How To Set Yourself Up For a Better Night’s Sleep

by snorby, November 14, 2023

How To Set Yourself Up For a Better Night’s Sleep

By East Village Physical Therapy’s Daniel Sherman, PT, DPT, CMPT, BDN and Dan Halfman, PT, DPT, BDN, COMT, FAAOMPT

How well did you sleep last night?  Did you have a hard time getting comfortable?  Maybe you kept tossing and turning.  Did it take a long time for you to fall asleep?  Everyone agrees that getting enough sleep can be a game changer for our physical and mental well-being.  However, getting a good night’s sleep can be difficult for a variety of reasons.

Some of the most common orthopedic causes of sleep dysfunction are related to abnormal spinal alignment and poor structural support.  Fortunately, there are some basic things you can do to help correct these dysfunctions and improve your sleep tonight!

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What is “neutral spine”?

Neutral spine is a term used to describe the normal resting position of the spine.  In this position, the spine is relatively straight when viewed from the front and has an “S” shape when viewed from the side.  Of course, the spine is designed to move in and out of this position as part of our normal daily lives.  However, when external stress causes the spine to remain in an abnormal position for an extended period of time the tissues can become overstressed and painful.

How to achieve “neutral spine”

Side sleepers: 

The first thing to consider is your cervical spine or neck.  We want to make sure the head is not propped up too high or dropped down too low.  In either of these situations, the joints and muscles on one side of the neck are excessively compressed and shortened while the joints and muscles on the opposite side are stretched and strained.  Often this will result in waking up with a “kink” in the neck or a variety of other pain complaints.  Think of it this way; stand up tall and tip your ear to your shoulder and stay like that for 20 minutes.  Now imagine how that would feel after 8 hours!

The best way to avoid either of these compensations is to examine the height and the shape of your pillow.  Your head should rest supported in the center of the pillow and the border of the pillow should intimately fill the space between your head and shoulder.  This facilitates contact and support throughout the cervical spine.  The problem is there is no perfect pillow for everyone.  If such a pillow existed, then there would only be one pillow on the market!  Your physical therapist can help you identify which pillow may be best for you at your initial consultation.

The next area to consider is the thoracic spine, the part of your spine between your neck and low back.  Here, we want to avoid excessive side-bending and rotation.  Similar to our previous example with the neck, standing twisted for 20 consecutive minutes is usually uncomfortable.  Obviously, trying to rest in a twisted position for 8 hours won’t end well.

The best way to avoid twisting at your thoracic spine is to keep your top arm from falling forward or backward.  This can be achieved by using another pillow to support your arm.  The pillow can be placed in front of your chest if your arm tends to fall forward or behind your back/shoulder blade if you tend to fall backward.

The last area to consider is the lumbar spine or low back.  The lumbar spine’s primary functions are bending forward/backward and tilting side-to-side.  It does not respond very well to excessive or prolonged rotation.  During side sleeping, adequate hip rotation is required for the top knee to fall down to contact the opposite knee or all the way down to the bed.  If the hip cannot move enough, the mechanical stress is transferred into the lumbar spine in a rotational plane.  Often, people are familiar with the concept of “sleeping with a pillow between the knees.”  However, if the pillow is placed only between the knees, the top ankle remains unsupported and falls down to the bed.  This results in the hip rotating the opposite direction which can transfer stress to the low back.

So, the best way to maintain neural spine at the low back is to place a pillow between the knees and ankles simultaneously.  The pillow should be thick enough to keep your legs about the same distance apart as when you are standing comfortably.  It should also be dense enough to keep from collapsing under the weight of your top leg.

Back sleepers:

The same concept applies to those of us who like to sleep on our backs.  For the cervical spine, we want the head and neck to be supported and maintained in a neutral position.  If the head is tipped too far back or jammed too far forward then there is abnormal stress placed on the cervical spine and upper thoracic spine.

Make sure to have a supportive pillow that contacts your head and entire neck all the way down to your shoulders.  The height and density of the pillow should produce a good neural resting position.

For the lumbar spine, lying flat on your back can create the feeling of arching backwards.  This is especially true for individuals with tight hip flexors.  This position places extra stress on the joints of your low back and sacroiliac region.

The best way to neutralize the low back is to place a pillow under your knees to keep them elevated.  This will position your hips a small amount of hip flexion and help to unload pressure on your low back.  This is a similar position to what is referred to as “zero gravity” and can also be achieved with an adjustable base bed frame.

Of course, not everyone will need to use all of these strategies.  If you are experiencing pain, try one or more of these modifications for a few nights and see how you feel.  If you still have questions or decide you want to make an appointment, click here!

When is it time to see a physical therapist?

If you have tried the tips and tricks mentioned above and you are still having pain then it’s time to make an appointment.  At East Village Physical Therapy our clinicians have a combined 22 years of experience and advanced training in back pain management.  Schedule a formal evaluation or a free assessment and begin your journey towards better sleep!


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