Better Sleep

Table of Contents

Sleep is a critical part of your overall health. This guide is dedicated to showing you how to get a better sleep through better support and alignment. These guidelines are a part of my Health Guides series.

Better Sleep: The Best Way to Sleep with Osteoporosis

Welcome to the Guide to Better Sleep. In this guide, I provide my perspective, as a Physical Therapist, on the physical things you can do to have a better sleep, especially the best way to sleep with osteoporosis. I will cover the following topics:

  • How to choose the best mattress for sleeping.
  • How to support the space between your ribcage and pelvis.
  • Side sleeping and shoulder pain.
  • How to sleep to avoid neck pain.
  • The importance of recovery position.
  • Pillows and watching TV in bed.
  • Sleeping tips for back sleepers.
  • Sleeping pillow for neck support.

If you have osteoporosis, you need to be concerned with compression fractures. Compression fractures can cause back pain and can disturb sleep. Further, if you have one compression fracture, you are at risk of more compression fractures. To reduce this risk you will need to take appropriate measures. I discuss many of these in this better sleep guide and also in my blog post, How to Treat a Compression Fracture.

We know that your overall quality of life improves when you have a good night’s sleep so we should do each of these things well.

When you sleep well your ability to perform exercise and your balance improves. So sleep becomes a really critical part of overall health and wellness of all parts of your body.

I encourage you to check out my review of several important books on how to improve your sleep.

I hope that this guide is a good source for you to go to if you’re currently not having a good night’s sleep or if you’re looking for ideas or suggestions on positioning when sleeping.

How to Choose the Best Mattress for Sleeping

The foundation for a good night’s sleep is a good mattress. Therefore, let’s start this guide to good sleep with how to choose the best mattress for sleeping. Specifically, I will cover how a good mattress can help you sleep better and how to support the space between your ribcage and pelvis while you sleep.

You want to support your body as best as possible. A medium to firm mattress seems to be regarded more highly for people.

Ideally you want to spend time on different mattresses and try them out for comfort. Pay attention to how you feel after you sleep at a friend’s house. If you get invited to sleep over and you have a great night’s sleep, find out what kind of mattress it was. The same goes for pillows.

Support the Space Between Your Ribcage and Pelvis

Once you successfully find the best mattress for you, the next thing is supporting the space between your ribcage and pelvis while you sleep.

When it comes to sleeping comfort is key. Your sleep position is key determinant in the comfort of your sleep. Some people prefer a side sleeping position while others are more comfortable sleeping on their back. The tips in this blog are not just for someone who’s had a compression fracture but are helpful for any type of back pain or neck pain from motor vehicle accidents to common sprains and strains.

I’m going to cover this because it’s equally as important whether you’re a side sleeper or a back sleeper. In either case, you need to support the space where the ribcage ends and the pelvis starts. We have a little space there that tends to be unsupported when we’re sleeping, whether it’s on our side or on our back.

How to Create Space Between Your Ribcage and Pelvis

Here are the steps to creating a support for the space between your ribcage and pelvis:

  • Start by finding a towel that’s the perfect size for you.
  • A hand-towel size generally works well.
  • If you do not find the perfect size for you,  cut a towel. You’re worth it. Watch the video above if you’re not sure of the towel size before cutting.
  • Find one of your softer belts,  a belt from a bathrobe or one of the older loop belts works well.
  • Take the belt and rest it on one edge of the towel.
  • Next roll the towel and the belt together. You’re creating is a little supported belt for your waist.
  • The towel has to be wide enough so that it sits on both sides of your waist. It’s got to come around so it’s sitting on the waist itself and leaves me enough space that I can actually tie it in the front, or enough end of my belt that I can tie it in the front.
  • Whether I’m lying on my side or on my back, the towel roll will support my spine.

This is not something that you have to do if you don’t have back pain. But certainly if you have back pain, it just gives you more support.  Individuals with disc pain will appreciate the support. If however, your back pain is coming from spinal stenosis or facet joint irritation you may benefit from the support while on your side but should not use it if you are a back sleeper.

Another idea, suggested by Physiotherapist Mark Edwards, is to find the correct size of support that you require and rather than making a belt, roll it up and place it under the bottom bed sheet. Your weight will hold the support in place.

Sleep Position and Dowager's Hump (or Kyphosis)

In the video above I demonstrates the best posture to sleep for neck pain. I show the correct sleep posture for neck pain and how to sleep for better neck posture. I also cover Dowager’s Hump pillow and the best Dowager’s Hump sleeping position.

Neck Pain, Posture and Sleeping

One of the symptoms of forward head posture is neck pain. Often, if you wake up in the morning or during the night and your neck pain is worse, then your pillow is definitely one of the contributing causes.

The Best Pillow for Posture and Dowager’s Hump

When we think about the optimum pillow or the support that we need when we’re sleeping, a lot of it has to do with what position we sleep in. When we’re sleeping on our back the only thing that needs support, if we have good alignment, is the arch and the small of our neck.

If we tend to have a bit of a forward head posture, we’re going to need to support that space. Otherwise, our head is going to fall back. The more forward your head is, the more pillow you’re going to need to support. But know that if you continually support yourself when you’re lying on your back, you are never going to have an opportunity to actually get a little bit of a stretch and to gradually bring yourself back.

Dowager’s Hump Sleeping Position

In many movies you always see the actor in bed with two big pillows. But this is terrible for the average person because it puts you back into the same head forward posture. Your spine never gets an opportunity to elongate.

If you’re a back sleeper, try to minimize your pillows as much as possible, so that you have the support just in the small of your neck. You don’t really need anything under your head.

But if your head is not yet comfortable going all the way flat, do use the smallest pillow you can under your head and still support your neck. Pillows should not be underneath your shoulders.

If you’re a side sleeper, however, then you are going to want to have a pillow that allows you to fill in the space between your shoulder and your neck. A pillow that is little bit flatter in this situation works, and the other pillow can be used between your knees and ankles. you want your chin to line up in the middle of your breastbone.

I hope these tips help you have a better night’s sleep and wake up pain-free.

Side Sleeping and Shoulder Pain or Neck Pain

Many of my clients are side sleepers but they need some coaching on side sleeping and shoulder pain. The tips below also apply if you have neck pain and side sleep.


  • The key elements to a comfortable side sleeping position is supporting your entire body in a side-lying position.
  • You want to ensure that your pillow fills in the space between your shoulders and your neck and that it’s not sitting under the shoulder. It should support you at the neck.
  • You could also use a rolled towel in your pillow case to support your cervical spine for support.
  • The pillow that works for me tends to be a feather pillow, but that’s not the case for everybody, especially if you’re allergic to feathers.  🙂
  • The little belt that I’ve created provides me with support between my pelvis and my lower rib cage.
  • I suggest that you put a pillow between the knees and ankles to create a supported position for your pelvis.
  • Your spine is now supported at the small of the waist and your spine is totally straight.
  • A point that I forgot to mention in the video, is to align your shoulder directly beneath your torso.
  • Avoid letting your shoulder roll forward.
  • There are more tips below for shoulder pain sufferers.

How to Sleep to Avoid Neck Pain

I will cover and demonstrate how to sleep to avoid neck pain. This is also appropriate for people who experience back or shoulder pain as well as neck pain. Here are the steps you should follow:


  • As mentioned above you want to ensure that your pillow fills in the space between your shoulder and your neck and that it’s not sitting under the shoulder.
  • Your pillow should support your neck in a neutral position.  This means your chin aligns with the centre of your breast bone.
  • To learn how to create an ergonomic pillow read the section on Sleeping Pillow for Neck Support. The only difference is that the entire pillow will be the width of the distance between the base of your neck and your shoulder joint.
  • Some people will try to fall asleep with their arm resting on the upper side of their torso. When you fall asleep it will slide off and  hang in front of you.  This can aggravate already irritated neck and shoulder tissues.
  • Instead of just letting the arm hang,  support your arm in a neutral position. A body pillow works well for this purpose.
  • This is a comfortable supportive sleeping position.
  • This position will allow you to sleep to avoid neck pain, many  of my clients with back and shoulder pain find it helpful.
  • As the name implies, you’re trying to support everything that is potentially going to move or be unsupported when you’re sleeping. This is supported sleeping.

Importance of Recovery Position

Another topic I cover with my clients is the importance of recovery position. Sleeping in recovery position is for people who are side sleepers. You need to be flexible in your chest and shoulders to be comfortable with this position. My clients who are tight in the shoulder don’t particularly like this position. But it is an excellent position in that it keeps your back in a very neutral position.If you can do it, I encourage you to give it a try. Here are the steps you can follow:

In the video above I demonstrate the recovery position.

  • Top knee and top arm are both bent.
  • Bottom knee and bottom arm are both straight.
  • Bottom shoulder is behind you.
  • Pillow should be thinner than if you were in side sleeping.  Placing your head on the edge brings your neck in a neutral position in line with your torso.
  • If you are looking for more support, place a small pillow or even a rolled towel underneath your upper arm , to give you an additional support. It allows you to roll your body into it.
  • The type and size of support varies greatly with the size of the individual. For example, if you are large breasted and have a small waist you will benefit from support from your groin to the bottom of your breast and another support under your shoulder.  If you have a large tummy but are small breasted then you’ll want to support the space above and below your tummy.
  • With enough support your whole body is supported in this recovery position.
  • Body pillows are great for those who like to sleep in either the recovery position or on their side and have an even space to fill i.e. are small waited and small breasted.

If like to read or watch TV in bed you might want to pay attention to the next section of the blog.

Better Sleep, Pillows and Watching TV in Bed

We see so many of the role models that we watch on TV and in movies, sleep with pillows. Usually they have, at least, two pillows, and sometimes they’re even more upright than I am right now.

That’s great if you’re in Hollywood and you’re getting paid big bucks. But if you’re just going to sleep, and want a good night’s sleep, I highly recommend that you follow these tips:

  • Don’t sleep with pillows under your shoulders.
  • Don’t have two pillows under your head.
  • If you have gastric reflux and you need to have your head up for some reason, then you should have the whole bed lifted, or raised, just by little furniture blocks.
  • One of the things that breaks my heart when I go to emergency wards, and I see people in hospital beds. I see people who have had compression fractures, and the top half of the bed is propped up. But the break in the bed, is right about where the compression fracture is. They were not positioned tis way by the hospital staff but with time they slide down.  This can certainly lead to further compression of the vertebra.
  • If you have an electric bed be sure to make the it flat before you go to sleep.  We do so much sitting throughout the day that going flat is for some, one of the few times we fully stretch out.
  • Also, the fold of the bed should be at the hip and not at your spine.
  • Sleeping and reading in bed is also problematic for other neck or back issues. Read and watch TV in more supportive positions before you get to bed.
  • Sleep experts recommend you do your reading and watching TV before you get into bed.  Your bed should only be associated with sleep (and sex).

If you are still determined to read in bed here are some safe suggestions:

  • Read from a supported side-lying position as discussed above.
  • Read from a supported back-lying position.
  • To support your book/e-reader, rest your elbows on a large pillow, decorative bed pillows work well.  It should allow you to have your arms fully supported, elbows at roughly 90 degrees of bend and your reading material a comfortable distance from your eyes.

Finally, ensure that your pillows are underneath your head and neck, and not underneath your shoulders.

Sleeping Tips for Back Sleepers

Back sleepers will need to make modifications to their sleep position to avoid back and neck pain. In the video above I cover best sleep positions for people who sleep on their backs. These recommendations help you avoid neck and back pain from sleep. I suggest that you have support in small of your back, your neck and under your thighs while you sleep.

Here are the sleeping tips for back sleepers:

  • If you’re a back sleeper, then it’s important that you have the low support in the small of your back and that you have support in the small of your neck.
  • A softer pillow that allows you to conform just so that you get the support in your neck works really well, if you’re a back sleeper.
  • Next, having your legs out straight can sometimes put a little stress on the back. Place a pillow that supports you under your thighs. This works quite nicely.
  • If you tend to get a little bit of swelling in your feet, you can actually have a longer pillow, and turn the pillow the whole length of your legs. This allows you to elevate your legs as you support your back.
  • When you occasionally go from being a back sleeper to a side sleeper, you can roll from the back position, and the pillow will be there for you to slip between your knees and ankles.

Sleeping Pillow for Neck Support

Those of you who are looking for a little bit more support in a pillow and you are not in a position to go and buy all these different expensive pillows can use this easy solution — at least temporarily. Find or create a roll that’s going to support you at the neck.

In the video above I cover how to create a simple sleeping pillow for neck support. Here are the simple steps:

  • Roll up a hand-towel lengthwise.
  • Slide the towel into the pillow case just above the bottom edge of the pillow.
  • Test out the pillow during the day and try different towel densities/sizes until you find the one that feel just right. You’ll be too tired to do this when you’re ready for bed.

This is often a solution that I use if I’m in a hotel room. I rarely like their pillows. I’ll take the thinnest of the pillows, if I’m choosing to sleep on my back, I create a little roll and slip it into the pillow case.  Often, I will just use the rolled towel alone.

For my husband who likes to sleep on his side, I use a pillow the thickness of his neck to shoulder length and place a rolled towel at the base of the pillow case.

Creating an ergonomic pillow for yourself whether you’re lying on your back or on your side to provide the support you need for your neck is this easy.

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