The loop
Sleep deprivation lowers pain threshold and amplifies the emotional response to pain. Pain fragments sleep. Each night of poor sleep makes the next day's pain worse, and each day of worse pain makes the next night worse. Breaking it early matters more than breaking it perfectly.
Position and support
- Back sleeping — a pillow under the knees reduces lumbar load; a thin pillow under the head keeps the neck neutral.
- Side sleeping — a pillow between the knees keeps the pelvis level; one under the waist supports the lumbar curve; the head pillow should be thick enough to keep the neck level with the mattress.
- Avoid stomach sleeping if you have neck or lower back pain, since it requires sustained rotation of the neck and extensions the back.
- Use more pillows than feels reasonable. Wedges under the upper body help reflux; a body pillow helps side sleepers stay put.
The protection problem
This is the part most advice misses. When something hurts, you brace around it — continuously, including while lying still. That bracing is muscular work, it never fully stops, and it keeps the nervous system in a state of low alert. So you have pain driving arousal, and the protective response driving arousal, and the second one is often larger than people realise.
Reducing protective effort is precisely what Feldenkrais work is built for: small movement inside a comfortable range, with the instruction to do the movement with less effort and notice what changes. Nothing is stretched, nothing is pushed, and nothing is done into pain. Start with the bedtime routine and modify anything that disagrees with you.
Specific situations
- Lower back pain — see Feldenkrais for lower back pain.
- Neck pain — see Feldenkrais for neck pain.
- Shoulder pain — side sleeping on the painful side is usually the problem; support the upper arm on a pillow rather than letting it fall forward.
- Hip pain — a pillow between the knees is usually the single most helpful change.
Timing and medication
- If you take analgesia, time it so it covers the night rather than the evening only — worth discussing with your doctor or pharmacist.
- A warm shower before bed reduces muscle tone and can ease the transition.
- Avoid alcohol: it helps you fall asleep and worsens both pain and sleep later in the night.
When it becomes chronic
If pain has been waking you for more than a few weeks, the sleep problem is now partly learned and will persist even if the pain improves. Add stimulus control, and consider CBT-I — it remains effective for insomnia that accompanies chronic pain.