Written by Peter B. Derman, MD, MBA
The average person spends about a third of their lifetime in bed. For those suffering from neck and back pain, optimizing sleep characteristics may be a way to alleviate symptoms. There is an abundance of information available recommending various sleep positions or products, but much of this is anecdotal. Filtering through the hype and misinformation can be difficult. Fortunately, there have been some rigorous research studies performed on this topic. Read on to learn what science really has to say…
Mattress Selection
The conventional wisdom that a firm mattress is required for good spine health is not necessarily true. Several studies have been performed that support the use of medium-firm mattresses to reduce pain. One such experiment found that people who switched to a new medium-firm mattress experienced an average of 48% less back pain over the course of four weeks.
However, body shapes and sizes differ from one person to the other, and the best mattress for one person might not be good for another. A mattress should keep the spine well aligned over the course of the night. In side sleepers, a mattress that is too firm does not allow the shoulders to sink down sufficiently, and a mattress that is too soft allows the heavier pelvis to sag excessively – both of these scenarios result in a poorly aligned spine and potentially more pain and stiffness.
Finding the right mattress for your spine can therefore be a process of trial and error. Laying down on one for a few minutes in a mattress showroom may not be enough to make a judgement. Consider trying out a new mattress that comes with an extended money-back guarantee so that you have time to really give it a test drive. There is evidence that beds that allow you to actively control the firmness improve spinal alignment, sleep quality, and back pain – this way you never have to make a final decision on firmness, and you can even adjust it based on your current sleep position. Some adjustable mattresses have multiple zones that provide customers with even more control.
Pillow Selection
There is no shortage of pillow options, each of which is touted as a cure for neck pain. A plethora of materials and shapes are available. However, the scientific evidence in support of specialized designs is limited. In fact, a review of the literature concluded that there is not sufficient evidence to recommend the use of specialized cervical pillows over a traditional pillow for reducing neck pain. Pillow height has been associated with changes in neck alignment during sleep so side sleepers might consider a taller pillow, back sleepers may benefit from a flatter pillow, and stomach sleepers might not use a pillow at all.
People often initially rate softer pillows as more comfortable, but the degree of support and resulting spinal alignment change significantly with time, even within the first 10 minutes of using a pillow. So as with mattresses, it is important to spend some time with your pillow before making a final decision. And while no one material has been convincingly been shown superior to the others, people with allergies should avoid materials that trigger them (e.g., down) or consider a pillow cover that protects against dust mites and allergens.
Sleeping Position
Now you’ve found the perfect bed and pillow, but how should you be lying on them? The scientific literature on this subject is somewhat sparse and not completely consistent, but it seems to suggest that sleeping on your side is protective against spinal pain. Sleeping on your back or stomach may increase the risk of low back pain, possibly because it increases the amount of pressure on the small joints in the back of the spine. However, the results of another study suggest that a combination of side and back sleeping, with a pillow between the legs in the former and under the knees in the latter, is effective for reducing back pain. So sleeping on your side is likely the safest bet, but some back sleeping might be permissible as well.
Wrapping it Up
Finding the right mattress, pillow and sleep position is a process of trial and error. There is no single perfect combination that works for everyone, but minding the above recommendations will guide you in the right direction and help you avoid all the hype. Keep experimenting to find the optimal sleep environment for you. Sweet dreams!
About the Author: Dr. Peter Derman is a minimally invasive and endoscopic spine surgeon at Texas Back Institute. Dr. Derman spends his time helping patients, conducting medical research, and exploring ways to better medicine for future generations.