I think most of us have woken with a stiff neck at one point or another from sleeping in a funny position. Sometimes that crick in the neck can be extremely painful and I have seen many patients over the years presenting with acute neck pain that was triggered by a bad night’s sleep. But what if you were sleeping incorrectly every night and waking regularly with a stiff neck or neck pain? We are generally not taught about correct neck posture when lying down and certainly not about what to look for in a pillow.
The most common cause of neck pain and stiffness in the morning comes from facet joint compression during the night. Facet joints connect the vertebrae together and run down the back of the neck on both sides. These joints are particularly prone to compression from positions where the neck is tilting too far backwards, or too far to the side.
For this reason, the worst sleeping position for the neck is sleeping face down. As the neck must rotate completely to the side in this position with the head tilting backwards, this position puts the most compression on the facet joints. It is very common for patients who present with chronic or reoccurring neck pain to be front sleepers.
To train the body to avoid sleeping face down, it can help to sleep with a pillow between the knees and another hugged under the top arm. This can help to keep you on the side and prevent rolling onto the front at night.
The second most common reason is having pillows that are too low or too high, again causing compression by tilting the head to the side, either toward or away from the mattress, when lying on the side. But it is hard to get the pillow height correct as often one pillow is too low, and two is too high.
Feather pillows squash down during the night and all the filling moves to the side, losing a lot of the support that you had when you lay down first. This can lead to problems developing in the neck. Any other type of pillow than a feather one will have more consistent support throughout the night. But it is important that it feels comfortable to you too. Foam pillows have the most consistent support but some people find them too firm and hard to sleep on. Personally, I prefer a hollow-fibre pillow because I can turn it to the cold side during the night.
To get the pillow height just right, lie on the side and allow the shoulder to sink into the mattress. Feel whether the head is tilting towards or away from the mattress. If the head is tilting away, the pillow is too high. Switch the pillow to a lower one. We can then add height afterwards.
If the head is tilting towards the mattress, the pillow is too low. We can now add gradual height by folding over a towel and placing it underneath. A thicker towel will add more height if needed or a second towel can be used. Test it out by lying on the side again.
When the height is just right it will feel like the head is neither tilting towards nor away from the mattress when on the side. This is the ideal height for your pillow. This can then be used as a guide when buying a new pillow, or the towels can be left in place and used every day.
If you are a side or back sleeper already and your pillows are already the correct height, then chances are you don’t wake up too often with neck pain. However, if you are one of those who suffers regularly then hopefully this article will highlight something about your sleeping position or pillow height that could help you wake with less pain and stiffness in the mornings.