Got Neck Pain and Can’t Sleep? Try These Sleep Positions and PT Tips

While it’s hard to navigate daily activities while dealing with neck pain, it may feel even more challenging to sleep when your neck hurts. 

We know that getting poor sleep because of neck pain can make you feel frustrated and even a little hopeless, especially if you get into what experts call the pain-sleep cycle. This is when neck pain disrupts sleep, and then poor sleep worsens your neck pain. 

But rest (literally) assured: Hinge Health physical therapists frequently work with Hinge Health members who have musculoskeletal pain that affects their sleep. And there is a lot you can do, both during the day and at nighttime, to reduce neck pain and improve your sleep quality.

Much of this starts with a good exercise therapy routine for your neck. As one Hinge Health member recently shared with us, “I have progressed from pain in my neck and shoulders keeping me awake to very little issues sleeping.”

Here, learn more about how to sleep with neck pain, especially with exercises and tips from our physical therapists.

Waking Up With Neck Pain From Sleeping

First and foremost, there’s no “right” or “wrong” way to sleep. Everyone is different, and what works for one person may not work for another. But if you wake up every morning with a stiff, painful neck, your discomfort may be related to how you sleep. Here’s a look at a few factors that can contribute to neck pain for many people:

Too much or too little mattress support. A mattress that is too firm or too soft can contribute to neck pain for some people. “It can put stress on your neck as you sleep,” explains Cody Anderson, PT, DPT, a physical therapist at Hinge Health. A medium-firm mattress is generally a pretty comfortable option for people, according to a 2021 study published in the Journal of Orthopedics and Traumatology. But remember: A softer or firmer mattress isn’t bad or wrong if those mattresses are more comfortable for you. 

Not sure if you need more or less support? You can try a few experiments. Put a plywood board under your mattress, or place your mattress on the floor. If you notice an improvement in pain or comfort, it’s probably worthwhile to shop for something firmer. You could also try an egg shell mattress topper to see if a softer bed feels better. Or take note of how your neck feels after sleeping in a hotel or another bed. 

Sleeping position. If you sleep with your neck at an awkward angle, you may wake up with stiffness and pain. It helps to take note of whether sleeping in certain positions impacts your pain consistently. (If not, sleeping position may not be a contributor to your pain.) Read more below about tweaks to your sleeping position you may want to consider.

Pillow choice. Your pillow’s job is to hold your neck and head at the right height for you. If the pillow is too high or too low relative to what’s comfortable for you, your neck muscles try to compensate for the lack of support. Sometimes this can trigger neck strain and pain. Try using a different pillow that is more or less plump for a few nights and see if that helps your pain the following day. 

Other Causes of Neck Pain While Sleeping

Here are some other reasons you may have neck pain that disrupts your sleep: 

• Using your bed or couch as your office. A 2019 study published in the journal Work found that people reported more neck pain after working on a laptop from either location. “Since you’re not in a chair with good back support, you end up sitting slouched, which puts your neck in an awkward position,” says Dr. Anderson. While that’s not necessarily the sole cause of your neck pain, muscles can stiffen up from disuse at night, leading to more pain. While there’s no perfect position or one right way to sit at work, it’s important to get up often and move (at least every hour or so) to give your body a break.

• Feeling stressed. Yep, stress can trigger or worsen neck pain, according to a 2022 paper published in BMC Musculoskeletal Disorders. “When you’re stressed, your body holds tension in your neck and shoulder muscles,” explains Dr. Anderson. This can persist, even at night.

• Cervical spine pain. Certain conditions, like neck arthritis, can cause neck pain that worsens at night (when your neck is in one position for a prolonged period of time). Other conditions, like whiplash from a car accident, can also contribute to this.

Best Sleeping Positions for Neck Pain

Let’s start with this important takeaway: There’s no right or wrong position for sleeping with neck pain, stresses Dr. Anderson. “Most of the time, people end up in the sleep position that’s best for them.” But there are some tweaks you can try making to your current sleeping position to ease neck pain during sleep.

Back sleepers. This is a good position for many people, provided you don’t sleep on a pancake-flat pillow. “Here, some pillow support for your neck is actually a good thing,” says Dr. Anderson. “If your head is flat against the bed, this may cause neck muscle tension.” You can also place a pillow beneath your knees or thighs to help relax your neck muscles.

Side sleepers. A 2019 review published in the journal BMJ Open found that side sleeping was generally a good option for people who experience neck pain. While that doesn’t mean it’s most comfortable for everyone with neck pain, it can be a good position to try. It might help to use a pillow that’s higher under your neck than your head. You could also experiment with using a wedge-shaped pillow or a couple pillows behind you. (Note: This technique works for some people because it prevents you from rolling around in your sleep. But it can actually make some feel more stiff in the morning because it keeps them in the same position all night.)  

Stomach sleepers. This position can be tricky because you need to turn your neck to one side or the other to breathe, which can contribute to some stiffness when you wake up. You can help fix this by placing pillows under your chest or body. If it’s still uncomfortable, consider sleeping without a pillow under your head.

How to Sleep With a Stiff Neck

In addition to the above adjustments to your sleep position, these tips can help ensure that you and your neck get the rest you need.

• Do some nighttime stretches. Gentle exercises as part of your bedtime routine can help reduce stress, which makes your muscles less likely to stiffen and tighten during the night, says Dr. Anderson. (See our next section for some specific stretches.) 

• Practice good sleep hygiene. You may have heard that you should avoid looking at screens like TVs, phones, laptops, and iPads as bedtime approaches since the blue light they emit can make it harder to fall asleep. It’s also not great for your neck to use these devices for long periods. “Every time you look down at your tablet or phone, you contribute to strain on your neck,” says Dr. Anderson. Opt for old-school books instead.

• Apply heat. Use a hot water bottle or damp hot towel on your sore neck for a few minutes before you go to sleep to help relax tight muscles and relieve any spasms. 

• Stay active during the day. A 2020 study published in the journal Psychological Health Medicine found that both mood and sleep quality improved among patients with chronic neck pain when they increased their exercise levels. “Physical activity increases endorphins, which helps your body better deal with pain,” explains Dr. Anderson. It also has been shown to improve sleep quality.

• Consider physical therapy. If you’ve tried all the above, and your neck pain still impacts your quality of sleep, you might benefit from a short course of physical therapy, advises Dr. Anderson. Your physical therapist can help determine what may be contributing to your neck pain and create a tailored exercise and stretching program so that you can get to sleep with minimal discomfort. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

These targeted stretches and exercises can help relieve neck pain flares and help prevent future episodes. Hinge Health physical therapists commonly recommend them for nighttime and morning neck pain.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Don’t Spend a Fortune on Pricey Pillows

You don’t need to shell out a lot of cash on expensive therapeutic pillows, Dr. Anderson stresses. “There are other, more effective changes you can make,” he says. These include things like simply replacing pillows that have flattened and doing neck exercises and stretches in your bedtime routine. 

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Lee, M. K., & Oh, J. (2022). The relationship between sleep quality, neck pain, shoulder pain and disability, physical activity, and health perception among middle-aged women: a cross-sectional study. BMC Women’s Health, 22(1). doi:10.1186/s12905-022-01773-3

3. Cohen, S. P. (2015). Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings, 90(2), 284–299. doi:10.1016/j.mayocp.2014.09.008

4. Staffe, A. T., Bech, M. W., Clemmensen, S. L. K., Nielsen, H. T., Larsen, D. B., & Petersen, K. K. (2019). Total sleep deprivation increases pain sensitivity, impairs conditioned pain modulation and facilitates temporal summation of pain in healthy participants. PLOS ONE, 14(12), e0225849. doi:10.1371/journal.pone.0225849

5. Lee, M. K., & Oh, J. (2022). The relationship between sleep quality, neck pain, shoulder pain and disability, physical activity, and health perception among middle-aged women: a cross-sectional study. BMC Women’s Health, 22(1). doi:10.1186/s12905-022-01773-3

6. Lee, W.-H., & Ko, M.-S. (2017). Effect of sleep posture on neck muscle activity. Journal of Physical Therapy Science, 29(6), 1021–1024. doi:10.1589/jpts.29.1021

7. Intolo, P., Shalokhon, B., Wongwech, G., Wisiasut, P., Nanthavanij, S., & Baxter, D. G. (2019). Analysis of neck and shoulder postures, and muscle activities relative to perceived pain during laptop computer use at a low-height table, sofa and bed. Work, 63(3), 361–367. doi:10.3233/wor-192942

8. Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A.-A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskeletal Disorders, 23(1). doi:10.1186/s12891-021-04957-4

9. Cary, D., Briffa, K., & McKenna, L. (2019). Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ Open, 9(6). doi:10.1136/bmjopen-2018-027633

10. Juan, W., Rui, L., & Wei-Wen, Z. (2020). Chronic neck pain and depression: the mediating role of sleep quality and exercise. Psychology, Health & Medicine, 25(8), 1029–1035. doi:10.1080/13548506.2020.1724308