By Dr. Michael J. Chamberland
Many people experience difficulty either falling asleep or staying asleep during the night. They wake up with increased body stiffness or discomfort, typically focused in the neck and shoulders as well as the lower back and hips. For some, this might be related to underlying degenerative, arthritic joints or a medical condition. For the rest of us, this is a frequent occurrence. It’s generally due to a combination of factors. The most typical ones are either due to what’s called, “sleep posture,” laying on your side or back. The other causes can be from the wrong type of mattress or pillow. Let’s discuss a few considerations and potential changes which might help reduce difficulty sleeping and prevent unnecessary morning stiffness and discomfort.
Difficulty Falling Asleep?
There are many reasons it may be difficult to fall asleep, but some are very simple fixes that can make dramatic changes. In addition to a comfortable mattress and the correct pillow for your sleep position and body size, here are a few things you can do to enhance your ability to fall asleep successfully each night.
*Be Consistent. Go to bed at the same time every night and get up at the same time every day, even on weekends and during vacations. Your body has a natural circadian rhythm, meaning hormones (serotonin and melatonin) are adapted to the natural daylight cycle as well as your regular sleep pattern.
*Make sure your bedroom is quiet, dark, relaxing and at a comfortable temperature. Although some people benefit from white noise, too much noise or light will distract and prevent settling into sleep. A good sleep temperature is typically 62-67F, which is somewhat dependent on how many layers you are wearing as well as the type of bedding. Too much noise will prevent you from relaxing.
*Remove electronic devices. Too much screen time/bright from TV’s, computers and smartphones prior to going to bed will affect circadian rhythm and provide neurological over-stimulation. Try to avoid screen time at least 30-60 minutes prior to going to bed.
*Avoid large meals, caffeine and alcohol before bedtime. Aside from having a full stomach and potentially experiencing acid reflux while lying down, caffeine and alcohol affect the central nervous system, which decreases quality sleep.
*Be sure to Move! Being physically active during the day will help you fall asleep more easily at night.
Waking with Morning Stiffness or Pain?
As mentioned previously, aside from having a specific medical condition contributing to morning stiffness and pain upon waking, there are most likely issues with your mattress, pillow or potentially related to your sleeping position(s).
Is it your mattress?
Ask yourself, how old is the mattress. Regardless of the sales pitch and marketing materials, most mattresses are only good for 6-10 years before breaking down, which can be dependent on usage patterns and the type of mattress (foam vs spring vs hybrid). I haven’t heard of a mattress yet that has a solid 15-20yr lifespan, as may be marketed during purchase. Is there a large divot or depression or crater in the mattress that you fall into when lying down? If yes, this is a very clear sign that it’s time for replacement. Do you wake up feeling much better when sleeping on another bed or sleeping surface? If yes, your mattress is the problem. If not, symptoms are more likely related to your sleep position/posture. You can attempt to prolong the life of a mattress by frequently (every 2-3 mo) rotating the position 180 degrees to prevent focused depressions. If mattress construction allows, consider flipping it over to the other side in addition to rotating horizontally. You won’t be able to do this with a hybrid (coil on bottom and memory foam on top) mattress.
When purchasing a new mattress, I recommend buying one that is labelled “firm.” You can always make a mattress softer by adding memory foam on top. It is impossible to make a soft mattress firmer. The “old school” approach is to add a plywood board between the mattress and box spring. This will only help if your box spring is unstable and will not “firm up” a mattress. Two other things to look at are integrity of the box spring and bed frame. Any movement or weakness of these 2 items will contribute to your mattress being unstable and breaking down earlier than appropriate.
I recommend a platform bed frame or even consider placing your box spring and mattress directly on the floor. I know this is an aesthetically unpleasing approach, but the solid base will contribute to a more comfortable sleeping surface and likely increase the lifespan of your mattress.
Is it your Pillow?
Depending on your preferred sleep position, the pillow you choose will make a big difference regarding how you feel and the quality of sleep.
Stomach sleeper? This position requires the smallest pillow. Too large of a pillow creates excessive neck extension. The associated rotation causes twisting in the spine and imbalance of the surrounding tissue including muscles, tendons and ligaments. It will contribute to potentially acute or chronic neck pain, muscle spasms and secondary headaches. If you wake up with low back pain, consider placing a pillow under your waist.
Back sleeper? This requires the 2nd smallest pillow behind stomach sleeping. Too big of a pillow will create forward bending of the neck and head which lengthens and increases muscle tension in the neck and upper back/shoulders which tends to contribute to stiff and achy upper back/shoulders and neck with potential headaches. I recommend using a pillow which supports a gentle arch in the neck without pushing the head forward from the rest of your body. Some people find tremendous comfort with using a rolled towel under the neck and no pillow. If you wake up with low back pain, consider placing a couple pillows underneath your knees.
Side sleeper? This position requires the largest pillow. Ideally when lying on your side, the pillow after compression, will cover the distance from the outside of your shoulder to the side of head and neck. The goal is to have an essentially straight spine without your head and neck being pushed away from or towards the bed. A general rule of thumb is if you feel more shoulder pressure than head and neck pressure, the pillow is too small. If you feel more head and neck pressure than shoulder, the pillow is too large. If you feel equal pressure on shoulder and head and neck, then you have found an appropriately sized pillow. If you regularly experience lower back or hip pain, consider placing 1 or 2 pillows between your knee such that your thighs are parallel to each other and her lower back/pelvis is not twisting compared to the rest of your body.
These are just a few considerations to assist with your ability to fall asleep and improvement of sleep quality. If you have further questions, please reach out to the Sharon Health Center at 802-763-8000.
Dr. Chamberland specializes in chiropractic sports medicine. He enjoys treating acute and chronic sports injuries as well as providing treatment plans and guidance to help prevent future injuries during athletics, exercise and general activities. He also treats general acute and chronic neuromusculoskeletal conditions. His primary goal is to provide non-invasive conservative, drug-free treatment and to help patients avoid surgery whenever possible. An active athlete, he understands your need and desire to participate in a favorite sport or exercise routine.