Sleep and Neck Pain

Mattress Nerd consulted Dr. Tom Ingegno, DACM, MSOM, LAC to ensure that this article met our editorial standards

---

Neck pain is … well, a pain in the neck. Unfortunately, it’s one of the most common ailments, affecting as many as a third of adults, and it becomes a chronic problem for up to half of them, according to the journal Mayo Clinic Proceedings. Chronic pain is a leading cause of insomnia and other sleep problems. That’s a recipe for poor health. When sleep is compromised, it affects our physical and mental health, makes us prone to injury, and increases our risk of death, according to the National Heart, Lung, and Blood Institute. 

Inadequate sleep can also reduce the body’s tolerance to pain and worsen inflammation. Like chronic pain, a sleep deficit can lead to feelings of hopelessness and depression. It can also make you more sensitive to pain, according to a study published in the journal Sleep. This further hinders your sleep, creating a seemingly never-ending cycle.

“Neck pain is a common cause of poor sleep and sleep disruption,” says Dr. Peter J. Scordilis, a Certified Chiropractic Sports Physician at Scordilis Family Chiropractic in Clifton, New Jersey. “Most people with neck pain have difficulty finding a comfortable sleep position and will typically awaken from the pain due to small movements while sleeping. Restless sleeping is also a common cause or contributing factor to neck pain. Inability to find a comfortable, supported sleeping position leads to restlessness and eventually neck pain.”

Causes of Neck Pain

There are several causes of neck pain. Let’s take a look at a some of the more common ones:

• Poor posture: Spending too many hours hunched over your computer or slouching in general can strain the muscles in the back and neck and cause pain. If you talk on the phone a lot, avoid tucking the phone between your ear and shoulder when you talk. If you can’t hold your phone to your ear with your hand, use a headset or speakerphone instead.
• Sleeping position: You can create or aggravate neck pain if you have poor sleeping posture, too. Chiropractors warn against sleeping on your stomach because doing so forces you to turn your head to the side. It also puts strain on the neck and lower back. Another contributor to nighttime neck aches is grinding your teeth, which some people do while sleeping. If you are a teeth-clencher, talk to your dentist about treatment options. 
• Bed pillow: Your pillow can have a huge impact on your sleep quality whether you’re a stomach sleeper, side sleeper, or back sleeper. Your pillow should provide comfort but also not knock your neck and spine out of alignment. For example, stomach sleepers sleep best with a super thin pillow or no pillow at all. Back sleepers can benefit from a flatter pillow with a little more cushioning. But side sleepers need a pillow with just enough loft to hold up their head and keep their spine aligned, so their neck shouldn’t rest too high or low. 
• Mattress: Old, sagging mattresses are just as bad on the neck and spine as the wrong pillow. Without proper support, mattresses can knock your spine out of alignment and put unnecessary pressure on sensitive points at the shoulders and hips, and cause sleep-interfering discomfort even if you’re sleeping with the right pillow. 
• Injury: Falls, car accidents, sports or exercise injuries — all can force the muscles and ligaments of the neck outside their normal range and cause pain. Sudden jerking of the head can cause a neck injury called whiplash. 
• Heart attack: Neck pain can also be a symptom of a heart attack. If it is, the neck pain is usually accompanied by other symptoms such as shortness of breath, sweating, nausea, and arm or jaw pain. If you experience any of these symptoms, seek immediate medical attention. 
• Meningitis: A stiff neck accompanied by fever and headache is a classic sign of meningitis, an inflammation of the thin tissue that surrounds the brain and spinal cord. Meningitis is a serious medical emergency and can be fatal. Seek medical attention immediately if you have symptoms of meningitis. 
• Rheumatoid arthritis: Arthritis is pain and swelling in the joints. This inflammation can also affect the neck area and cause neck pain. 
• Osteoporosis: Neck pain can be caused by osteoporosis, a condition that causes bones to become weak and brittle. 
• Fibromyalgia: This largely misunderstood condition causes muscle pain throughout the body, especially the neck and shoulder area. 
• Disc degeneration: As you age, the discs in your spine can degenerate and cause a narrowing of the space between the vertebrae, a condition known as spondylitis or osteoarthritis of the neck. 
• Herniated cervical disc: When the soft, rubbery center of a spinal disc pushes through a crack in the tough exterior casing of the spine, it becomes a condition known as a herniated disc. It can also occur in the neck region. 
• Spinal stenosis: Inflammation caused by arthritis or other conditions can cause the spinal column to narrow and put pressure on the spinal cord or the nerve roots at the vertebrae. 
• Other causes: Rarely, neck pain can be caused by congenital abnormalities, abscesses, infections, or tumors.

Symptoms of Neck Pain

Common symptoms of neck pain include:

• Stiffness and tightness
• Soreness
• Muscle spasms
• Decreased mobility in trying to move your head
• Headache

In some circumstances, neck pain can be a sign of a more serious condition. If you experience any of the following symptoms along with your neck pain, seek prompt medical attention: 

• Fever
• Lump in your neck
• Swollen glands
• Difficulty swallowing
• Numbness/tingling down your arms or legs
• Severe neck pain without any cause
• Neck stiffness with fever and headache
• You’ve been in an accident or suffered a fall

Sleep Remedies for Neck Pain

Your sleep habits can have a huge impact on your quality of sleep as well as the management of your pain, says Dr. Jordan Duncan, owner of Silverdale Sport & Spine, a clinic specializing in difficult-to-treat musculoskeletal pain conditions. “For the vast majority of neck pain diagnoses, promoting optimal posture of the neck during sleep is necessary for the treatment of the condition,” he says. Let’s take a closer look at the most common sleep positions and how they can affect your neck.

Which Sleep Position is Best?

Sleeping on your stomach

Chiropractic doctors agree that sleeping on your stomach is the worst possible position to sleep in. “It’s not upcoming for people to wake up on their stomach with their neck assuming a position of extreme rotation and complain of a ‘crick’ in their neck,” Dr. Duncan says. Dr. Gregory Funk, owner and operator of Ideal Health Chiropractic, agrees. “This prone position almost always forces your head out of proper alignment with your spine into a twisted position. This will lead to a stiff neck in the morning and recurring neck pains.” 

The best bet is for you to switch sleep positions. But if you must sleep on your stomach, then you can take some measures to reduce your risk of waking with neck pain:

• Use a flat pillow or now pillow at all. A pillow with too much loft will strain your neck.
• Stretch your neck several times a day at least one minute every couple of hours by tilting your head forward and back, then turning your head to the right and left.

Sleeping on your back

Sleeping on your back is one of the best sleeping positions if you suffer from neck pain. That’s because it evenly distributes your body weight and prevents unnatural or unnecessary curves in the spine. 

Here are some things to keep in mind if you are a back sleeper:

• Use a softer pillow with plenty of give so that it doesn’t prop your head up too high and cause your neck to strain.
• While back sleeping is best for people with neck pain, it’s not ideal if you snore, or suffer from acid reflux or sleep apnea. Consider rolling over onto your side instead.

Sleeping on your side

If you’re not comfortable sleeping on your back or suffer from sleep apnea or acid reflux, the second best sleeping position for avoiding neck pain is on your side.    

Here are some things to keep in mind if you are a side sleeper:

The right pillow is vital for side sleepers. That’s because your pillow needs just the right amount of loft to prop your head up to keep your spine aligned. Too much or too little pillow height can knock your backbone out of line and contribute to neck pain. 

For optimal spine alignment, slide a pillow between your legs to help align your spine at the hips as well. 

When sleeping on your side, be sure to stretch your legs out rather than curling them to your chest in fetal position. And don’t tuck your chin to your neck. This prevents your body weight from being distributed and ultimately throws off your spine alignment.

The Proper Sleep Equipment

Pillow

The kind of pillow you use can either help or hinder a sore neck. “If you’re experiencing poor sleep due to your chronic neck pain, then you may want to reevaluate which pillow you are using,” Dr. Funk says. “Make sure you select one that is wide enough to support the distance between your shoulders and your neck and that it effectively supports your sleeping style.”

• Feather pillow: Feather or down pillows, or down alternative pillows, are cozy and plush. Your head literally sinks into them. Because they don’t hold their loft, feather pillows are better for stomach sleepers and back sleepers. Side sleepers will need to adjust the pillow to get enough loft to keep their head propped so the neck isn’t strained. Down pillows also wear down over time and should be replaced every year or two for best results.
• Memory foam pillow: Memory foam pillows are cushioning and supportive, but they also offer just enough give as they conform to your head and neck. Memory foam pillows may be too lofty for belly or back sleepers, but should be ideal for side sleepers.
• Cervical pillow: Cervical pillows are specially shaped to support the neck and guide the head into the right angle so that the neck stays in alignment with the spine. These pillows come in a range of shapes, sizes, and materials. “Specialty pillows that promote the natural spinal curve of the neck and don’t push the neck into excessive flexion can be of great benefit for those who sleep on their back or sides,” Dr. Duncan says.
• Horseshoe pillow: As you probably guessed, horseshoe pillows are shaped like horseshoes. These pillows are designed to provide proper head placement whether you are sleeping on your back or your side. They’re also a good option for providing support and relieving strain while sitting upright or slightly inclined and watching TV or riding in a car.

Mattress

Old, sagging mattresses can exasperate or even cause neck and back pain. That’s because they do not provide the support needed in the lumbar area to prevent strain along the spinal column. A medium to medium-firm mattress is best for people who suffer from neck pain, especially one with built-in performance factors. Many online mattresses made with memory foam, latex foam, or one that combines foam with innerspring provide necessary support to keep the spine aligned but also enough give to protect sensitive pressure points at the shoulders and hips. This greatly reduces lower back and neck aches and pains.

The Importance of Sleep Hygiene

Establish a nighttime routine.

Establishing a nighttime routine is a great way to help toddlers and young kids wind down for bedtime. But it’s also an effective strategy for adults. About 30 minutes before bedtime, take a warm bath and any nighttime pain relieving medications, read a book or listen to soothing music. You can also do some relaxation exercises or stretches to help your body relax and prepare for a good night’s sleep.

Avoid strenuous exercise too close to bedtime.

Aerobic exercise is a great way to burn off excess energy so you sleep better. But try not to do any strenuous exercise too close to bedtime. Aerobic exercise releases endorphins, the “feel good” hormone, which peps you up and can keep you from falling asleep at night. Instead, practice yoga or do some stretches before bedtime to loosen and relax muscles. Be sure to focus on neck stretches, which can relieve vertebrae compression and allow muscles in the neck to relax.

Create a welcoming bedroom environment.

Your bedroom should be conducive to sleep. Turn the thermostat to a comfortable but cool temperature (experts say between 60-67 degrees is best). Use blackout shades or curtains to block out unwanted light, or use a sleep mask. And try earplugs or a white noise machine if noisy neighbors or outside traffic keeps you awake.

Avoid blue light too close to bedtime.

Blue light is the type of light that is emitted from your TV, laptop, or mobile phone screen. It has properties that actually help keep you alert, which is great during the day, but not so great when you’re trying to sleep. It’s best to turn off these devices at least 30 minutes before bedtime so they don’t interfere with your sleep.

Avoid stimulants before bedtime.

Coffee, sodas, and even chocolate can contain caffeine, which is notorious for keeping you awake. Cigarettes act as stimulants, too, and can hinder sleep. Try to avoid these at least three hours before bedtime to help you fall asleep.

Final Thoughts

Neck pain can be a real pain in the neck and can prevent you from getting a good night’s sleep. But that doesn’t mean there aren’t things you can do to improve your sleep, such as changing your sleeping position, using the right pillow, or getting a new mattress. If your pain is severe or lingers for weeks or months, you should see a doctor. “Proper diagnosis is essential for proper treatment,” Dr. Scordilis recommends. “If the root cause is not addressed, neck pain can become chronic and debilitating.”