To help you enhance your practice and increase your bottom line, Dynamic Chiropractic PracticeINSIGHTS asks practicing DCs like you, for ideas and solutions that have been tested in real-world environments. In this issue we asked: "Considering that most people spend a third of their lives in bed, what recommendations do you make to address issues related to poor sleep posture/positioning and their effect on your patients?" As always, your feedback provided us with valued insight and effective methods to implement in your practice. The following responses are what we found most useful in answering this question:
Explain Why Sleep Posture is Important
Dr. Peter Morgan, of New York, addresses this issue by first informing his patients on why sleep posture is important, then follows with specific instructions on what to do to attain proper sleep posture. He tells his patients:
"Posture is the position in which you hold your body upright against gravity while standing, sitting or lying down. Poor sleep posture can result in vertebral subluxations and distortions of your spine. The correct sleep posture is just as important as having the correct sitting and standing posture, especially if you want to enjoy a pain-free and healthy life. Good posture keeps the vertebrae and joints in the correct alignment so that muscles are being used properly. Good posture can also prevent spinal fixations that will lead to vertebral subluxations. So here are my instructions on improving posture while sleeping.
- Make sure you have a good cervical pillow. If the pillow is too large or too small for you, it may lead to excess stretching of the extensors in the neck, possibly contributing to a forward-head posture. The pillow should be under your head, but not your shoulders, and should be a thickness that allows your head to be in a normal position.
- Make sure you have a firm mattress. Mattresses that sink or are too soft allow the spine to move too deeply into a curve. You can support your back by choosing a firm mattress.
- Make sure to sleep in a position which helps you maintain the curve in your back (such as on your back with a pillow under your knees or a lumbar roll under your lower back; or on your side with your knees slightly bent). Avoid sleeping on your stomach; it lets your lower back sink far inward and may cause spinal distortion. Line up your hips so that they're stacked one on top of the other.
- Place a small or medium-sized pillow between your legs to maintain the curve of your spine and alleviate any pressure or stretching.
- Move to your back if side sleeping doesn't work for you. Add a medium firm pillow under your knees and lower legs for a relaxed, natural position.
To summarize the best sleep posture is simply to sleep on your side, knees bent, pillow between the knees, and your head resting on a single proper-sized pillow."
Michael McGillicuddy of Winter Park, Fla., takes it a step further by providing helpful tips in achieving a good night's sleep.
"Do not go to bed until you intend to fall asleep. Do not sleep with the television on. Keep the bedroom dark. For most people, sleeping in the side-lying position with pillows often works best. Do not sleep with air blowing directly on you. Sleep in comfortable clothing. Avoid sleeping pills. Do not drink fluid right before going to bed. Try and get eight hours of sleep every night. Try to develop a pattern of sleeping at the same time."
Finding the Right Mattress
While some of you choose to address this issue by educating your patients about proper sleep function, most of you believe that the solution lies in a good mattress.
Chad Harrison of North Dakota believes the right mattress is the key to supporting proper sleep posture. He explains that mattresses should vary to individual patient needs:
"I do not believe that a bed is about firmness or softness, or specifically comfort. The primary consideration for purchasing a bed is support. Does the bed, that you purchase, or currently have, support you? This is an individual question. Each person presents with their own uniqueness so to say there is a perfect bed and one-size-fits-all is not accurate. The nice side effect of a supportive bed is that it is also comfortable.
"I recommend to anybody that learning the lingo before purchasing a bed is a must. Understand the difference between spring mattresses, number, size of springs, etc. Learn about foam beds, along with their pros and cons.
"Once you understand what a bed is supposed to do, then you can learn what bed you should have, individually. Consider your bed an investment in your health, not something you sleep on until you get up. Once a person has the right supportive bed, sleeping posture, positioning and discomfort tend to right themselves."
Dr. Jenny Armstrong, of Georgia, believes that finding the right mattress is highly important to sleep posture and advises her patients not to settle for the wrong mattress.
"When shopping for a new mattress, I always advise my patients to buy from the store offering the longest return policy. It may take weeks or months to decide if you've found the correct mattress," she said. "So it's important to be able to return it and try another, as many times as it takes to find the right one."
Dr. Niels Peter Carstens, of Aalborg, Denmark, cautions his patients not to select a mattress that is too soft.
"Regarding beds, I feel that many beds are too soft, thus causing the patient to have less movements during sleep. I think the body needs the motion in the sleeping hours, to facilitate the lymphatic systems to function optimally," Carstens said. "When the bed is harder, we turn during the night with lesser effort. This prevents morning stiffness."
Finally, Lex R. Rathbun of Tamuning, Guam, believes a foam mattress is the way to go. He writes: "As random sleep movements are inherent to individual patients, my advice is simply to invest in the best sleep system possible. In my opinion, Temper-Pedic mattresses provide the best orthopedically sound product on the market today."
