how you sleep matters
Xandra says: In the same way that sitting incorrectly all day can play havoc with your back, poor sleeping posture can affect your back and joints too. Poor posture when sleeping can cause back and neck pain, headaches, tiredness, reduced circulation, cramp, reflux and digestive upset.1
A good night’s sleep is not only about sleeping in a way that relieves and averts joint pressure. Choosing the right bed and bedding, and being sure to limit stimulants before bed is also important. ‘Sleep hygiene’ is a term used to describe the ways to create an environment, routine and healthy habits to help ensure that you sleep well at night.
We are a sleep-deprived nation. One in six of us2 fail to get even six hours of sleep per night. The quality of the sleep that we have can also affect us. Our bodies work in cycles of sleep, moving through four phases, from light sleep, into deeper sleep, and back. Each cycle happens multiple times throughout the night and our circadian rhythm – our body’s own alarm clock – works to tell us when to sleep and when to wake.
On average, most adults require between seven to eight hours of sleep each night. Ideally, we should go to bed when we are tired and wake naturally, feeling refreshed and ready to start the day ahead. Stimulants like caffeine, stress, technology and too much sugar can all disrupt that natural sleep pattern, leaving us feeling tired and stressed. Medication can disrupt our sleep, as can menopause and the night sweats that come with it can also affect our sleep, leaving us feeling exhausted, rather than refreshed when we wake.
how can I sleep better?
If you are sleeping badly, while a trip to the GP can help, we advise first checking your own home, your bed and the way in which you sleep, to see if there are simple ways to get a better night’s sleep. As we discuss in the better sleep toolkit, it’s also important not to overlook our diet and nutrition when considering our overall sleep routine in the hours before bedtime.
Check your diet. Sugar and stimulants can all disrupt your sleep. If you are a caffeine addict, try and ensure you are avoiding it in the evenings, especially before bed. Try and eat dinner earlier in the evening, so that your digestive system can do most of its work while you are awake. A glass of warm milk before bed is not an old wives tale! Milk contains tryptophan, which, when drunk, converts to melatonin, which helps us sleep. Almond milk contains high levels of magnesium, another natural sleep support, which can help ensure a restful night. Chamomile or decaffeinated green tea can also help you to drift off to sleep.
Avoid alcohol: It may seem like a good idea to have a few drinks to help you sleep, but the opposite is true. Alcohol disrupts our sleep and can lead to a restless, rather than a restful night’s sleep.
Check your stress levels. As we discuss in the better sleep toolkit, cortisol, which is released when we are stressed, can play a major role in causing havoc in our sleep patterns. Try and do something relaxing before bed, such as a warm bath or read a book.
Create a sleep routine. In our section on sleep hygiene in the better sleep toolkit, try and go to bed and wake up at the same time each day. Be realistic – if you’re a natural night owl, then trying to sleep at 9 pm is futile, and only going to cause more stress that will keep you awake. Try and listen to your body and set a sleep/wake cycle that works for you.
Check your room for good sleep hygiene: Make your room your sleep sanctuary. Avoid watching TV or checking your phone in bed and ensure your room is cool, but not too cold. Dust mite allergies can be common and can disrupt our sleep at night. These microscopic little things live in our bedding and our mattress and carpets and can leave us feeling as if we are suffering from hayfever or asthma symptoms. Anti-allergy bedding is available, including protectors that can prevent dust mites from getting through your mattress.
Avoid carpets in your bedroom and be sure to wash your bedding at least weekly at 60°C. If you can’t wash things like your duvets, you can either tumble dry them or use a steam cleaner. When vacuuming, ensure your mattress is also cleaned and try to clean at least once or twice a week, including all soft furnishings, including soft toys and decorative pillows. UV light can also help minimise dust mites (we can’t get rid of them completely), so on sunny days, leave your bedding off the bed (yes, don’t make the bed!), to let Mother Nature help you minimise their population.
Natural cotton or wool mattresses are a good choice if you have a dust mite allergy. While latex or memory foam mattresses and pillows can help to reduce dust mite populations, (as these are harder to penetrate), some are made using a lot of chemicals that can cause problems of their own. If you do choose a memory foam mattress or topper, choose one that carries the Allergy UK seal of approval, or one that is made using a non-toxic process.
Choose the right pillow:
These days, there are so many choices of pillow that are available. You can buy different material types, from feather down to memory foam, and it really is a matter of preference which material you choose. While a soft, down pillow may feel comfortable, they offer virtually no neck support at all. If you’ve ever found yourself shaping or pummelling the pillow under yourself, it’s because your neck needs that extra support.
Your neck should have a natural curve, yet daily life, technology, and how we sit and move can all contribute to minimising this curvature. It’s important to rest your neck muscles at night with a supportive pillow that supports those natural contours. This allows you to relax the muscles around your neck and undo some of the bad posture habits of our daily lives.
To correctly support your neck, each joint should be in alignment with the next. This helps to ensure correct shoulder positioning, aligns your lower back and puts your hips in a good position too – it all starts from the neck!
Xandra says: Some of my chiropractic patients experience issues with memory foam pillows, due to their hard density and the heat that they can generate. I suggest patients try a shaped foam pillow instead. My own pillow is foam, with a curve at the front and a dip for my head to sink into. It really helps me to get a good night’s sleep!
Which sort of mattress is best?
If you’re buying a new mattress, there are a few things to consider. First is the weight – not only of yourself, but of your partner too. If you both are very slim, then a medium/firm mattress is a good choice to support you as you sleep. A softer mattress will not offer enough support, especially as your mattress ages. For people who are average build or above, a firmer mattress will give better support.
A mattress that is too hard is uncomfortable to sleep on and can make joints sore – neither of which equal a good night’s sleep! It’s always possible to make a harder mattress softer and more comfortable, thanks to mattress toppers. However, it’s never possible to make a very soft mattress support your spine.
Xandra says: I believe that a mattress alone is simply not good enough. For me, a mattress topper is the key to helping my patients to have a great night’s sleep. Once my patients have chosen the correct firmness of mattress, adding a topper makes sleeping feel luxurious and supports your joints at night. I always recommend a foam-type topper, between 3”-7” thick. It allows side sleepers to have their hips and shoulders sink in (so comfy!), whilst their backs are nicely supported. Back and front sleepers can also gain more support from their bed by using a topper.
My personal preference is the egg box foam type of topper, as I feel it puts less pressure on my hips, as I lie on my side. It’s also cooler to sleep on than memory foam, which can get too hot at night (particularly if you are menopausal). This is the option that I recommend to my friends, family and patients.
practical ways to sleep better
Sleep in the most comfortable position:
The reason that many of us struggle sleeping comfortably at night is down to the strength in your core muscles. When you’re awake, two types of muscles are supporting you. The first are your conscious muscles; the ones that if you were asked to tense them, you could. For example, if you think about tensing the front of your upper thigh, you can. However, the second set are your unconscious core muscles. These are controlled by your brain and nervous system, but have no conscious link. This means that you can’t simply tense them by thinking about them.
It’s the unconscious muscles that support our spines while we sleep. If they get too weak because during the day you are sitting too much, or you’re carrying an injury, recovering from surgery or simply not doing enough exercise, then when you sleep those muscles are not strong enough to help you. Instead, your body uses the bigger conscious muscles to turn and support you at night. These muscles are bigger, stronger and put more strain on your joints.
Knowing what your posture is like during the day (and your type of posture) is key to improving your posture at night.
Should I lie on my back to sleep? Sleeping on your back has always been seen as the ‘gold standard’ for keeping your spine correctly aligned. However, it can cause tension in your lower back, due to the natural curve there. Women who sleep on their backs tend to notice discomfort more than men, as their lower back curve is bigger. Lying on your back can cause an increase in snoring, which can disrupt your sleep quality (and your partner’s too)! If you feel this is the most comfortable position to sleep in, then putting a pillow under your knees will help to relax the lower back curve.
Is lying on my front bad for me? Lying on your front can help to ease snoring, but is bad not only for your back, but for your breathing too. Sleeping on your front straightens the normal lower back curve, creating pressure that could lead to pain. To breathe through the night, most people will turn their neck a long way to one side. With the added weight on your neck in this position, your joints will be stressed, which could cause neck pain or headaches.
Breathing is more difficult if you sleep on your front. This can lead to a lighter sleep pattern, meaning you may not feel fully rested and more tired during the day. If your natural sleeping position is on your front, try and sleep with a pillow under your lower abdomen, to help relieve any pressure on the spine. Ideally, front sleepers should try to train yourself to sleep in a better position. If you want to try to stop sleeping on your front, try using a body pillow, which can help you to stop rolling onto your front in your sleep.
Which sleeping position is best for your back? If you’re a back sleeper and that position is most comfortable for you, then simply adding a pillow to support your lower legs (and the lower back curve) can help optimise your sleeping.
Try and sleep on your side. Sleeping on your side is the most common position and the one that we recommend. Side sleeping puts the least amount of strain on the spine, whilst allowing the natural contours of the body to sink into the mattress. And, it’s comfortable! There is no right or wrong way to sleep. If you worry about what angle your legs are at, or how bent your knees are, that in itself can disrupt your chances of getting a good night’s rest! If your legs are uncomfortable, try placing a pillow between your knees.
Whichever position you choose to fall asleep in, it is likely your body will move as you sleep, so your core strength is important in helping support your position while sleeping.
Which side should I sleep on? Due to our anatomies, our left side is considered to be optimal, as it can help your circulation.3 But really – just sleep on the side you are most comfortable on! Once asleep, almost everyone moves and changes position anyway. Most important to a good night’s sleep Is the pillow and mattress you choose. They both play a huge part in how your body shifts when you sleep, how much strain you place on your body while asleep and are fundamental to good sleep hygiene.
exercise and stretching
A little exercise before bed can help you sleep better at night. Try something relaxing, like yoga, or some pre-sleep stretching, such as those in our 3 minute posture challenge.
Stretching, using an ice pack on your back or neck before bed and maybe even doing some work on your spine with a foam roller can all really help with how you sleep.
Exercises to strengthen your core and back muscles, such as the ones in the Realign programme (coming soon!) can help to make your spine healthy and to move freely. This can help minimise inflammation from muscle and joint pains, which will allow greater connection throughout your entire body, and allow your unconscious brain to let it find the most comfortable sleep position for you.
q&a with Xandra
Q: I’m pregnant – how should I sleep?
Whichever way you feel most comfortable! While there are safe ways to sleep and that are better for your spine, trust your body to guide you. Sleeping on your left side – pregnant or not – is always the best way to sleep, if you can. Sleeping on your back is not recommended for pregnant women.3
As you get further into pregnancy, the harder being comfortable becomes. This is where different pillows can help support you and ensure you get at least some sleep!
- Invest in a good neck pillow. Odd as it may sound, when you want to make your lower body comfortable, a good neck pillow can help you relax your shoulders. Even if you have lower back discomfort, my pregnant patients find that getting good neck and upper body support seems to help the lower back.
- Try a pillow between your legs. This helps the pelvis to align and can relieve a lot of pressure as you sleep. This can also help patients who are experiencing sciatica (leg pain) at night.
- A full body pillow. Best in the later stages of pregnancy, but if you find it helps earlier on, that’s okay too. Place one end between your knees and then the mid-section should be under your bump, to support some of the extra weight you are carrying. The other end should be there for you to hug, so your arms are supported too. The best thing about these pillows is that you can also use them once the baby is born to wrap around your back and support yourself and the baby in bed if you are breastfeeding.