Beyond a sleeping position, research suggests that not just the sleep position, but sleep itself, can play a role in reducing musculoskeletal pain, including neck and shoulder pain. In one study, researchers compared musculoskeletal pain in 4,140 healthy men and women with and without sleeping problems. Sleeping problems included difficulty falling asleep, trouble staying asleep, low amount of sleep during the night, and waking early in the mornings without feeling 'rested,' and non-restorative sleep.
People who reported moderate to severe problems in at least three of these four categories were significantly more likely to develop chronic musculoskeletal pain after one year than those who reported little or no problem with sleep. One possible explanation is that sleep disturbances disrupt the muscle relaxation and healing that normally occur during sleep. Additionally, it is well established that pain can disrupt sleep, contributing to a vicious cycle of pain disrupting sleep, and sleep problems contributing to pain.
With many things, like neck pain, an ounce of prevention may be worth a pound of cure. It's true that some causes of neck pain, such as aging impact on the body, wear and tear on the neck and spine, stress are not under your control, finding the sleep position to support sound sleep is. On the other hand, there are many things you can do to minimize the risk of improper (read discomfort producing) positioning of the head, neck, shoulders and spine. One place to start is to look at how you sleep and what effect this may have on neck and shoulder pain.
What is the best sleeping position for neck pain?
Two sleeping positions are easiest on the neck: on your side or on your back. Of these two, sleeping on your back, puts less stress on the neck muscles, because you may not toss and turn as much throughout an average of 5-6 hours of sleep. If this is what you choose, find a ‘rounded’ pillow to support the natural curve of your neck…not too high (flexion and extension as it pushes the chin forward) with a flatter pillow ‘plane’ to cushion your head above. Any material will do, as long as this can be achieved by tucking a small neck roll into the pillowcase of a flatter, softer pillow, or by using a special pillow that has a built-in neck support with an indentation for the head to rest on (think bamboo or all natural fiber).
Additional tips for side- and back-sleepers:
If you try using a feather pillow, it will easily conform to the shape of the neck, but the feather pillows will collapse over time, and will need to be replaced every year or so. Thicker ones may push the neck up to far, and thinner ones may need to be ‘rolled’ which will not provide anything but a bolster to the neck (without support for the head).
Another option is a traditional ‘shaped pillow’ made of "memory foam,” which will conform to the contour of your head and neck. Some cervical pillows are also made with memory foam. Manufacturers of memory-foam pillows claim they help foster proper spinal alignment. You must find one that isn’t too high or stiff, so that it doesn’t keep the neck flexed overnight and can result in morning pain and stiffness.
If you sleep on your side, keep your spine straight by using a pillow that is higher under your neck than your head. Be sure to keep your neck inline with your upper back when lying down - and ensure that this is the primary position attempting to achieve (ie. not sleeping upright in bed).
When you are riding in a plane, train, or car, or even just reclining to watch TV, a horseshoe-shaped pillow can support your neck and prevent your head from dropping to one side if you doze. If the pillow is too large behind the neck, however, it will force your head forward. Resting with your 'head propped' up, should not be counted in your prone, sleeping position, as this is translates into incomplete sleep for the parasympathetic nervous system. The entire idea of rest to to remove as much of the influence of gravity on muscles as possible.
Side sleeping or on your stomach is tough on your spine, because the back is arched and your neck is turned to the side. Preferred sleeping positions are often set early in life and can be tough to change, not to mention that we don't often wake up in the same position in which we fell asleep. Still, it's worth trying to start the night sleeping on your back or side in a well-supported, healthy position.