral rotation of the hips in sidelying.
  3. If you have a narrow waist, try rolling up a towel to place in the space between your waist and the bed. You can also hug a pillow to support your shoulder.

  Do double up a flat pillow, and put it in the case folded so that it stays in this shape and you don’t have to struggle with your pillow at night.

• Prone sleepers: Freefaller.
  1. Try not to sleep completely on your tummy with your head rotated to one side. This is very hard for your neck and puts extension forces all the way through your lumbar spine. Instead, try a partial prone position with a pillow supporting your upper shoulder and your upper hip and knee.
  2. Use a very flat pillow in this position with your head near the edge so that your neck can avoid being in severe rotation.
• Back Sleepers: Solider & Starfish.
  1. Use a pillow that supports the natural curve of your neck. Try not to use a pillow that is too fluffy or raises your head too high unless you are experiencing symptoms of snoring or sinus blockage. Temporary elevation of the head may help these symptoms, but may cause neck pain or stiffness as a trade off.
  2. Place a pillow under your knees. Supported bent knees helps decrease the amount of extension forces on your low back and keeps your lumbar spine in neutral.
  3. Place a small, flat pillow under your low back to support your lumbar curve. You can use a rolled up towel for this as well. If you tend to switch positions throughout the night from sleeping on your back to on your side, leaving a medium sized towel rolled up across the middle of your bed may be helpful so that there is support under your waist when you are on your side, and support under your low back when you are on your back.

Other Ideas to Improve Your PM Comfort

Use a sound conditioner or ear plugs. Sound conditioners and ear plugs can help you deal with background noises that may awake you in the middle of the night. Uninterrupted sleep will do wonders for you in the morning.

Low Back Pain (LBP) is an epidemic in our modern society. LBP is reported as the #1 reason for missed work and #2 reason for seeing a doctor. According to National Institute of Neurologic Disorders and Stroke (NINDS), Americans spend over $50 billion each year on the evaluation, diagnosis, and treatment of LBP. It is the second most common “neurological ailment”; second only to headaches. Many clinicians and researchers estimate that 70-85% of people will experience LBP at some point in their lifetime.

AN ANATOMICAL APPROACH TO THE PROBLEM

LBP is a “catch-all” diagnosis. There are many structures in the spine that can cause pain. It is important to see a physician for a diagnosis and a good physical therapist or chiropractor to address your particular movement impairments and functional limitations.  Here is a list of the most common causes of LBP:

• Intervertebral discs: There is a disc between each vertebrae.  These discs allow for smooth movement and shock absorption.  Discs are frequently injured as a result of repetitive activities and trauma and can degenerate with age (more on bone loss).  Terms used to describe disc injuries include “herniated disc” or “bulging disc”.  If a disc is the source of LBP, the pain is usually aggravated by bending and twisting motions. Activities such as reaching down to tie your shoes or sitting for a long period of time can increase pain.  Also, quick movements such as a cough or sneeze can be painful.  Pain may be felt on one or both sides of the spine, and can be accompanied by nerve root irritation.
• Facet joints: These are the joints that, along with the discs, connect adjacent vertebrae.  Often these joints become dysfunctional and restricted into certain movements.  Facet-induced LBP usually affects one side of the spine more than the other.  It generally stays more localized than disc pain.  Painful movements include extending the back, leaning towards the side that is painful, or twisting.  Activities such as walking, running or reaching behind you to pick something up may be painful.
• Soft tissue: This includes fascia, superficial muscle, deep muscle (read about muscle strains).  Pain associated with soft tissue restrictions can present in any number of ways depending on which tissue is involved.  Generally, an active contraction or stretch of the affected muscle will elicit symptoms.
• Nerve roots: This is often referred to as a “pinched nerve”.   Nerve root pain can be experienced locally in the back, but it can also radiate down into the buttox and legs (sometimes called radiculopathy or radicular symtpoms. “Sciatica” is an example of this.)  As aforementioned, an injury to the intervertebral discs can precipitate nerve root pain as well.  Nerves from the spinal cord exit the spinal canal thru foramina (holes) between each vertebrae.  If a disc is injured it can impinge upon a nerve (“pinch”), and this prolonged compression creates pain both in the spine and down the length of the nerve (some of these nerves go all the way to the feet!).  This pain can be aggravated by similar activities as were mentioned above in the section on intervertebral discs.
• Degenerative Changes: Discs can degenerative over time.  The vertebrae also can become compromised by degenerative changes such as arthritis.  Pain from “Degenerative Disc Disease” is variable.  EVERYTHING can cause pain; bending forward, leaning back, twisting, anything!  A common arthritic condition affecting the vertebrae is termed “Spinal Stenosis”.  This is a narrowing of the spinal canal or the foramina (“holes”) through which the nerve roots exit the spinal canal.  Stenosis often causes pain both in the back, and radiating into the lower extremities.  It is generally made worse when the back is extended (or fully erect to neutral) and thus leaning forward tends to ease the pain.
• Fracture: Compression fractures can occur due to a fall or impact injury.  A spondyloslisthesis can occur as a result of a fracture in a particular part of the vertebrae.  Pain from fractures varies.  Generally a compression fracture will result in pain with bending and twisting, while pain from a spondylolisthesis occurs while extending the back.  Diagnostic imaging is needed to confirm these diagnoses.

OTHER THINGS TO RULE OUT:

Only a physician can rule out other, potentially more serious causes of back pain. These include:

• Cancer: Some common questions used to determine a person’s susceptibility to cancer / likelihood of having cancer are: Do you have a prior history of cancer?  Do you have a family history of cancer?  Are you over 50 years old?  Have you experienced recent, unexplained weight loss?  Do you have a constant fever or night sweats?  Does the pain remain constant, even while resting?  If you answer yes to any of these questions it is typically a red flag, and a clinician will want to rule out cancer, using diagnostic tests.
• Referred Pain From Internal Organs: Some organs that can refer pain to the area of the lumbar spine include the ovaries, uterus, testes (pelvic organs), kidneys, urinary bladder (retroperitoneal organs), pancreas, large intestine, and the sigmoid colon (digestive organs).
• Abdominal Aortic Aneurysm (AAA): This is a sac formed by dilation of the wall of the aorta.  Pain associated with AAA has been described as throbbing and pulsating.  No postural or positional changes alleviate the pain.  This is a medical emergency!
• Endometriosis: A condition in which the tissue that normally lines the uterus (endometrium) grows in other areas of the body.  Signs and symptoms include pain, irregular bleeding, and possible infertility.
• Psychological Factors: Some say that the the mind induces physical pain to serve a psychological purpose (Dr. Sarno).  Under this theory, the pain serves to distract the mind from some more disturbing, repressed psychological conflict.  It is a form of self-preservation.  On the other end of the spectrum are those who believe that pain is purely physical.  The majority of health care practitioners recognize both the physical, structural mechanism for pain and the psychological and emotional factors that affect the pain.  A good definition of pain addresses both the mind and the body: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (from IASP, Subcommittee on Taxonomy, 1979).

LBP is an epidemic that is complex in nature.  Diagnostic and treatment approaches vary.  In Part 2 we will discuss some conservative treatments that can help manage LBP and hopefully alleviate the symptoms.