I have a confession to make. It’s tough to talk about, especially as someone who often finds herself speaking from a place of authority on the topics of spinal health and neurological hygiene. I mean, I don’t want to destroy the flawless postural image you all have of me in your heads, but it needs to be said:
I, Dr. Pamela Woodward, was a stomach sleeper.
For years, I would find myself only falling asleep once I made my way to my stomach, one leg pulled up, hugging a pillow. Usually head turned left. And I saw nothing wrong with this.
That was until I became more body-aware through chiropractic care and school. I started to notice the positions I was contorting myself into while studying, watching TV, and, yes, while sleeping. All of a sudden I realized that if I was going to talk to others about taking care of their spines, I would have to make a change myself. Little did I know, this would be a task easier said than done. But I have emerged victorious…and I believe you can, too.
What’s The Big Deal?
Much has been made of the psychology of sleep positions and the health benefits of various sleeping postures in the last year. Sleeping on your side means lopsided effects of gravity and a desire to be comforted. Lying on your back means openness and improved circulation. The lists go on and on. I’m not really speaking on those types of observations; all I’m trying to comment on are the effects of your sleeping posture on your spine. Trust me, there is plenty to say on that topic alone.
Why do we care about sleep posture at all? Many are of the camp that if I’m able to be comfortable enough to fall asleep, it can’t be that bad. Well I’ve seen plenty of pictures of sleeping toddlers and sleeping, um, let’s call them “grown-up toddlers” to refute that argument – I don’t think anyone would say that sleeping hanging off the side of a couch or flat on the kitchen floor with a bag of cheese curls in one’s hand is a good sleeping position. Consider that you spend (hopefully) six-to-eight hours a night in about the same posture. If you were to spend six-to-eight hours a day in the same posture without a break, I’m sure you would notice yourself growing pretty uncomfortable (Netflix marathoners and desk warriors, I’m looking at you). So why would it be any different when you are unconscious? Yes, the effects of gravity aren’t quite as detrimental because you are lying relatively flat, but the pressure of a leg or head pressing down over that period of time is still going to have an effect. Just like we should be considering our posture over the course of the day, we should be considering it at night as well.
Why Am I Sabotaging My Own Spine?
“But Dr. Pam, I can’t control what happens in my sleep? I try to fall asleep on my back, but I just end up on my stomach eventually anyway.” I hear this all the time. First things first: be patient with yourself. It takes time to break old habits and build new healthier ones. I know that when I am especially stressed, I tend to revert to my previously banished sleeping postures. It’s my body’s defense mechanisms subconsciously kicking in while I sleep. What does that look like? Picture an angry cat ready to pounce: flexed limbs, raised shoulders. That’s what defense posture tends to manifest as. It’s incredibly common in a high-stress society. Even when they’re awake, patients don’t recognize that their necks have disappeared into their trap muscles. This stress doesn’t just dissipate when they fall asleep. The trapezius muscles, now tight and contracted, stay that way all night. A leg (or two) has to be curled into the chest to account for a shortened hip flexor. Tight muscles in the chest bring the arms curled forward. Knots at the base of the head tip the chin up, while an imbalance from side to side causes the head to rotate to the left or right. Try to put yourself into this position now (if you aren’t already in it) – not so fun, is it? This is defense posture, and it takes some deconditioning to get out of it.
How to Sleep
Something so instinctual shouldn’t be so difficult! There are plenty of things that you can start to do to reduce your stress levels to allow yourself a fighting chance of relaxing your wound-up system. Many people swear by spraying or defusing lavender oil in their bedrooms. Some deep breathing and meditation before bed goes a long way for me, personally. Make sure your room is dark and cool. Try not to look at a cellphone or other screen just before bed – there are plenty of studies that link this habit to insomnia, since the lights wreak havoc on your internal clock. And of course regular chiropractic and massage can do wonders for re-aligning your spine, relaxing tight muscles, and getting your nervous system to settle down. These things alone may have you finding yourself in a more advantageous sleeping position. A close friend of mine actually knows he needs an adjustment these days not by whether or not he’s in pain, but because he ends up with his blankets in a knot as opposed to completely undisturbed. When he’s in alignment, he sleeps like a baby – tossing and turning means it’s time for a visit with our mutual chiropractor!
But how to break your own habit in the meantime so you end up less sore in the mornings? Firstly, let’s talk about what we’re aiming for here: a neutral spine. Viewed from the front, the spine should look like a nice, straight line. Looking from the side, there should be a gentle set of curves. Those side curves, though, should have the ear over top of the shoulder and the shoulder over top of the hips. It’s important to keep this normal anatomy in mind when choosing how you’ll be sleeping.
Ideally, I like to see my patients sleeping on their backs (well, not see them, but you get it). A properly supportive mattress will conform to the curves of your upper and lower back. A pillow under the knees is helpful as well. The trap many back sleepers fall into is that they sleep with too many pillows under their head. All you need is one – if that! Personally, I prefer to sleep with a small rolled towel supporting the curve of my neck, with my head resting on the bed itself. This allows me to feel supported without putting too much flexion in my neck. For a person that is trying to become a back sleeper, I recommend keeping a pillow nearby in case you roll over in the middle of the night – more on that later.
If someone is completely opposed to the idea of sleeping on their back, they can still find a good side sleeping position. Again, we want to keep the spine neutral. This means a pillow between the knees so as not to stress out the hips. It also means finding a good pillow. This pillow should be supportive enough that it takes up the space between your head and your shoulder (which in men especially can be quite a distance). It also means that you don’t want too many pillows, pushing your head the other way. We’re aiming for a straight line, nose to belly button. To support the low back, especially in pregnant women, many find comfort in putting a pillow behind their back as the sleep. My husband basically builds himself an entire pillow fort, but at least he’s taking his spine into consideration, even if it means my bed real estate is minimal.
Stomach sleepers, I’m sorry, but I can’t give you much more advice than to break this habit! Having the head turned to the side is a sure-fire way to develop a muscular imbalance when you’re trying to breathe at night. An unsupportive mattress will increase the curve in the low back, resulting in pain there too. Oftentimes the arms up over the head will cause shoulder pain, and rotation to the side to pull one knee into the chest (due to shortened hip flexor) can throw the entire spine in to a torsional pattern. Remember, I’ve been here – I know how cozy this can seem when you’re first getting to sleep. Still, with these types of detrimental effects on hand, it’s time to make a change. I did this by way of pillow-bracing. You can also go extreme and tape a golf ball inside your pajama top – no one wants to sleep on that. The goal is to make it uncomfortable for you to roll on to your stomach and stay there. I personally found that stretching out my hips and shoulders with some gentle yoga before bed coupled with getting adjusted made it much easier to fall asleep on my back, especially while I was forming the new habit. It takes some practice. And be easy on yourself! You will have nights that you fall asleep perfectly positioned and wake up back at square one. Just start again the next night, add an extra pillow and schedule with your chiropractor – you can do this!
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