I'm Sensitive! Why the position you sleep in matters but really shouldn’t. (Part Three: 5 minute read)

A process called pain sensitization could be the reason an otherwise harmless sleeping position could be your pain-causing-culprit!

What is sensitization?

Whether you call it a pathway, a network, a matrix or something else, you are generously supplied with neurons designed to sense and qualify anything that could harm you. When your brain says “this is pain,” neurons in your periphery (read: anywhere outside of your spinal cord) have labeled an event as noxious stimuli. Those neurons carry that information toward the spinal cord (and toward the brain). So, “pain is in the brain.” [1]

Why are we riffing on the physiology of pain perception in a blog about sleeping position? The answer is associated with the phenomena of sensitization or pain amplification. When we are injured our pain sensing networks are activated. Sometimes these networks become sensitive to input that would not normally raise the “this-may-harm-you-flags.” [2]

How could this impact your sleeping position? To illustrate, let’s say you’ve been dealing with an annoying shoulder injury you sustained from a particularly productive day in the yard. It’s hard to raise your arm overhead and it’s getting in the way of your gardening. The pain feels deep and seems to reside around the joint. But when your well meaning partner gives your shoulder a light squeeze in an effort to bring you some relief, a searing sensation races toward your spine or down your arm. Your partner is surprised by what looks like an overreaction. You’re surprised yourself. Why would such a light squeeze hurt so badly when the problem seems to stem from deeper tissue? The answer is: pain pathway sensitization.

How does this ramble relate to sleeping position? If you have ever dealt with an injury for more than a few days, you know that you could easily spend a sleepless night culling through every possible configuration in search of comfort. Pressures and positions that would normally be comfortable tend to irritate sensitized pain-sensing neurons when they pick up on sensory input that would usually be coded as harmless. Additionally the increased pressure from a sleeping position will naturally cause tissue deformation and increased blood flow. Think: red spot left over from sitting on a chair or leaning on a hard surface. This small increase in vascular activity may cause just enough of an increase in pressure to tick off pain sensing neurons that are already excitable because of the extant inflammation from your injury. In a nutshell, falling asleep with any pressure on the injured area usually produces more pain.

To someone dealing with chronic or persistent pain we would say, sleep in any position that allows you to get some shut eye. However, in most cases, finding yourself in one of our “don’t” positions will increase pain. Click here to view our “don’t” postitions. If you find yourself sleeping in a position that stresses a sensitized area of your neuro myo fascial net you may shift to a more comfortable position while still asleep. Or you may wake up in pain and shift to a more comfortable position. Or you may sleep right through the pain and wake more uncomfortable. In any case, when dealing with amplified pain perception choosing a sleeping position becomes challenging. If you deal with this condition long enough you may start to show some shape bias while you sleep, consciously or unconsciously picking the same position night after night. When this happens we are back to the whole “the shapes we make make our shape” thing (if you missed our explanation of this principle click here to read more). The position you are biased toward will begin to show up in your waking life since it is being written into your neuro myo fascial net and into your structural behavior.

If you are working with some chronic pain and, due to the sensitization of your profoundly plastic pain sensing network, you choose a compensatory sleeping position, you may be setting yourself up for more pain. But if you don’t compensate, you could also have more pain. This is sort of a “damned if you do...” sitch’. The solution, of course, is to handle the pain. We have some good ideas about how to do that. If you need help, we strongly encourage you to schedule a consultation.

But staying on the topic of sleeping positions: let’s talk “salience”...in our next blog! Click here to read it!

[1] Cervero, Fernando. Understanding Pain Exploring the Perception of Pain. MIT Press, 2014.

[2] Cervero, Fernando. Understanding Pain Exploring the Perception of Pain. MIT Press, 2014. See page 74