Use Pillows Strategically for Pain-Free Nights

I know from experience that pillows can make a difference between a good night’s sleep and a bad one.

A reader suffering low back pain and insomnia wrote in with a question about pillows a few days ago, prompting me to do a little research. Here’s what I found out.

Insomnia and back pain can be alleviated by placing pillows correctlyThis morning I landed on a blog promoting use of a wooden pillow for intestinal health and insomnia relief. No joke. You’re supposed to lie face down with the “pillow” under your lower stomach and gently shake the abdominal area from side to side. This rocking motion supposedly helps with digestion and spinal alignment, relaxing you and helping you fall asleep.

Pardon my skepticism, but frankly the adjective wooden does not belong in the same sentence as insomnia relief. I’ve blogged about wooden pillows elsewhere and am no more convinced I should place one under my stomach than under my neck!

But I know from experience that pillows can make a difference between a good night’s sleep and a bad one. A reader suffering low back pain and insomnia wrote in with a question about pillows a few days ago, prompting me to do a little research. Here’s what I found out.

Low back Pain and Insomnia

That pain can interfere with sleep is a no-brainer. But there seems to be an especially tight and complex relationship between back pain and insomnia or disturbed sleep. Recent studies from Korea and the United Kingdom suggest that 43 to 47 percent of patients diagnosed with chronic low back pain or chronic back pain also suffer insomnia. A large study conducted in Japan found that low back pain is significantly associated with poor sleep quality and sleeping less than 6 hours a night.

Insomnia also places people at greater risk for the development of low back pain, Israeli researchers found recently. Other investigators have shown that just as low back pain can disturb sleep, so disturbed sleep tends to increase the intensity of pain. This creates a vicious circle: pain disturbs sleep, leading to greater pain, leading to further sleep disturbance, and on and on.

But strategic placement of pillows can alleviate back pain by straightening out the spine and keeping it in alignment, relieving pressure on pain-sensitive areas and creating conditions where you’re more likely to get a decent night’s rest.

Stomach Sleepers

If you like sleeping on your stomach, the pillow supporting your head and neck should be fairly flat. If it’s got too much loft, you wind up sleeping with your neck cranked too far to the side, torquing the upper spine and straining muscles in the neck.

Straighten out the lower spine by sleeping with another fairly flat pillow under your stomach.

Back Sleepers

The pillow supporting your head, neck, and shoulders should be thicker if you prefer sleeping on your back. In its natural position, the human neck curves slightly forward, say doctors writing on spine-health.com. This curve should be maintained during sleep. A too-high or too-low pillow causes muscle strain in the neck. It can also obstruct breathing and result in snoring.

To straighten out the spine in the lower back, take one or more thick pillows and place them under your knees. Flattening out the spine this way relieves pressure on the pain-sensitive joints in the lumbar area.

Side Sleepers

If you prefer to sleep on your side, the pillow supporting your head and neck should be fairly thick. Otherwise the upper spine will be unnaturally bent.

Use of a knee pillow is critical for side sleepers with low back pain. Side sleepers often sleep with bent knees, and without use of a knee pillow, there’s a tendency for the upper leg to fall forward, twisting the lower spine and aggravating lumbar pain. Placing a small, firm pillow between the knees straightens out the spine and will allow for greater comfort and a better night’s rest.

I’m a side sleeper myself, and to avoid low back pain I use a variation of this suggested to me by a physical therapist. Instead of positioning my legs one on top of the other, I pull my top knee forward so it’s at right angles with my torso and place the knee on a small, thick pillow. This helps me sleep through the night and wake up in the morning pain free. Sleeping on the left side in this position is recommended for pregnant women, too.

Pillows flatten out over time and may cease to provide the support you need. My husband teases me about running through pillows likes hotcakes, but expert opinion is on my side. When your pillow loses its loft, it’s time to add stuffing or buy a new one.

Insomnia and Back Pain

Back pain, like insomnia, has been a rival of mine for decades. My mild scoliosis didn’t bother me much in my teenage years. But by adulthood, low back pain was an intermittent feature of my life. It got harder and harder to find a comfortable position for sleep.

Back pain and insomnia go hand in hand. But literally by accident, I finally found my way to pain-free nights.

body-pillowBack pain, like insomnia, has been a rival of mine for decades. My mild scoliosis didn’t bother me much in my teenage years. But by adulthood, low back pain was an intermittent feature of my life. It got harder and harder to find a comfortable position for sleep.

The fabulous stomach sleep-a-thons I remember during adolescence, when I awoke hugging my pillow, were the first thing that had to go. Then I had to give up sleeping on my back. (But while sleeping, I’d sometimes flip to my back and wake up to a backache). Finally there was nothing to do except sleep on my side curled up in fetal position. But even this was no guarantee of a pain-free night.

A Relationship between Insomnia and Back Pain

Research now shows that back pain and insomnia go hand in hand. Two studies published just this year, one conducted in Morocco and the other in the UK, show the prevalence of moderate to severe insomnia in people with back pain is 44 to 47 percent—quite a bit higher than the prevalence of chronic insomnia in the general population.

Insomnia, in turn, increases sensitivity to pain. In a recent study in the European Journal of Pain, insomnia subjects had lower pain thresholds than healthy control subjects and less ability to inhibit pain. It looks like back pain increases the risk of insomnia, which can then make back pain worse.

Steering Clear of Pain

By trial and error I found ways to hold the pain at bay. The rules I now live by at night are simple:

  • Never sleep on a too-soft mattress. If friends offer me a bed with a soft mattress, I ask to sleep on the sofa instead. Never take a hotel room without first checking the mattress.
  • Avoid hard mattresses as well. Inflatable camping mattresses spell doom.
  • Use a pillow that provides just enough support so the spinal cord feels straight. When a pillow loses its loft, get a new one.

But following the rules and making other adaptations didn’t allay my back pain completely. Frequent low-level pain was something I resigned myself to, thinking I had no other choice.

An Accident with a Silver Lining

Then last year I tried rollerblading with an 8-year-old friend, and I fell and broke my wrist. The pain was so bad I passed out. But it was short-lived compared to the shoulder pain I developed from wearing a heavy cast, which forced me to sleep on my back—and then my back pain returned with a vengeance. I was a mess!

Fortunately I got a referral to a good physical therapist. First, she dealt with my shoulder pain. Then she started on my back. She had me lie on my right side in the same position I use for sleeping.

“That’s not quite right,” she said. “Can’t you feel the torque in your spine? Try propping your left leg up on a pillow,” she said, sliding a pillow under my knee. “Doesn’t that feel better?”

It DID feel better—a whole lot better. In fact, propping my knee up on a pillow night after night led to months and months of pain-free living, and also probably helped to consolidate my sleep. Who knew such a simple change could have such a profound effect?

Have any small changes you’ve made led to marked improvements in your sleep or your sense of wellbeing? Please share for all to see.