Slumber is a time for recovery and recuperation. In addition to preparing you for the challenges of the following day, sleep involves various physiological functions vital for processes like digestion, cell repair, and growth. But suboptimal resting conditions can negatively impact more than just energy levels and autonomic functions.
Have you ever sat through a movie and left with neck or back pain? Imagine resting in a harmful position for triple that amount of time. You may not need to look any further than your sleeping conditions to address your aches and pains. Read below to learn more about how to identify common pain related issues associated with sleep, and the steps you should take to alleviate them.
A Special Mention for Headaches
You should feel rejuvenated after a good night’s sleep. Unfortunately, some of us may awaken with a headache. Headaches often linger, making the ability to concentrate or tackle the day’s tasks challenging.
The pain from tension-type headaches is often symmetrical and distributed in a band-like pattern. They may be associated with stress or poor posture. Compared to other types of headaches, tension headaches are more easily aborted with massage, using heat or ice on neck musculature, and nonsteroidal anti-inflammatory drugs (NSAIDs). If you have identified this type of headache as being related to your rest, take steps to address the positioning of your cervical spine (see Neck Pain section below). If bruxism (teeth grinding or clenching) is suspected, it is best to seek the advice of a medical professional.
Your morning headache may also be associated with sleep apnea – frequent and dangerous arrests in normal breathing during sleep. Though this type of headache may be difficult to discern from other types, the commonly associated symptoms can point you in the right direction. Frequent awakening at night, dry mouth, waking up gasping for air, snoring (a loved one may have a better idea), and excessive daytime sleepiness are commonly found in those with sleep apnea. Elevating your head while resting and weight loss can help, but if suspected, the first step should be to see your primary care physician.
More serious yet, awakening with a headache can be associated with derangements to intracranial pressure (the pressure in your skull). These headaches are often related to body positioning and worsen while lying down, bending over, or any activity that increases the pressure within your skull. If these headaches seem to be associated with constitutional symptoms such as fever, night sweats, change in appetite, weight loss, or fatigue be sure to seek care from your physician.
Neck (Cervical Spine) Pain
Waking up with neck pain can be, well, a pain in the neck. This common ailment can be related to any number of activities, so finding relief requires careful attention. To best identify the source, be sure to take note of when the pain arises, activities that exacerbate it, associated symptoms, and where the pain is located.
As it relates to sleep, neck pain is often reflective of suboptimal positioning of your cervical spine. Ideally, the entirety of your spine should be in a neutral position. Resting for hours with unusual and exaggerated bends in your spine is a surefire awaken with pain.
For back sleepers, it is relatively easy to accomplish a neutral cervical spine. The trick is to position your pillow behind your head and neck. Placing your pillow too high (i.e. only behind your head) can result in increased neck forward flexion. Also, ensure appropriate thickness of your pillow as a pillow(s) that are too thick can also place you in too much forward flexion. Through trial and error, determine if a firm pillow, a thick yet soft pillow, or 2 thin pillows places your cervical spine in a neutral position.
For complete support of their neck and to ensure neutrality, side sleepers must fill the negative space bound by their bed, shoulder, neck, and pillow. Simply placing a pillow at the level of your head leaves your neck unsupported (and thus, working all night). Also, you may spend hours in lateral flexion and/or rotation. I recommend filling the negative space by folding a pillow in half, and wedging it so it is in contact with your head, neck, and traps. This may similarly take trial and error.
I do not recommend stomach sleeping as having your cervical spine in full rotation for long periods of time is unavoidable.
Shoulder pain is also commonly associated with sleep positioning, typically the unwanted effect of side sleeping. Structures in your shoulder are numerous – pain can be associated with bony, muscular, ligamentous or other structures. As with anything, listen to your body. Keep in mind that sleep may simply exacerbate an underlying issue rather than represent the actual source. Be sure to use the tips in the previous section to gain a better understanding of your pain.
If you awaken with shoulder pain, simply sleeping on your back (best case) or on the other shoulder can provide relief. The underlying issue may be little more than your shoulder’s inability to bear the weight of your body for hours at a time. Morning pain in the shoulder that is not in contact with the bed during sleep may be related to its inability to relax overnight. This can be remedied by ensuring the shoulder is in its resting position – neutral rotation and about 30 degrees of abduction. More simply: wedge a pillow in your armpit to achieve this position. Use trial and error to determine a thickness that is most comfortable. This allows your shoulder to truly rest rather than having a variety of muscles fire even as you sleep.
Those with rotator cuff (these muscles provide dynamic stabilization for you shoulders) tendonitis can similarly awaken with pain in the shoulder that is in contact with the mattress. In addition to waking with pain, you may notice pain with overhead movement, difficulty keeping you arm elevated, or even pain that wakes you from slumber. Though this may be remedied by back sleeping or switching sides, it is best to seek the care of a physician for a more comprehensive plan.
Back pain is another common complaint that has a wide variety of underlying causes. Again, keep a watchful eye over activity that worsens the pain, associated symptoms, and the location of the pain as sleep may not be the source.
Most often, the pain is located in your lower back. This can be muscular or related to your lumbar spine. Again, I don’t recommend stomach sleeping as this position is less than ideal for your cervical spine (see Neck Pain above), and also causes your abdomen to sink into the mattress creating an increased lordotic (back arch) curve in your lumbar spine. If you must sleep in this position, remedy this issue by placing a thin pillow underneath your stomach to prevent back arching.
Back sleeping can also prevent you from maintaining the ideal curve of your lumbar spine. Pain with rest in this position can be alleviated by placing a pillow(s) under your knees to gently flatten your lower back against the mattress.
Your lower back may similarly ache upon awakening if you opt for side sleeping. Again, this is often related to positioning. Relief can be achieved by utilizing a body pillow. The great length of these types of pillows allow for bear-hugging with your arms, and straddling with your legs. The purpose here is also to maintain a neutral spine.
Hip pain that arises during rest are similar to those found in the shoulder. Both the hip in contact with the mattress, as well as the contralateral hip, may be painful in the morning. Just as we have learned already, there are numerous structures that can all have a varying role in the actual source of pain – listen to your body!
As seen in the shoulder, pain in the hip that is in contact with your bed can arise from an inability to bear load throughout the night. This is the hallmark sign of a hip bursitis (your bursa is a fluid filled sac that reduces friction between bone and soft tissues). Sleeping on your back or the other hip can provide relief, in addition to rest, ice, elevation, and NSAIDs. If the pain persists, seek the opinion of you physician.
Pain in the hip that is not in contact with the bed can be relieved by allowing the muscles surrounding this joint to relax at night. Straddle a pillow to reduce strain on the hip while you rest.
The Take Home Message
Sleep should ensure you are energized to take on the challenges of the next day, as well as provide ample time for physiologic functions vital to overall health. Waking up with aches and pains can leave you feeling flat. Keep a watchful eye to determine if your sleeping conditions are causing or exacerbating pain. The following tips can provide relief to some of the most common sleep related issues.
- Headaches can be associated with neck pain, sleep apnea, or increased intracranial pressure. Fill the negative space between your neck and the bed with a folded pillow. Seek medical care for suspected sleep apnea or positional headaches.
- Neck pain can be relieved by maintaining a neutral cervical spine. Whether a back or side sleeper, ensure adequate support of your neck without forcing your cervical spine into too much forward flexion, lateral flexion, or rotation.
- Limit shoulder pain by sleeping on your back or the opposite shoulder. Ensure the shoulder that is not in contact with your mattress is truly at rest by placing a folded pillow in your armpit. If rotator cuff injury is suspected, seek medical care.
- Back pain can be addressed by placing a pillow under your stomach if you are a stomach sleeper, a pillow under your knees if you prefer rest on your back, or by straddling a pillow if you opt for side sleeping.
- Hip pain can be addressed by avoiding contact of the painful hip with the mattress, back sleeping, or straddling a pillow. For a suspected hip bursitis that is unresponsive to rest, ice, elevation, and NSAIDs, seek medical attention.
Author: Anthony Dugarte, M.D., C.S.C.S
Dr. Anthony Dugarte has enjoyed success in academics, as well as collegiate sports. He accepted a full athletic scholarship to attend Kent State University and graduated, Cum Laude, with a B.S. in Exercise Physiology. While at Kent, Dr. Dugarte was a member of the Golden Flash Football Team and earned Academic All-American Honors as a defensive lineman.
Prior to continuing his education, Dr. Dugarte worked as an Exercise Physiologist in an outpatient physical therapy. During this time, he became a Certified Strength and Conditioning Specialist and now boasts over 10 years’ experience in the field.
A 2016 graduate, Dr. Dugarte obtained his medical training at Case Western Reserve University School of Medicine. Most recently, Dr. Dugarte completed a postgraduate Research Fellowship in Orthopaedic Trauma at Regions Hospital in St. Paul, Minnesota. While a fellow, he garnered invaluable experience in virtually every aspect of the research process. While he plans to continue his training in an Orthopaedic Surgery residency, Dr. Dugarte is passionate about sharing the knowledge he has acquired through creative and technical writing.