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Ergonomics during sleep - correct sleeping position

Ergonomics during sleep

Topic overview

  1. Ergonomics during sleep – definition
  2. Wrong sleeping positions at a glance
  3. Correct sleeping position
  4. Correct sleeping position – implementation in practice
  5. Ergonomics during sleep – the right mattress

1. Ergonomics during sleep – definition

Ergonomics is a specialist field in which incorrect, one-sided and unphysiological movement patterns are analyzed.

These samples are then used for the treatment and prevention of orthopaedic clinical pictures adapted. When we talk about ergonomics, the first thing that comes to mind is an improvement in the workplace. For example, changes are made to the office chair, the desk height or the position of the screen.

By contrast, ergonomics when driving, ergonomics in everyday life and ergonomics during sleep are much less important.

Ergonomics during sleep is primarily about the sleeping position. But the right mattress and the right pillow also play a role when we talk about ergonomics during sleep.

In this article, however, the focus is on incorrect sleeping positions and their orthopaedic consequences. It also explains the correct sleeping position and how best to implement it.

2. Incorrect sleeping position – overview & explanation

2.1. Incorrect sleeping position – prone position

As illustrated here with lightning bolts, the cervical spine is impaired in the prone position. Since the cervical spine must inevitably be rotated strongly to one side in the prone position, shortening occurs in the rotator area. This can also result in restricted movement in rotation.

Furthermore, the external rotators in the shoulder joint are constricted and shortened. This in turn is a common cause of shoulder joint disorders.

The frequent prone position at night has even worse consequences for the lumbar spine. If you haven’t worked in the field of physiotherapy/orthopaedics for ten years yourself, then you probably think this statement is a complete exaggeration.

However, the analysis of hundreds of intervertebral disc patients in personal care has shown that this sleeping position is one of the main causes of herniated discs in the lumbar spine. A lasting improvement in the condition usually only occurs when the patient himself changes his sleeping position on the therapist’s advice.

2.2. Incorrect sleeping position – side position

The slight lateral tilt of the cervical spine can still be tolerated. For the shoulder joint it is the most damaging sleeping position of all.

The arm is positioned upside down and the humerus is pressed into the acromion. In addition, there is probably the greatest possible external rotation in the shoulder joint with shortening of the external rotators.

Internal rotation and adduction can be seen in the hip joint. Hip joints are very often positioned too far inwards and internally rotated. It is usually caused by falls on the trochanter (outer hip bone) and a weakened longitudinal arch in the foot. Osteoarthritis of the hip joint is significantly accelerated by this sleeping position.

Knee problems can also occur in this sleeping position. On the one hand, compression can cause problems if the knee rests on the knee for a long time. On the other hand, there is a narrowing in the area of the outer meniscus.

Changing this sleeping position brings great progress, especially in the treatment of shoulder joint disorders.

2.2. Incorrect sleeping position – side position

The slight lateral tilt of the cervical spine can still be tolerated. For the shoulder joint it is the most damaging sleeping position of all.

The arm is positioned upside down and the humerus is pressed into the acromion. In addition, there is probably the greatest possible external rotation in the shoulder joint with shortening of the external rotators.

Internal rotation and adduction can be seen in the hip joint. Hip joints are very often positioned too far inwards and internally rotated. It is usually caused by falls on the trochanter (outer hip bone) and a weakened longitudinal arch in the foot. Osteoarthritis of the hip joint is significantly accelerated by this sleeping position.

Knee problems can also occur in this sleeping position. On the one hand, compression can cause problems if the knee rests on the knee for a long time. On the other hand, there is a narrowing in the area of the outer meniscus.

Changing this sleeping position brings great progress, especially in the treatment of shoulder joint disorders.

2.1. Incorrect sleeping position – prone position

As illustrated here with lightning bolts, the cervical spine is impaired in the prone position. Since the cervical spine must inevitably be rotated strongly to one side in the prone position, shortening occurs in the rotator area. This can also result in restricted movement in rotation.

Furthermore, the external rotators in the shoulder joint are constricted and shortened. This in turn is a common cause of
shoulder joint disorders
.

The frequent prone position at night has even worse consequences for the lumbar spine. If you haven’t worked in the field of physiotherapy/orthopaedics for ten years yourself, then you probably think this statement is a complete exaggeration.

However, the analysis of hundreds of intervertebral disc patients in personal care has shown that this sleeping position is one of the main causes of herniated discs in the lumbar spine. A lasting improvement in the condition usually only occurs when the patient himself changes his sleeping position on the therapist’s advice.

2.3. Incorrect sleeping position – arms over head, legs bent

The last picture shows an overhead position of the arms with an external rotation position of the hip joint. This sleeping position rarely occurs in combination. However, one of the two is occasionally done in exactly the same way.

An overhead position of the arms leads to a severe narrowing of the subacromial space. This space is the distance between the acromion and the humerus. Furthermore, the external rotators in the shoulder joint are also severely restricted and shortened. Both are reasons for the development of shoulder joint diseases.

The bent, externally rotated legs pose no problem for the hip joints. However, the flashes should represent a severe constriction in the area of the medial meniscus. It is a particularly unfavorable sleeping position for patients who already have knee problems.

3. Correct sleeping position – supine position

The correct sleeping position is the supine position. A slight rotation of the cervical spine is possible and unproblematic. The arms can be positioned next to the body or on the stomach.

In this sleeping position, there is no constriction of the cervical spine or shoulder joint. The entire back is also relieved.

Only a very soft mattress can have a negative effect on an existing hollow back.

This sleeping position is also very beneficial for the hip and knee joints. Misalignments in the knee and hip joints can even be positively counteracted before falling asleep in the supine position.

For people with knock-knees (hip joint in internal rotation and adduction), it is advisable to bend the legs 10 degrees and rotate them slightly outwards.

People with bow legs (hip joint in external rotation and abduction) can try to rotate their legs slightly inwards before falling asleep.

3. Correct sleeping position – supine position

The correct sleeping position is the supine position. A slight rotation of the cervical spine is possible and unproblematic. The arms can be positioned next to the body or on the stomach.

In this sleeping position, there is no constriction of the cervical spine or shoulder joint. The entire back is also relieved.

Only a very soft mattress can have a negative effect on an existing hollow back.

This sleeping position is also very beneficial for the hip and knee joints. Misalignments in the knee and hip joints can even be positively counteracted before falling asleep in the supine position.

For people with knock-knees (hip joint in internal rotation and adduction), it is advisable to bend the legs 10 degrees and rotate them slightly outwards.

People with bow legs (hip joint in external rotation and abduction) can try to rotate their legs slightly inwards before falling asleep.

4. Correct sleeping position – implementation in practice

Probably the most common sentence you hear as a therapist is: “I can’t influence that. I’m always tossing and turning at night anyway”.

The second most common sentence is: “But then I can’t fall asleep.”

Admittedly, both statements are not entirely unjustified, but they are no reason not to do so. You should consistently try to fall asleep lying on your back.

In the first 10-14 days it is very unfamiliar and you will actually find it much harder to fall asleep.

In the initial phase, you will also turn to your usual side or stomach position much more frequently at night.

After a few weeks, however, the body gets used to it. You no longer have any problems falling asleep and you will also sleep through the night mainly in the supine position.

The effort is worth it, because you will have significantly fewer orthopaedic problems in the future.

5. Ergonomics in sleep – The right mattress

With regard to nutrition, our behavior and environmental medicine, you will often find references on this website to the Stone Age. These lay on the bare ground, at best somewhat shielded by mosses and ferns.

After three 4-week bike tours with overnight stays on an air mattress (1.90m x 0.60m), I can give a personal assessment. In addition, due to material fatigue, the mattress was completely without air for three nights.

Unfortunately, you don’t really get used to it and in this case it is better to fall back on the comforts of the modern age.

There are hardly any upper price limits for mattresses. Whether this is necessary and the prices are always justified is at least questionable. Based on my own analysis and anamnesis of almost hundreds of back patients from personal physiotherapeutic care, I can say with absolute certainty that extremely soft mattresses and waterbeds are not advisable.

I recommend a medium-firm mattress in the medium price segment and to test the mattress in person on site. Furthermore, for environmental medical reasons, care must be taken to ensure that no toxic substances from the mattress are emitted.