Sleep and Physical Therapy: How Better Sleep Can Support Pain Relief and Recovery

By Conlan Brown, PT, DPT

When people come to physical therapy, they usually expect to talk about their shoulder, back, knee, or neck. They’re often surprised when I start asking about their sleep.

How many hours do you sleep?
Do you wake up because of pain?
Do you snore?
Do you feel rested when you wake up?

I ask because sleep can have a significant impact on pain, healing, and recovery. If you’re not sleeping well, it may be harder for your body to recover from an injury, manage an irritated nervous system, build strength, or get the full benefit of the work we’re doing together in physical therapy.

At Stride Physio in Seattle, I’ve found that sleep is sometimes one of the missing pieces for patients who aren’t making the progress they expected.

How Sleep Affects Pain, Healing, and Physical Therapy Recovery

Of course I want your shoulder to move better and your back to hurt less. But as a physical therapist, I’m also looking for factors that may be getting in the way of your recovery.

Sometimes that’s weakness or limited mobility. Other times, it may be stress, poor sleep habits, an unsupportive sleep setup, or a sleeping position that repeatedly aggravates sensitive areas night after night.

I’ve had patients make significant progress after changing their sleeping position or pillow setup—sometimes without needing to add another exercise to their home program.

That’s why conversations about sleep have become a routine part of my physical therapy evaluations.

Sleeping Positions for Neck, Shoulder, Hip, and Back Pain

We spend roughly one-third of our lives in bed. If your neck, shoulder, hip, or low back is uncomfortable or poorly supported for seven or eight hours every night, it can be difficult to give irritated areas an opportunity to settle down.

One of my favorite parts of an evaluation is helping patients find a more comfortable sleeping position.

Depending on your symptoms, we may experiment with:

• Pillow height and placement
• Support between or underneath the legs
• Arm and shoulder positioning
• Side-sleeping posture
• Neck support
• Ways to reduce pressure on a painful hip or shoulder

There isn’t one “best” sleeping position for everyone. The right setup depends on your symptoms, body type, preferred sleeping position, and what feels comfortable for you.

Many patients tell me it’s the first time anyone has actually helped them experiment with their sleeping position instead of simply telling them to “sleep differently.”

If you regularly wake up with neck, shoulder, hip, or back pain—or pain is keeping you awake at night—a physical therapy evaluation can help identify whether positioning or musculoskeletal factors may be contributing to your discomfort.

Can Your Pillow or Mattress Contribute to Neck or Back Pain?

Patients ask me about mattresses almost as often as they ask about exercises.

Usually, my answer isn’t, “Buy this brand.”

There isn’t one mattress or pillow that is best for everyone. The right setup depends on your body, symptoms, preferred sleeping position, and how well your current mattress and pillow support you.

Someone experiencing shoulder pain may need something very different from someone dealing with low back or neck pain.

The same is true for pillows.

The goal isn’t necessarily to find the softest or most expensive pillow. It’s to find one that supports your head and neck comfortably throughout the night.

Sometimes a patient’s neck feels better after we discover their pillow is too tall. In other cases, placing a pillow between the knees or supporting an arm can reduce pressure on an uncomfortable shoulder or hip.

Before spending hundreds—or even thousands—of dollars replacing your mattress or trying another pillow, it may be worth looking at how your current sleep setup actually fits your body.

During a physical therapy evaluation, we can discuss your sleeping position, pillow and mattress setup, and any musculoskeletal symptoms that may be interfering with comfortable sleep.

Physical Therapy and Sleep Apnea: What a PT Can—and Can’t—Do

Another reason I ask about sleep is that physical therapists may be in a position to notice symptoms that warrant further medical evaluation.

Symptoms such as loud snoring, waking up gasping for air, morning headaches, dry mouth, or feeling exhausted despite spending enough time in bed may be signs that your sleep quality is being disrupted.

If your symptoms raise concern for obstructive sleep apnea or another sleep disorder, I’ll recommend following up with your physician or an appropriate sleep specialist for evaluation, diagnosis, and testing.

Physical therapists do not diagnose or medically treat obstructive sleep apnea.

For someone who has already been diagnosed with sleep apnea, physical therapy may still address related musculoskeletal concerns such as uncomfortable sleeping positions, neck or jaw symptoms, posture, mobility, or other factors that make comfortable sleep more difficult.

If you’ve been prescribed CPAP, BiPAP, or another medical treatment for sleep apnea, physical therapy is not a replacement for that treatment.

My role is to recognize when something may require medical evaluation and help address the movement, positioning, pain, or musculoskeletal issues that fall within physical therapy.

Simple Ways to Sleep More Comfortably With Pain

Not every sleep problem requires a complicated solution.

Sometimes relatively small changes to your environment or positioning can make sleep more comfortable.

If your bedroom is too bright, blackout curtains or a sleep mask may be worth considering.

If noise frequently interrupts your sleep, earplugs or white noise may help.

If you regularly wake up overheated, adjusting your bedding or bedroom temperature may make you more comfortable.

If you use CPAP or BiPAP, changing your pillow or sleeping position may sometimes make it easier to get comfortable with your equipment.

These recommendations aren’t one-size-fits-all. They’re based on identifying the individual barriers that may be interfering with comfortable, restorative sleep.

Why Better Sleep Can Support Physical Therapy Recovery

Exercise, movement, hands-on treatment, and education can all play important roles in physical therapy. Sleep and recovery matter, too.

Sleep supports many of the processes involved in physical and mental recovery. When sleep is consistently interrupted by pain, uncomfortable positioning, breathing problems, or other factors, recovery may become more challenging.

That’s why I believe conversations about sleep belong in physical therapy.

Sometimes improving recovery isn’t about adding another exercise. Sometimes it’s about making sure your body has the opportunity to rest and recover once you get home.

References:

Effects of Oropharyngeal Exercises on Snoring – CHEST

Sleep and Physical Therapy: Frequently Asked Questions

Can physical therapy help me sleep better?

Physical therapy may help when pain, uncomfortable positioning, movement limitations, or other musculoskeletal issues are interfering with sleep. A physical therapist can help identify those factors and develop individualized strategies to address them.

Why does my physical therapist care about how I sleep?

Sleep and recovery are closely connected. If pain repeatedly wakes you up or your sleeping position consistently aggravates your symptoms, those factors may make recovering from an injury more difficult.

What is the best sleeping position for back, neck, or shoulder pain?

There isn’t one sleeping position that’s best for everyone. Your symptoms, body type, injury, mattress, pillow, and preferred sleeping position all matter. Sometimes small changes in support or positioning can make a meaningful difference in comfort.

Do I need a new mattress if I wake up with back pain?

Not necessarily. Before replacing your mattress, consider your sleeping position, pillow setup, and how your current mattress supports your body. Back pain can have many causes, and a new mattress isn’t automatically the solution.

Can a physical therapist diagnose sleep apnea?

No. A physical therapist cannot diagnose obstructive sleep apnea. However, physical therapists may recognize signs or symptoms that suggest further medical evaluation is appropriate and recommend that you speak with a physician or sleep specialist.

Can physical therapy replace CPAP or BiPAP for sleep apnea?

No. Physical therapy is not a replacement for CPAP, BiPAP, or other medical treatment prescribed for obstructive sleep apnea. Physical therapy may help address related musculoskeletal concerns such as positioning, neck or jaw discomfort, or other issues affecting comfort.

What should I tell my physical therapist about my sleep?

Tell your physical therapist if pain wakes you up, you have difficulty finding a comfortable sleeping position, you regularly wake up stiff or sore, or you believe your pillow, mattress, positioning, or other factors may be contributing to your symptoms.

You should also mention symptoms such as loud snoring, waking up gasping for air, or persistent daytime fatigue so your physical therapist can determine whether discussing them with another healthcare provider may be appropriate.

Do I have to be injured to talk to a physical therapist about sleep?

Not necessarily. Sleep can be part of a broader conversation about movement, recovery, physical performance, pain, and musculoskeletal health.

Is Sleep the Missing Piece in Your Recovery?

If you’re waking up sore every morning, struggling to find a comfortable sleeping position, experiencing pain that interrupts your sleep, or wondering whether your mattress or pillow setup is contributing to your symptoms, it may be worth taking a closer look.

Sleep is one of my particular areas of interest because I see how closely it intersects with pain, movement, healing, and recovery.

At Stride Physio in Seattle, we look beyond just where it hurts. We consider the different factors that may be influencing your movement, comfort, and recovery so we can develop an individualized plan for you.

If sleep and pain seem to be working against each other, schedule a physical therapy evaluation with me at Stride Physio. Together, we can look at your sleeping position, movement, symptoms, and other factors that may be getting in the way of a more comfortable night’s sleep and a better recovery.

— Conlan Brown, PT, DPT