Sleeping With Lower Back Pain, Neck Pain, and Shoulder Pain
Quality of sleep and the pain you experience go hand in hand. Whether you have chronic pain or just “slept in a funny position” you’ve experienced stiffness or soreness in the morning. Aches and pains can keep you from sleeping well or cause you to wake up during night. If that describes your situation, you’re not alone. Chronic pain interrupts the sleep of 20% of Americans multiple times per week.1 It’s a vicious spiral that can reduce your quality of life. Equally as important, quality sleep allows your body to recuperate and gives you the mental energy to face your day fully.
A 2013 study found that poor sleep is a RELIABLE predictor for the worsening of existing pain or development of new pain. It goes on to say that poor sleep likely interferes with your body’s natural pain management processes.2
You might be surprised to learn that poor sleep can actually cause you to feel more pain than you would otherwise and quality sleep can reduce your sensitivity to pain.2 Research has found that pain intensity can be greatly affected by the number of hours you slept the night before.3 Armed with this information you can see how important it is to manage your pain during the day and get the best sleep possible at night. With a healthy sleep routine, you may even be able to reduce the amount of pain medication need to take.
Your healthy sleep routine needs to be built on good sleep habits. We know that it takes about three weeks for a habit to become ingrained. Pick a few things from this list and dedicate yourself to making the changes for 21 days. You have to give yourself a chance to succeed. If after 21 days you think the routine is working, it will be that much easier to continue because you’ve already built the habits.
How to Fall Asleep
Don’t Force It
Only go to bed when you are tired. This might sound obvious, but for some it’s not. If you can’t fall asleep due to your mind racing or simply not being “sleepy”, get out of bed and do some other activity for a bit. Read a book or the newspaper, meditate, work on a puzzle or crossword, or write in a journal. Don’t use an electronic device or watch T.V. It has been extensively studied and proven that the blue light from those devices inhibits your ability to fall asleep. Try to fall asleep again after 20 – 30 minutes. On a bad night you may have have to get out of bed a second or third time. Just go with it. There’s no point in getting stressed and making it even harder to fall asleep.
Simple Sleep Solutions – Prepare Yourself
Establish a Sleep Schedule
When your sleep schedule has been irregular your body’s hormone production can be disrupted. Melatonin (sleep), cortisol (stress), and insulin (blood sugar) have all been shown to be affected by your sleep pattern.4
When your sleep schedule is irregular your body may not produce those hormones at the times and at the levels necessary for normal function. When you wake up, getting outside and letting the sun hit your skin can help reset your “body clock.” Establishing and sticking to a wake-up time and bedtime allows your natural circadian rhythm to get grooved in. As your hormone levels normalize you should be able to fall asleep and stay asleep more consistently.
Don’t Nap During the Day or… Take a Nap
There is some conflicting information on taking naps. You have to do what makes sense for your energy levels. If possible, you should avoid taking naps during the day. For most people this makes sense. It allows you to build towards your maximum level of tiredness so you can fall asleep more easily. But if you need to nap during the day in order to have enough energy, go for it. Try to schedule the nap at the same time everyday too and keep it as short as possible. If you can, take your nap in the early afternoon to avoid affecting your bedtime. Generally, a 5 – 20 minute nap will help you recharge without making you feel foggy.
Exercise
You’ve heard this before. Exercise before going to bed. But that’s not the whole story. Exercise produces endorphins and increases your body temperature, both of which keep might keep you awake. The trick is to exercise at least 2 hours before you want to go to bed. You should exercise with an appropriate intensity for your fitness level, but don’t just go through the motions. It can be helpful to push yourself just a little so you are more tired. Anyone with chronic or acute pain may have limits in this regard. If you have access to a pool, utilize that! Water-based exercise can take a lot of stress off of your joints while still getting your heart rate up. Something you can actually do just before bed is to stretch gently. You just want to loosen any tight muscles and relax so that you can get into a comfortable position when you’re sleeping. Of course, follow any advice and warnings from your medical providers. You’re trying to manage pain not increase it.
Relax in the Bath
Just like exercise, many sources advise taking a bath before bed. A bath or shower can help you relax, but it will also increase your body temperature. A more effective was to use this advice is to work the bath into your bedtime routine. Time your bath so you’ll be done at least an hour before you want to go to bed. Turn down the temperature in your bedroom so that the it will be cool when you’re done bathing. After you you get out of the bath, do some reading or other light activity until it’s time to go to sleep. Then go to bed relaxed, cool, and comfortable.
Avoid Late Day Caffeine
Lots of folks use caffeine to jump start their day or to power through the afternoon. Unfortunately, having caffeine even six hours before bed can reduce your quantity and quality of sleep.5 If you need an afternoon boost plan to do have it as early as possible to avoid conflicts with your sleep schedule.
Watch Out for Spicy Food
If you’re trying to improve your sleep this one is worth a shot, especially if you’re sensitive to spicy foods. Indigestion and heart burn are fairly common with spicy meals. That discomfort can affect your ability to fall asleep. The capsaicin in chili peppers can also raise your body temperature. So, while it can be good for weight loss, it’s not helpful when you’re trying to go to sleep.
Alcohol Does Not Actually Help With Sleep
Despite what some people might think, alcohol is not a good sleep aid. Although it can make you feel drowsy, the effect is misleading. Alcohol triggers receptors in your brain to make you feel tired. After about five hours those receptors stop responding to the alcohol AND your body’s natural triggers. This causes your brain activity to increase in the middle of the night and wake you up. It takes about three drinks for an average person to really feel this effect.6 But why not give yourself the best chance at a good night’s sleep? Having to wake up to use the toilet more frequently is also common with alcohol consumption.
Prepare Your Bedroom for Sleep
Treat the bedroom as a “bedroom activity” only zone. By only using your bedroom for sleep and other bed related activity (you know what that means), you can condition yourself to use the space for what it is intended. You will subconsciously start preparing to go to bed when you are in that space. Try to keep all other activities outside of the bedroom; including reading, work, and web surfing.
Keep Excess Light Out
When your eyes detect light your melatonin production decreases. Your eyes can even “see” low intensity lights when they are closed. Move or block nightlights and digital clocks in your bedroom. If the moon or street lights shine into your room, pull the shades or consider blackout curtains. Place nightlights in hallways or other strategic locations so that you can see your way to the bathroom at night without turning on the main light or tripping over things. If those solutions aren’t possible, a sleeping mask might work for you. They are relatively inexpensive and do block almost all light from your eyes.
Make it Quiet
Strange or loud sounds can even wake up heavy sleepers. Do whatever you can to minimize noise interference in your bedroom. Close all the windows and doors. A rolled-up towel or t-shirt at the base of a door can block additional sounds. Many people use a “white noise” machine to drown out external sounds. Your options for that range from “sleep machines” you can buy online or in stores, mobile apps on your phone, or just turning on a table fan in your room. Soft earplugs block an impressive amount of noise. You can choose from silicone pads, rubber plugs, and compressible foam plugs. You should also let anyone else in your house know that you are going to bed so they can behave accordingly.
Adjust the Temperature
Lots of us like to sleep under the covers. There’s something that feels good about being snuggled up under your blanket. That might be due to the body’s temperature lowering as we get close to bed time. The optimal room temperature for sleeping is about 65° Fahrenheit (18.3° C). If you have a thermostat or air conditioner set the temperature a little lower at night. If you don’t have one, opening a window or using a fan to circulate the air can help. A fan can serve double duty cooling the room and cancelling out extra noise.
How to Stay Asleep
Once you’ve made your bedroom as comfortable as possible and drift blissfully to sleep how do you stay asleep? The factors below will help you fall asleep too, but ultimately should help you sleep longer and more comfortably.
Sleeping Position For Pain Management
The key thing to remember about your sleep position is NEUTRAL POSITION. You want your skeleton resting in the most natural position possible. By keeping your spine, neck, shoulders, knees, and hips in a natural, unstressed, and supported position you put the minimal amount of strain on the soft tissues in your body. All of the recommendations below can help you maintain a neutral position.
Mattress Matters
You spend about 1/3 of your life on your mattress. Just based on how much use you get out of it, that makes your mattress a huge factor in your sleep quality. You don’t need to break the bank on the newest astronaut bed, but you do want one that is in good shape with no sagging or bowing. You’ll want to tailor the firmness of your bed to your preferred sleep position. In general, side sleepers will want a soft bed, back sleepers will want a medium to firm bed, and stomach sleepers will want a firm bed. If your bed is showing any bulging on the sides or sagging/bowing in the middle and you are waking up stiff, sore, or tired you’ll want to consider a new mattress.
Using Pillows
Pillows are a less expensive alternative to replacing a whole mattress. And for some issues they can make a huge difference. Standard shaped pillows conform to and support your neck’s cervical curve. You can find these types of pillows with contours, pockets to cradle your head, or “normal” pillow shaped. Pillow fill can be cotton or polyester fiber fill, shredded memory foam, solid memory foam, and other more “exotic” materials.
Cylinder Bolster Pillows
This shape a pillow can be beneficial because it more easily maintains your cervical shape and neutral neck position. Standard pillow shapes can raise your entire head elevating your neck out of neutral. Many people have shoulder pain or headaches that originates with cervical tension. Cylinder support pillows, even when used for shorter periods of time can help alleviate that tension and pain. If you aren’t a back sleeper starting your night out with a cylinder bolster and switching to a standard pillow later is an option. Make sure to use a pillow that is firm enough to support your head and neck. A mushy pillow won’t give you the position and support you need.
Different sized bolster pillows can also be used to support and isolate other parts of your body. You can take pressure off of “hot spots” by placing pillows under your ankles, knees, or arms.
Knee Pillows
These are really for side sleepers. If you have knee, hip, or lower back issues a knee pillow can help to keep your top leg from sliding downward. This will keep pressure off of you back and hips. The scalloped shape of the knee pillow will help it to stay in place. You can use a standard or cylinder pillow for this purpose as well. You’ll just have to be mindful of the pillow position through the night.
Body Pillows
A side sleeping position with a body pillow can help with multiple issues of you have room on your bed. By sleeping on your side with your free arm and leg on top of the pillow you relieve pressure on your shoulders and hips. You get similar benefits to a knee pillow and peace of mind knowing that a body pillow probably won’t shift on its own. By maintaining a higher shoulder position you are even helping to reduce pressure on your neck.
Lower Back Pain for Stomach Sleepers – Pelvic Sleep Pillows
You won’t hear of a lot of people using these pillows, but stomach sleepers can wake up with a sore or stiff lower back because of their pelvis being in a forward position while sleeping (anterior pelvic tilt). A pelvic support pillow is a relatively thin pillow that will help maintain a neutral pelvic position and keep extra pressure off of your lower back. A folded towel may not be as comfortable as a pillow, but it could provide enough “lift” to relieve your lower back.
Sleeping Upright
Sometimes it’s not possible to find a comfortable, neutral position while lying down. In that case try sleeping in a more upright position. Large “bed wedge” pillows can help you with this. Or you can try sleeping in a reclining chair with some sort of neck support pillow. The u-shaped travel pillows can be useful in this position.
Set Yourself Up to Win – Manage Your Pain
One of the best ways to give yourself a chance for recuperative sleep is to stay ahead of your pain in the first place. None of us want to take any unnecessary pills or deal with washing extra supplies, but a little preparation can make a big difference.
Hot Cold Therapy for Pain
One of the simplest and cheapest ways to manage your pain is to use hot or cold therapy as recommended by your healthcare professional. This can be an Epsom salt bath, ice pack, hot water bottle, warming plaster patches, and more. If you know one of these small things helps reduce your pain, don’t hesitate. Make whatever it is that works for you part of your nightly routine.
Natural or OTC Supplements
There are a ton of over-the-counter (OTC) and natural sleep aids to consider. The OTC sleep aids and supplements do carry warnings and some conditions will preclude you from using them. If you have never used them before talk to a medical professional about whether they are appropriate for you or not.
Almost all of the OTC sleep aids will contain diphenhydramine (Benadryl) or doxylamine succinate (Unisom). They are both antihistamines approved by the FDA to treat insomnia. The expert recommendation is to use this type of sleep aid for no longer than two weeks.7 Some users report drowsiness in the morning after using these at night, so follow the package directions and pay attention to how you feel in the morning. You may have to get to bed earlier or reduce the dosage.
The most popular natural supplement sleep aids are melatonin and valerian. Melatonin is a key hormone in your sleep cycle. Many people take it to deal with jet lag or sleep cycle irregularities. When I used to work a night shift I took 1 mg – 3 mg and that worked for me. Melatonin supplements are now sold in strengths of up to 10 mg. It can cause headaches or daytime drowsiness, so use it appropriately and adjust the dose to work for you. The studies on valerian are less conclusive.8 There is some data that suggests it can help with sleep. It does seem gentler that melatonin. So, while the sleep effect may not be as strong, any side effects should be mild too.
Prescription Medication
If your health provider prescribed you medication to manage your pain you probably need it. Even if you’re trying to take the minimum dose during the day, make sure to use it effectively just before bed. If the directions are flexible, ask your doctor or pharmacist what an appropriate amount should be. Your situation is unique, but there is lots of information available to your medical professionals on how medications should be used. Keeping your pain under control while you sleep will help you stay asleep and be better prepared to take on the new day when you wake up.
Summary
Sleep and Pain Sensitivity are Linked – The quality and quantity of your sleep has a direct impact on your ability to deal with your pains on a daily basis.
Prepare Your Bedroom – Manage the light, noise, and temperature in the bedroom.
Prepare Yourself – Develop a daily/nightly routine that supports your healthy sleep schedule.
Sleep Position – Neutral skeletal position relieves pressure. Upright sleeping is an option.
Physical Support (Mattress, Pillows, DIY) – A good mattress and support cushions can be game changers for your sleep comfort.
Medications and Supplements – Your should always consider the advice of your medical professionals. Prescriptions medications, when used properly are powerful tools for pain management. Supplements have less evidence to support their effectiveness, but have been shown to work for some people.
Give Yourself a Chance to Win – Dedicate yourself to making the changes for 21 days. Build good habits.
This is a lot to consider, but with these tools you have to ability meaningfully affect the quality of your sleep and potentially your overall pain. Pick a few of these solutions and implement them every day for the next 21 days. Even a small improvement in your sleep quality could make a big difference for your well being.
This website does not provide medical advice. The information on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
References
- https://www.health.harvard.edu/pain/how-to-sleep-well-despite-chronic-pain
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046588/
- https://www.swedish.org/services/pain-services/pain-management-guide/sleep-and-pain)
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372003/
- https://jcsm.aasm.org/doi/10.5664/jcsm.3170
- https://www.livescience.com/58990-why-drinking-alcohol-makes-you-sleepy.html
- https://www.uspharmacist.com/article/insomnia-and-its-treatment-with-nonprescription-products
- https://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/valerian/faq-20057875
