Sleeping Positions: Tips to Wake-Up Pain-Free with Andrew Bang, DC

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host. Blame for body aches and pains often get directed at muscle-burning activities, a tough workout, for instance, or maybe long hours cleaning up the yard. But there's a pretty low-intensity thing we do every day that can leave you feeling pretty creaky. We're talking about sleeping.

Awkward sleeping positions can put stress and strain on your body as you're catching ZZZs, leading to pain when you should be ready to rise and shine. So, what's the best way to sleep? That's what we're going to learn today from our good friend, Doctor Andrew Bang. Dr. Bang is a chiropractor and one of the many experts at Cleveland Clinic who join us weekly to share their wisdom. So, let's see what advice he has to help you rest easy at night and wake up feeling great.

Dr. Bang, welcome back to the podcast. Always a treat to have you on.

Dr. Andrew Bang:

Oh, John, I love being with you, man. So good to be with you and all the listeners.

John Horton:

So I got to tell you, I got up this morning and I got out of bed and I took what can best be described as about 10 zombie steps as I tried to work out all the creaks and aches and everything else, and I started thinking ahead to talking with you, and I thought, you must not have that in the morning.

Dr. Andrew Bang:

Well, I was just teasing you. No, I have six kids, so I don't know what the word "sleep" means any more sometimes. But no, if you plan your sleep out, you have a higher chance of feeling better when you wake up. And there's some very easy tips and tricks that you can add right into your life to get the same benefit as everybody else trying to get restful ZZZs.

John Horton:

Well, that's why we have you on because you always give us helpful tips. And I know when we've talked, it seems like the basics of sleep come down to getting in the right position. Why is that so important?

Dr. Andrew Bang:

Well, there's a lot of reasons that positioning is important because we want to take as much pressure off of your joints and muscles. We want to create maximum blood flow. We want to create a neutral spine so our ligaments can creep back to their normal position to keep you nice and protected when you're going about your daily activities. And it's easy to do, it's not challenging. There's been studies that's shown you can actually change your sleep patterns, because it seems impossible to change something you do while you're sleeping. With a little pre-coaching before you fall asleep, your body will get used to the new habit.

John Horton:

Let me ask you, how much fatigue can you put on your body while you're just laying down there? I mean, it just seems like your body should be at rest. I mean, how are you taxing your muscles while you're doing that?

Dr. Andrew Bang:

Well, that's a good point because you think, "Yeah, gravity's not pushing down on me, and what's the big deal?" Well, I'll tell you what the big deal is. When you're going through your normal day, you're putting a lot of stress on certain parts of your body, and we're all a little different. So let me talk in general terms, so then your audience can then apply each to their own specific situation.

But let's talk about your night situation. OK? We'll use the contrast of us. Your job primarily is at a computer, talking with people, editing, reading, writing. Does that sound fair enough to say?

John Horton:

It sounds exactly like how all my days go.

Dr. Andrew Bang:

Yeah. And so, with that being said, you probably put a lot of stress on your neck, shoulders, maybe even the low back as you sit in positions for long periods of time without moving.

I'm fortunate enough - I do have to sit and do documentation for notes - but I'm able to get up quite a bit throughout the day, move and help my patients. So, my area that gets a lot of work is my wrists, hands and shoulders; where your area that gets a lot of work would be like your neck, wrists as well, and low back.

John Horton:

OK. Those all ache on me, so you're right on point here.

Dr. Andrew Bang:

So, what you've done is all night - or, all day, you've stretched out those ligaments. They've gotten too loose. And then, when you go to sleep, like I mentioned earlier, is ligaments creep back to their normal position. They're supposed to. They're supposed to shrink back down, that way you can, when you do get up, you sound a little creaky, but that's keeping your body nice and tight, so you don't just topple over or be flexible like Gumby or Stretch Armstrong, right? We need integrity.

John Horton:

All right, that's good. All right. So, I'm keeping everything together. That's good news.

Dr. Andrew Bang:

But now, John, let's say you need to tighten your neck muscles and ligaments and your low back, all those ligaments, and even your wrists back to their normal spot, but you sleep on your stomach where you've twisted your neck, twisted your back, and maybe put your hands underneath you.

Now, instead of allowing your ligaments to creep back to their normal position, you continue to stretch them all night. Or if you sleep on your side and you get into the fetal position where you're super curled like a C, all night your neck continues to stretch forward, which it's already doing too much of using a computer, cell phone, driving, you name it, and your low back also is too curved and too stretched, so all night, it doesn't get a chance to get back to its normal position - and that's when people end up waking up with pain from poor sleeping posture.

John Horton:

Well, then, it seems the key seems to be getting into the right sleep position. So, let's kind of take a closer look at that, and, I guess, the different ways people sleep and how that affects different parts of your body. Let's start with sleep positions for our backs, because I know that is always an issue with people.

Dr. Andrew Bang:

Yeah. For sure.

John Horton:

Yeah. So, how should you sleep? What's the best way?

Dr. Andrew Bang:

All right, so when you look at what, there were some great studies done when they said, "Let's apply pressure to the spine in the sleeping positions and see which the spine has the least amount of pressure on it." Sleeping on your back, the spine has the least amount of pressure applied to it. Sleeping on your sides is the next, and then sleeping on your stomach has the most amount of pressure on your lower back.

John Horton:

OK.

Dr. Andrew Bang:

So, some people can sleep on their stomach probably with no problems, if during the day they don't already put a lot of stress onto their lower back. But that's getting rarer, right? It's hard to do a job where you're not taxing your lower back because of computers and all the sitting we do.

So then, what I try to recommend for low back pain sleepers is to sleep on your back or sides. And if you're like, "I snore, I have a problem with sleep apnea," then definitely you want to favor your side, right and/or left side. And I love, we always do this mantra, but I'm going to bring it up again - motion is lotion, and that's no different when it comes to sleeping. You can't always pick your one side, like the right-side sleeper, and always sleep there because you'll end up causing some issues as well. So, you've got to try to train yourself to slip sleep on both sides if you're a total side sleeper. It's not impossible to do, but it can take a little practice, and it's mostly just being conscious about what you're doing.

John Horton:

Well, that makes sense. You want to flip, so you're doing both sides equally.

Dr. Andrew Bang:

Yeah. You wouldn't cook your pancake just on one side, right? You got to flip that baby. So, here's another couple tips, since we're talking about low back pain, is someone may say, "Well, hey, when I sleep on my side, I still feel a lot of twisting in my low back, which causes me pain." Well, if you take a pillow and shove it between your knees and/or put a pillow in front of your legs, you could bring one knee up bent and rest it on the pillow, and that will kind of stabilize your hips instead of them twisting a lot. That pillow between the knees is a wonderful trick.

Also, you can do the same thing while you're sleeping on your back. When you lay on your back and your legs are flat, depending on how tight your hamstrings are, it can cause your lower back to arch too much.

John Horton:

OK.

Dr. Andrew Bang:

You're really stiff down low in the hamstrings and glutes. Either you're born that way - some people are just not flexible, let's face it - or you sit a lot, so they get tight. You lay on your back and you're like, "It's uncomfortable," because your spine gets too arched. But if you put a pillow underneath your knees, that tends to flex your hips - well then, will make your low back relax. And so, a lot of people, if they want to sleep on their back, if they'll simply add a pillow underneath their knees, that will help their back feel relaxed, comfortable, and they'll be able to doze off and sleep well.

John Horton:

What about your chin? Because I thought I remember reading that there's something when you're sleeping on your side, that you should have your chin in a certain direction, too.

Dr. Andrew Bang:

Yeah, sure. So, moving up the body into the neck, what's the best position for the neck, right? Well, we could make an assumption that sleeping on your stomach is the worst, and it's true because now you're having to turn your neck to the left or to the right for long periods of time.

There are also some people who love to sleep by bringing their hand up and they sleep on their arm, forearm, or their hand, or they put their arm underneath the pillow as they sleep on their stomach. That's shoulder problem city. You're just accelerating shoulder problems where you're going to be, "Oh, I got my rotator cuff problems." So, you got to get those arms down, even if you are still stomach sleeping. OK?

If you are sleeping on your side and you're worried about neck posture like, where should it be? Again, let's go back to the computer posture. As our neck goes forward, it stretches it over the day. If you sleep on your side with your chin tucked, you continue to stretch your neck all night long, those ligaments never creep back to where they're supposed to be to keep you nice and tight. So then, you wake up, your neck is still sore, and it feels cracky or creaky because you haven't allowed it to rest the way it's supposed to.

So, I try to tell people, when you go to sleep on your side, get perfect posture as if you were looking straight ahead, almost like a military posture or like when your mom told you, "Sit up straight," or grandma, whatever. Get nice and straight posture, then lay your head on the pillow. And your pillow, ugh, this is such a tough question. I get it asked all the time, "Well, what kind of pillow should I use?"

John Horton:

That's the question everyone wants to know.

Dr. Andrew Bang:

Oh, my goodness.

John Horton:

You figure there's got to be an answer.

Dr. Andrew Bang:

Well, I've read a lot of research. I haven't done pillow research of my own accord, maybe someday, but the research I have read about pillows is not done very well, and there's a few reasons, just because there's a million variables, right? There are 101 pillows you could possibly buy, and then, the issue you run into is no one's taken 50 pillows with thousands of patients and said, "OK, which pillows seem to be better for the vast majority?"

The research that is out there gives us a couple of guidelines. OK? They rank pillows in this fashion. They say the feather pillow, that's pillows filled with feathers, down feathers, they're the worst.

John Horton:

Super soft.

Dr. Andrew Bang:

They have the least amount of, yeah — they seem soft, right? Seems comfortable when you first lay down. But as you sleep, as the night wears on, as your body heat warms up those feathers and the pressure and weight from your head crushes the pillow, so it no longer is supporting your neck.

The next pillow they say is kind of in second place is the cotton synthetic filled pillows. Those are probably the most commonly used pillows out there, that look like cotton is shoved in your pillow. They're OK, but as they age, they'll lose their durability and they'll also be very non-supportive. And a problem I noticed is they're often very hilly, or a mound of that cotton, and the sides taper too much. And so, then what seems to happen is you're trying to push the cotton where it needs to be, and the issue we run into is now the very top of that mound is here, but then, this sinks into the pillow because you got no support here. Right? The feather pillow, you can kind of mush down and at least support your neck too. OK?

So then, they say the best pillows to have been memory foam pillows. And then, now you open a whole new can of worms because you're like, "Well, which memory foam pillow?” There's shredded, there's a block, there's the one with the dip in it. And then there's every other YouTube memory foam pillow out there in the market."

Some of the best advice of research-based evidence would say whatever fills this space between your head and the bed, remember that: head and the bed. So, my memory foam pillow shouldn't be too high or too low. Sometimes, those contoured kind of pillows are nice because they can kind of scoop and cradle your neck as your head falls into the ravine, but you might be able to get that same sensation with a block of memory foam — and I do have some people who use those shredded memory foam pillows where they can kind of push those memory foam pieces around to cradle their head, and they tend to hold up a little bit better because they have so much, oh, I don't know, like resistance, those shredded pieces. They kind of stick together and they're not moving around as much as the feather might be as you shift throughout the night. So, they'll tend to hold their shape a little bit better.

So, not an exact science, but science tells us memory foam, in some regard, is your best bet when it comes to sleeping with neck pain.

John Horton:

OK. So, we've hit the back, we've hit the neck. What about, and we touched on it a little bit, shoulders, and I know we've talked about when you have a bad shoulder, there's things you want to make sure you do, so that way, it does kind of stay in a neutral position or rest throughout the night.

Dr. Andrew Bang:

Yeah, for sure. So, this is where learning to sleep on both shoulders can be helpful. So, let's say you have a shoulder injury. If you've always slept on your right side, now it's really hard to now all of a sudden try sleeping on your left. But if you've always kind of been accustomed to being able to switch between left and right, you can give the injured shoulder a break and predominantly sleep on the non-injured side.

Typically at that point, too, we're going to want to keep the arm in a neutral posture and not let it fall forward, and so that's when another — like a pillow in front of you — becomes really vital and you can just rest your arm right on the pillow, or an outstretched arm resting on the pillow. That's going to need to be a pretty thick pillow or even two pillows in one pillowcase so that your arm stays at that neutral posture.

I've had some patients purchase pillows that are custom-made where you can actually slip your arm — there's like a cutout manufactured for your shoulder to rest in — the pillow nestles up into your neck and shoulder, creating stability. And if you have severe shoulder arthritis or a shoulder replacement or shoulder surgery, that can be worth the investment. But it's steep. We're talking, pardon me, we're talking like 150, 180 dollars.

John Horton:

Wow. OK.

Dr. Andrew Bang:

A lot. But again, it can be very helpful.

John Horton:

If you're sleeping on your back, what can you do if you have a bum shoulder? Is there something that you can do to kind of help it out a little?

Dr. Andrew Bang:

Yeah. So, this is going to be based off how do you feel when you're sleeping on your back. What you know you're not going to want to do is bring the shoulder up above you because that impinges everything. So, keeping your arm down on your side, sometimes a pillow behind the back of the shoulder and resting the arm on it so you have a slight elevation is helpful, and then sometimes just sleeping on your back with no pillow under the shoulder is actually comfortable. So, this is a little trial and error that you need to be doing.

One thing I can also tell you is many people will try all these things I've recommended, and they're still like, "Man, nothing seems to work." So, I try to get them, yeah, I'd say, "Well, OK, what can we do pre-sleep routine?" And this is where you have this wonderful array of people who have thrown information out there on YouTube, the internet — even, I know our Cleveland Clinic website has a lot of yoga, easy chair yoga, Pilates, stretches that you can do pre-sleep, and most people don't take advantage of that. They just kind of give up. "Well, I try sleeping on my back, doesn't work." Well, if you pre-stretch and then sleep on your back, you're able to do that. If you pre-stretch the shoulder, you're able to now sleep comfortably with that pain, or at least get a number of hours of good sleep before the pain wakes you up because that's all that we're trying to do is spend more time in bed. Even if it's a little disrupted, if you get a few extra minutes, you'll end up feeling way better than if it's all interrupted throughout the whole night.

John Horton:

Dr. Bang, that's great advice. What about if you're having leg pain? Is there anything you can do to kind of help there?

Dr. Andrew Bang:

Yeah, so leg pain typically comes in the form of leg cramps, and these are a mystery in and of themself. Most people, "Oh, drink more water, eat a banana." I've even heard things like pickle juice because of the high salt content, and even like hot, hot, hot peppers in a liquid form that they drink. And all these tips and tricks, they'll help some people. The problem is, it's hard to know where the research comes from to actually validate some of the things that people say work for them.

So, what I tend to do is that, OK, not sure whether those technique or those potential drinks and things might work, but what we do know is, if you will get a very good stretch on leg muscles, then typically, you'll have less cramping as you sleep. So then, the question becomes, "Well, what's a good stretch?"

The rule of thumb is it's got to be at least two minutes of stretching on a particular muscle group. And people are like, "Whoa, that's an eternity." That does seem like an eternity when you're stretching for two minutes on a hamstring per se, or your calf muscle. But the reason that seems to be, yeah, I know, right? Like, who stretches for two minutes. We're thinking for like five seconds, right?

Well, the reason that works is because your muscle needs enough stress on it to say that, OK, we need to adapt to the change. It's no different than if you went to the gym, John, and I gave you a five-pound weight. You could do a hundred curls and you'll never get much growth change in your bicep. But if I give you a 50-pound weight, you'd only need to do a few reps a few days or weeks in a row before you'd see change of their muscle strength and definition.

So, the muscles that we stretch are the same way. If I stretch for five or 10 seconds, it's not enough stress on the muscle for it to do anything. It just feels good. But it doesn't change. If you spend two minutes stretching a single muscle group, over time your body will, "Whoa, whoa, whoa. This is too much stress. We've got to adapt. We've got to get longer." And then, you'll end up going to bed with less muscle cramping. At least, if it's because you're having tight muscles in the lower extremities.

John Horton:

So, spend a little time before bed and just stretch everything out and it'll kind of help you sleep a little better. It gets your body ready.

Dr. Andrew Bang:

Yeah, it totally does. And actually, it will end up probably releasing some of those good feeling hormones that will help you also calm down and feel like your resting state of mind, your parasympathetic state.

John Horton:

So as long as we're talking about sleep, now, we talked about pillows — the other big item that you obviously have is your mattress. And I'm sure you get asked this all the time too, but is there a mattress that's best for sleep?

Dr. Andrew Bang:

Yeah. So again, we got to go off guidelines because, because there's so many mattress companies and types of mattresses, it's been difficult to perform a very good research study giving us the facts. But from what we do have on research when it comes to sleeping — let me give you the take home message: Medium-firm seems to be the recommendation. The issue with that is there's no industry standard, so one company's medium-firm might be another company's super-firm.

John Horton:

That makes it a little tough.

Dr. Andrew Bang:

It does. But keep in mind, you can always add a little softness to your bed. It is impossible to add firmness to your bed, unless you have mattresses that allow you to increase firmness, right? And there's different companies that have technology to do that. But for most of the beds, you can only add softness, like a pillow topper, a memory foam pillow topper or other types of toppers to give you a little bit more give if the mattress feels too firm when you lay on it.

But starting with the medium firm will give you the most support you need for shoulders, low back, neck, et cetera. Need to add a little softness? Put a memory topper on. But the research would then say, OK, medium-firm for standard mattresses — and even memory foam mattresses — they do say mattresses that allow you to have some control over it — so these would be ones that can increase the firmness or even vary the head and the feet, they say for people who have pain, those are the best because they can change it to what they need that day.

John Horton:

So how often should you change your mattress out? Because that's another thing that comes out. You see these companies and they say they have a 20-year mattress, which everyone … you think, "Oh, this will be great. I don't have to worry about it for a long time." But is that the way to go?

Dr. Andrew Bang:

I agree with you. It seems a lot, because I've even seen some that say you can go 30 years before you need to replace it.

John Horton:

Holy cow.

Dr. Andrew Bang:

I know, right? Well, here's the issue we run into. Like I'm 40 right now, so let's say I buy a brand-new mattress today. And if that theoretically will last until I'm 70, there's some issues that might happen between my age right now and 70. There's a high likelihood that I could have a joint replacement, a shoulder, a knee, a hip. There's a high likelihood that I could enjoy too much ice cream and gain 20, 30, 40 pounds, right? Or on the flip side, maybe I decide to go vegan and eat only carrots and broccoli and other healthy vegetables, and I lose 20 or 30 or 40 pounds.

With these big changes in our physiology over a 30-year period, that might dictate the need for a mattress a lot sooner before the mattress actually wears out. So, when I turned to find out from the scientific literature what did they say? They actually recommend that 10 years is, you should really reevaluate, "Do I need a mattress change?"

Because if I'm going to have a small frame right now and I find my medium-firm that seems to work for me, if in 10 years I've gained a lot of weight, then that medium-firm might not be medium-firm anymore. It might be medium for me. So, I might then need to increase the firmness of my mattress so that I'm supported as I sleep.

So, every 10 years, you really need to evaluate, “Where was I 10 years ago? Has my physiology changed? Have I had a joint replacement? Have I gained or lost a bunch of a weight?” And then, also just visibly looking at the mattress itself. Many mattresses are now only one-sided, and we can kind of flip them once, but you can't flip them like you used to with a traditional old mattress. They can wear out faster than what the claim is that they'll last 20 or 30 years, so you're going to really want to look for visible damage or alterations to what the mattress was originally when you purchased it.

Also, if the mattress frame that you put it on has also had, maybe that was from your previous mattress before, and so the frame or bed box spring and things is actually way older than the mattress itself, might have lost its integrity. So, there's a couple things to look out for.

John Horton:

And I take it that people should always go and test mattresses out because, and in the end, since there's no really big formal declaration as to what's firm or soft medium, you just have to go try it, right?

Dr. Andrew Bang:

You're 100 percent right, John. Because there's not an official scientific declaration, you've got to be your own investigator. You got to be your own advocate. And you're going to take a nap on that mattress in the store and really get an idea if it's the right thing for you.

John Horton:

I have to tell you, the last time I went and bought a mattress, we did that, and I fell asleep there.

Dr. Andrew Bang:

Oh. That's awesome.

John Horton:

And so, we bought it.

Dr. Andrew Bang:

I tell you; you must have had a bad mattress; you weren't getting some good sleep before. Well, I'm glad. That's good. It's OK, I think it's worth it because, I mean, you spend a third of your life in there. To me, it's a big deal, and you should spend as much time in a mattress store trying some things out as you do buy a car. I mean, usually a lot of people spend a lot of time and go back and forth and read reviews, and I think that's helpful. And I think spending time with a mattress is helpful.

And if you want to buy an online mattress, you might be surprised. A friend, a family member might already own that mattress, and it might be worth literally going to their homes, just say, "Can I just lay, can I feel, can I see if it's firm enough?"

And there is one other thing I was thinking when we were talking about this. Oh, I know — I do love that a lot of mattress companies recognize that you may not be happy with the mattress, and if they've got a decent return policy, you may lose a hundred dollars for a stocking fee or whatever, but I think that's worth it if you do not jive with your mattress. But I will give the warning, and most mattress companies will say this one caveat to that is you need somewhere like 30 to 90 to 60 days. There's not a definite number, but there needs to be some time with you to sleep in on the new mattress.

You can't make a decision that it's a "bad mattress" just after a couple of days of sleep, and that's been something that's been documented. When you do look at the literature, they do say, "Hey, people don't tend to get comfortable for a period of time," so don't give up right away on your mattress. And I think mattress companies have come around to this idea, and so they're giving you this three-month window of like, "Hey, if you hate it, return it." And I really think if you're not jiving with it in 30, 45 days, then yeah, you should really consider spinning that restocking fee, just trying a new mattress, or then maybe jump into that option of the softer topper.

John Horton:

Well, it sounds like you probably save money on doctor's appointments later if you do that with the restocking fee.

Dr. Andrew Bang:

Oh, that's true. Yeah.

John Horton:

So, we've covered a lot here. So, before we kind of say goodbye and look to put some of these tips to use, is there anything else you'd like to add?

Dr. Andrew Bang:

I would just say there's a lot of great mattresses and things, and consider your sheets, too. That's not the only thing because a lot of people sleep really hot or really cold, and that can affect your sleep just as much as poor positioning.

And then, I guess, I think my last take home would be just take a little time. When you're not sleeping well, it's amazing how a little bit of stretching and self-care for 10 minutes before you go to sleep, I find some people switch their morning shower routine for an evening shower routine to help relax, calm the body, get it into that parasympathetic sleeping and resting state, and that can go a long way and it can solve a lot of problems that you think might be coming from your mattress. So that was kind of what I would say, but happy sleeping to you guys, and good luck because it is a little bit of work to find the right mattress.

John Horton:

Well, I'm going to try some of these tips tonight, and then, hopefully tomorrow morning when I get up, I will not have those zombie steps.

Dr. Andrew Bang:

Yeah, you can text me and tell me how you're doing. All right?

John Horton:

Will do, Dr. Bang. Thank you very much. Always a treat.

Dr. Andrew Bang:

All right, bye.

John Horton:

We spend a lot of time sleeping, so it's important to use good sleep posture to avoid aches and pains. Try these tips from Dr. Bang the next time you go to bed to see if you wake up feeling a little bit better. Till next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.