30 Families TODAY
The Importance of Sleep
by Matthew Goodemote for Saratoga TODAY It is not always that easy to determine the most appropriate course of action we should take when dealing with an injury or physical ailment. I am as guilty as anyone for believing misinformation that I have heard in the past or read on the internet. Most times the information has come from good intentions, but unfortunately we tend to take what others say as truth without fully digesting what they are saying and without questioning them either. I know there are a lot of people reading this that struggle with sleeping and mixed in the struggles are confusing beliefs about sleeping postures, pillows and mattresses. I am often asked about my recommendations for the best pillow and/or type of mattress that is “good for you and the health of your spine. I have also been told, by my patients, that they are certain positions we sleep in that are “bad” for us. Last week one of my patients asked me about the best pillow to sleep with and informed me that she already knew sleeping on her stomach was “about the worst thing
she could do for her neck.” This is why I am writing this article today. My typical response to my patients regarding sleep related issues is as follows, “if you fix the day, most times the night will fix itself.” Sleep is precious, but consider the possibility that what you are doing at night is not the main issue. Most of my patients report their pain starting during the day and now that their back or neck hurts sleeping has become difficult or painful, not the other way around. What frustrates me at times is the myth that is perpetuated regarding the “dangers” of activities and positions that are in and of themselves perfectly safe. So when my patient told me she was told by a practitioner she had seen in the past for her neck pain that sleeping on her stomach was, “one of the worst thing she could do for her neck!” Really? The “worst” thing you can do for your neck sure seems to me to be far more intense than a position you sleep in at night. Worse yet this myth is perpetuated to such an extent that some will think that I am the one that is misinformed. At the time of this writing I have been unable to find any solid evidence that supports this myth and although I am sure there are times when changing how we sleep may be healthy, the likelihood of “injury” or “damage” from sleeping simply makes no sense to me and how resiliant the spine is under far more stressful situations. Before I get into too much trouble for bringing this up, I am aware that there are people that will have pain from ANY prolonged position and I am in no way suggesting that anyone should intentionally get into a position to sleep in that they feel pain from or brings any other symptom that
“prevents” them from sleeping. My point is quite the other way of looking at this scenario. If you have NO pain while sleeping in a particular position, including but not limited to your stomach, and you have no “new” symptom as a result of the position that lasts more than a few minutes (because let’s face it, if you fall asleep with your arm in a weird place, you may wake up with it tingling because it “feel asleep.”) Maybe what we are doing during the day is causing the pain and sleeping is difficult only because the neck hurts first during the day... not the other way around. The point is that sleeping is NOT dangerous and there is no physiological way that I am able to think of that would make a particular position “harmful” to the spine. I trust the body far more than I trust an opinion...even an expert opinion. If/when the body is sleeping and you are in a position it doesn’t like you will either move while sleeping, or wake up so you can change positions. So, again, you may have pain but the positions are not what “causes” injury or damage. There are far too many variables to blame the sleeping position as the “worst” thing you can do. In fact, if you asked me, I would say sitting for hours on a computer slouched causes far more issues for the neck than the position you sleep in at night. But even slouched sitting isn’t the worst thing I can think of to hurt the neck, it’s more likely to produce neck pain (or lower back pain) in my opinion. So, when this patient asked me about what pillow to use, I first asked if she was having difficulty sleeping due to neck pain. She said no. So I said the pillow you are using is fine. She was shocked that I didn’t think the ergonomic pillow was more helpful. What matters is what works for you individually. So my recommendation is to find what you like and stick with that. And IF you are going to try a new pillow, please keep your old style just in case so you can go back to it if/when the new one doesn’t help like you hoped. When I first started my career I treated a patient that was 65 years
Week of July 18 – July 24, 2014 old suffering from her first episode of lower back pain. This was unusual because lower back pain often affects us earlier in life. Anyway, she told me how her kids, in an effort to help prevent back pain (which remember she had never ever had in her 65 years of life) bought her a new “firm” mattress because “firm” is good for your back... right? In her case, NO, it was not good. Worse yet they threw out her old lumpy mattress so she was not able to go back to the old bed even though she hated the new mattress. Fortunately she had a couch and she was able to get some sleep on until she found a mattress that would work. About 10 years after this episode, I read a study that was conducted in Europe regarding the “best mattress” style to sleep on. Interestingly the best mattress turns out to be the one you like the best as an individual. There were a lot of people that liked firm mattress, just like there were people that slept better on soft mattresses. Surprisingly (not really) most preferred a medium firmness. Just like Goldilocks said about the Three Bears’ beds she liked the one that was, “not too hard and not to soft, but...just right!” If a person sleeps through the night without pain and wakes in the morning without pain, why would we need to change the position, pillow or mattress style? If a person with neck or lower back pain had no difficulty sleeping before their issues started, why do we now believe the position is the issue, the mattress is the issue, or the pillow is the issue? I will acknowledge that the possibility exists that people only have night pain and during the day their pain and mobility are normal, but this is extremely rare and in 18 years of working as a PT, I have never seen it happen. But possible? Sure. And for those folks I would like still try to find a way to help them alleviate their pain in the middle of the night without trying to change their mattress, pillow or sleeping posture. My next question is, “What person stays in the exact same position throughout the night.” As far as I know when we fall asleep our body moves into several different positions throughout the
night. This is not something we do on purpose, it is more that our body does it while we are sleeping. So just because you start on your side, does not mean you will stay on your side (or back or stomach). If you have any doubts check out the videos from sleep labs. People move in all different directions and get into all kinds of positions. I have never seen evidence that people literally don’t move or change positions at night. So the obvious question is, how can it matter what position we fall asleep in, if we are changing positions throughout the night? My recommendation is to fall asleep in whatever position is most comfortable and if you wake up, then find a position that is comfortable to fall asleep in, no matter what it looks like. I often recommend exercises for people to try to alleviate their pain so they are able to fall back asleep. This seems far more beneficial because it is something they can do no matter where they are and no matter what bed they are sleeping with and no matter what pillow they are given. The bottom line is: The best position for you is the one you sleep the best in. The best surface is the one you sleep best in. And the best pillow is the one you sleep best with. It is kind of silly to think that every person, every body type, every neck or every back will benefit from the exact same approach. If this was the case then every person would respond to the same exact treatments...which we know is absolutely ridiculous. We are all unique and should look at the situation from a unique perspective. Hopefully this will hit home for some of you out there and if you are struggling with your nights look for solutions during the day. If you never had a problem with your position, pillow or surface before your neck pain started, perhaps the issue is not at night as much as your night is a problem now that your neck hurts during the day. I remain confident in our ability to find relief because for most of my patients this is the case. It is necessary at times to trust our bodies ability to guide us, but in order to do this we need to learn how to listen to it!