Features September 2006 Issue

Pillow Talk

Nighttime arthritis pain can be caused by the type of pillows you use—or the way you use them. Here’s what you need to know.

You’ve tried everything under the sun—or moon—to get a good night’s sleep, uninterrupted by arthritic pain. Following the advice of pain-management experts, you eat dinner in the early evening, you never consume alcohol or caffeine late in the day, and although you exercise regularly, you avoid working out just before turning in for the night.

Despite your best efforts, you continue to toss and turn in intermittent pain throughout the night, deprived of the restorative slumber that you so desperately seek. What could be the problem? It may be the type of pillows you’re using or, more likely, the way in which you’re positioning them in relation to your vulnerable joints, says Erin O’Neill, PT, a physical therapist at The Cleveland Clinic.

Strategic placement
People with neck pain, she says, frequently wake up during the night and try to relieve their discomfort by bunching their pillows into a ball. This is inadvisable, says O’Neill. “If the support under your neck area is too thick, it may lift the head to the point where the neck may be on an angle that will increase the pain and cause headaches. What you want instead is for your head to be relatively flat and in line with the rest of your body.  So a thinner, rather than thicker, pillow is what’s needed.”

For elbow, wrist, or shoulder pain, says O’Neill, “Use a hug pillow—one that you place between your arm and the side of your body. This will keep the shoulder in an open position. The arm can be in either a flexed or extended position, whichever is more comfortable.”

People with nocturnal pain in their knees, legs, or hips should avoid lying on their backs and placing pillows under their knees. While temporarily comfortable, this position tends to keep the knees flexed, and straightening the joints upon waking can be difficult and painful. Instead, O’Neill recommends, “Lie in a sideways position, placing pillows longitudinally under the lower leg and foot, which will elevate your entire leg.” Arthritis, she explains, is often accompanied by the pooling of fluid (edema) in the ankles and lower legs. Elevating them encourages the fluid to flow and clear from the lower legs, thus relieving swelling and discomfort.  

Recommending the most effective placement of pillows to relieve lower-back discomfort is a bit more challenging, O’Neill points out, since there are “so many different sources of back pain.” In general, however, placing your pillow between your knees and calves while lying on your side “can be more comfortable because the top leg will not be pulling down at an angle to the lower back.”

Among all types of arthritis pain, she says, nighttime discomfort associated with disease in the hips, shoulders, and neck is most amenable to “pillow therapy” because “they are usually the easiest joints to unload.”

Beware of claims
A vast variety of pillows are marketed these days as sure cures for arthritis-related sleep discomfort. They’re U-shaped, wedge-shaped, flat, fat, and round, small, medium, and large. You can cool them in your refrigerator, heat them in your microwave, or use them at room temperature. And they’re filled with everything from buckwheat hulls to magnets, memory foam, air, water, lavender, rosemary, and cloves.

Any one of these pillows may be effective in promoting restful sleep, as long as it is positioned properly. As for the specific therapeutic value of pillows stuffed with, say, magnets or lavender, their virtues have yet to be scientifically established.

Although consultation with a physical therapist may be useful, O’Neill says: “You should experiment for yourself, and you don’t need the guidance of an orthopedic specialist to do that. Try out various pillows, until you find the one that is most comfortable and helps you sleep better. Keep in mind that a pillow that works one night may not work every night. And don’t expect immediate results. It may take a week or more of steady use before the benefits of a new pillow really start to become evident.

“Keep looking for new pillows and keep trying different positions until you find your comfort level. You have nothing to risk.”