Neck pain is the second most common muscle and joint complaint after back pain, affecting millions of Americans every day.

Based on current clinical practice guidelines, neck pain is estimated to impact up to 70% of the general population.¹

Most bouts of neck pain are acute and temporary, subsiding over a period of a few days to a few weeks.

We’ve all been there: you wake up one morning with a stiff and achy neck. Driving to work may be a little more taxing, especially when checking your blind spot, but after a couple days you’re back to your old self.

But how about that neck pain that’s “just different?” This time it’s painful, not just achy. The pain comes and goes, affecting your ability to do normal activities of daily living comfortably. Heck, it may even be waking you up at night, hindering your ability to get a good night’s rest. When you’re not sleeping you’re tired, which perpetuates irritability, brain fog, and lethargy. The vicious cycle continues, leading to more pain and in extreme cases, disability.

If neck pain is affecting your sleep, it may not be as straightforward as blaming it on your pillow or sleeping position, especially if you had restful nights prior to the occurrence of your neck pain.

In this article, we’ll discuss all the possibilities and contributors to your neck pain and why it’s affecting your sleep. Ultimately, we’ll offer you helpful strategies so you can start getting restful nights, starting tonight!

In the last century, we’ve been sitting substantially more than we ever have in our documented human history. Due to technology, i.e., watching TV, sitting in front of a computer, using smartphones, we’ve adapted our postures to our devices as opposed to the other way around.

Sitting in a poor working posture for prolonged periods of time is like pulling your finger back on full stretch then holding in there. Then pulling some more, more, and more — eventually you’ll stop because it’s going to hurt!

Is your finger broken or damaged? No. Other than being a little sore and achy for the few seconds after you let go, your finger is fine!

Do you ever notice your neck muscles getting tight, sore, knotted, bound-up — whatever adjective you want to use — after a long day on the job? Your neck is not tight because your neck is weak, rather you’re feeling the result of cumulative stress on the neck muscles.

Sure, you get your spouse to rub out the stress in your neck muscles, but how long does that last? When does it come back? If you’re not changing your daily postural habits, incorporating more movement and less sedentary positions, it will be a continuous cycle with no solution in sight.

Would you rather hold a bowling ball near your body or away from the body with your arm extended? The obvious answer is close to the body. Slumping your head forward into the computer screen like a turtle, commonly referred to as “text neck,” is like holding that bowling ball away from your body — your arm is going to strain and fatigue quickly!

Our daily postural habits are like cranking back on that finger on a daily basis. At some point, you’re going to feel the effects (pain) of repetitive strain.

Your neck is not weak, it’s simply exhausted!

To clarify, sitting with the posture on the left is not necessarily “bad” posture — it’s the amount of time we spend in positions like this that’s the problem. Even sitting in the more ideal or correct working posture on the right takes its toll on the body over time.

In a perfect, non-deskbound world, getting out of prolonged positions, constantly moving and assuming various positions throughout the day is ideal, and can make the difference between suffering with neck pain or not.

But what if I don’t have neck pain during the day, only at night?

Commonly, neck pain endured at night and when you wake up in the morning is the hangover of your postural habits and prior movement behaviors causing your neck pain in the first place.

In between every one of our spinal bones (vertebra) is a shock absorber or “disc.” Our discs are stressed by doing the job of supporting the vertebra against gravity and the various forces of movement all day long. At night, the discs decompress, filling with fluid via a physiological process called, “imbibition.”

Envision a sponge in water: you press down on it and the water is forced out. When you let go, the sponge sucks the fluid back in.

Discs become plump with fluid when decompressed. During the night, sensitive nerves of the neck can become more irritated, causing discomfort and a restless night. In the morning, your symptoms can be more sensitive during the first hour of the day where you’re getting used to gravity and movement forces.

Typically, when the appropriate changes are made to improve the causes of neck pain symptoms during the day, a reduction in nighttime symptoms follow.

If you experience unrelenting neck or back pain only at night that does not subside with rest or change of position, contact your physician immediately.

If someone tells you that you should sleep a certain way, it’s a bunch of malarkey. The best sleep position for neck pain at night is the position where you can get the most rest.

Ideal alignment and positioning of your body while sleeping is a real thing, but everyone is different, so you need to make sure to test the cause and effect of what’s best for you.

Do you prefer to sleep on your side? Sounds good. On your back? Awesome. On your face? It’s not usually very comfortable for those with neck pain but if it works for you, I’m cool with it. Ultimately, what matters is what allows you to achieve the best rest.

It’s best to sleep with your neck in a neutral, aligned position. When your neck is not supported properly, it can bend or twist into sustained positions which can lead to pain and stiffness in the middle of the night and in the morning.

Imagine pulling that finger back into a stretch again, but now holding it for hours. This is what can happen to your neck when you sleep in unsupported positions. 

What about mattresses?

There’s a lot of mattress “science” regarding what is best for you — a lot of “if, then that.” It may become an expensive experiment, but the only way to know if the surface you’re sleeping on is right for you is by testing it out.

If you’re having trouble with your current mattress and you’ve tried the strategies above and below, then you may want to try out other nests. A great way to know if your mattress is a problem for you is to sleep on a guest bed, your kid’s bed, a futon, when your wife sends you to the couch — whatever.

If you discover that an alternate surface makes a drastic difference, you may want to consider a new mattress or mattress topper. As you probably know, trialing mattresses is not exactly easy. Luckily, there are many “Bed in a Box” brands who guarantee a great night's rest or they will remove it from your home with a full refund.

Neck pain affecting your sleep is a vicious cycle. Neck pain affects your sleep, and not sleeping well can increase your sensitivity to neck pain!

A lack of sleep is linked to many progressive ailments which can easily snowball into major health concerns.

Insomnia disrupts your normal hormonal regulation which alters the way all of your body’s systems communicate with one another. Hormone dysfunction can lead to a slew of health problems.

Hormone dysfunction from insomnia is associated with problems such as weight control, diabetes, high blood pressure, heart disease, mental illness, and increased mortality rate.

When you’re tired you’re more likely to get sick.

The bottom line is that sleep is paramount and you need to do what it takes to get the rest you require.

Whether you have a nine-to-five job or pull a night shift, you probably have some sort of wake-up routine to start your day. Though “morning” routines are the norm, it’s not as common to have a consistent bedtime routine, because when and how we go to bed is determined by our business and urgency to complete particular tasks.

Establishing a consistent bedtime and accompanying routine sets the tone for a restful night, which equates to better production during the waking hours. Here’s how you can cultivate a solid bedtime routine so you don’t need to stay up late for extra time to get things done!

• Wake up and go to bed at the same time, every time.
• No screens 30-60 minutes before bed.
• Cut the caffeine and alcohol.
• Do a relaxing activity before bed.

It’s vitally important to place yourself in an environment promoting a restful night without sleep cycle distraction. The rapid eye movement (REM) stage of your sleep cycle is where your brain and body does its growth and recovery work, the primary period where the processes of learning, storing memory, and hormone balance occur.²

A few subtle bedroom changes can go a long way regarding sleeping through the night versus tossing and turning.

• Regulate the bedroom temperature to a consistent 68 degrees or below. Cooler temperatures are linked to better sleep. Your body needs its core temperature to drop in order to initiate sleep, so the cooler temperature helps your body self-regulate by promoting melatonin production where you not only fall asleep, but stay asleep.
• Turn off electronic lights. Even a simple alarm clock or “power off” light on your television can be enough light to impact your ability to fall asleep undisturbed. Blue lights inhibit melatonin production, a hormone essential for sleep.
• Blackout your room. You’ve got the electronic lights turned off, so make sure you’re not letting any light through your windows as well.
• Use one pillow that works for you. Typically, one pillow about 4-6 " thick is ideal for supporting your head and neck in as close to neutral or aligned as possible. Two pillows lift your head too high, inducing excessive forward flexion on the neck. Using no pillow at all can strain the neck in the opposing direction, or may simply be too uncomfortable to fall asleep. Ultimately, if it’s not comfortable, it’s probably not good for you.
• Use a neck roll. A neck roll is a simple tubular foam cushion you slip into your pillow cover which supports your neck as your head rests on the pillow. The roll helps maintain your neck in a neutral, aligned position. When your neck is not supported properly, it can bend or twist into sustained positions which can lead to pain and stiffness in the middle of the night and in the morning. While a neck roll is a great device for some, it does not work so well for others. The good news is you can make your own to see if it works for you by using a rolled up bath towel.

More important than what happens at night is what happens during the day, as postural stressors during the day can dramatically affect your nighttime.

• Move more often. Simply put, making it a point to move and frequently change positions throughout the day to avoid negative effects associated with prolonged poor postures and sedentarism can make all the difference between suffering with neck pain or not.  
• Address your workplace environment. Modify your workspace around you, not the other way around. It’s critical to ensure your computer screen is at eye level, your arms rest on your desk just above waist level when using a keyboard and mouse, and your lower back is supported by your desk chair or added lumbar support. Laptops need extra consideration especially when using them for prolonged periods of time. Neglecting workplace ergonomics draws your postural habits into compromising positions in order to see the screen. Here are some tips to improve your workspace:
  • Make use of a standing or convertible desk.
  • Set an alarm on your phone (or other electronic device) to alert you to get up and move every 30 minutes.
  • Use a headset.
  • Hold your phone up to eye level or use a desk mount.
  • Use an active standing desk mat.
  • Try kneeling at your desk with a cushion under your knee.
• Change how you carry your bag. If you carry a purse, tote, or messenger bag, frequently switch sides. Carrying your bag on only one side can lead to imbalances leading to unnecessary strain.
• Drink plenty of water. We all agree hydration is healthy and it makes you get up to use the restroom more often!

Neck pain is the second most common muscle and joint complaint after back pain, affecting millions of Americans every day.

In the last century, we’ve been sitting down significantly more than we have in our documented human history.

Most neck pain/strain is the result of our postural habits. Our daily postural habits are like cranking back on that finger on a daily basis. At some point, you’re going to feel the effects (pain) of repetitive strain.

There is no “best” sleeping position. The best sleep position for neck pain at night is the position where you can get the best rest.

A lack of sleep is linked to many preventable ailments which can perpetuate into major health concerns.

The three most important things to do right now to address neck pain affecting your sleep is to practice a consistent bedtime and sleep routine, optimize your sleep environment, and address your daily postural habits.

1. Blanpied PR, Gross AR, Elliott JM, Devaney LL, Clewley D, Walton DM, Sparks C, Robertson EK (2017) Neck pain: revision 2017: clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther 47(7):A1–A83.
2. National Sleep Foundation. (2010). REM sleep deprivation and migraines. Retrieved October 18, 2018 from https://www.sleepfoundation.org/alert/rem-sleep-deprivation-and-migraine