Ankylosing spondylitis pain doesn\u2019t pause for bedtime. In fact, many people find their stiffness is worse after a night of sleep. <\/p>\n\n\n\n
Below, we cover the best sleeping positions<\/a>, mattress<\/a> and pillow<\/a> tips, and simple evening routines to help you rest easier and wake up feeling as good as possible.\u00a0<\/p>\n\n\n\n Ankylosing spondylitis<\/a> (also called axial spondyloarthritis, or AS) is an inflammatory disease that primarily affects the lower spine. <\/p>\n\n\n\n If not treated properly, this condition can cause the vertebrae in the spine to fuse together, reducing flexibility and increasing symptoms.<\/p>\n\n\n\n Common symptoms of ankylosing spondylitis<\/a> include joint pain and stiffness, mostly in the lower back; inflammation of the eye; fatigue; weight loss; and skin rashes. <\/p>\n\n\n\n While researchers don\u2019t know the exact cause of this disease, genetic and environmental factors both seem to play a role.<\/p>\n\n\n\n If you notice that your pain and stiffness is worse in the morning, this is completely normal<\/a> for conditions like AS.<\/p>\n\n\n\n \u201cWhen the body is moving, you\u2019re getting joint fluids distributed, which helps with keeping inflammation down, explains Mallory Behenna, PT, DPT, orthopedic physical therapist at Brooks Rehabilitation<\/a>.\u00a0“The muscles are able to move and pump blood through them to help them not be painful too.\u201d <\/p>\n\n\n\n When you\u2019re asleep\u2014lying in one position or just a couple of positions throughout the night\u2014it\u2019s easy for your joints to get stiff because you\u2019re going for several hours without moving. <\/p>\n\n\n\n Your body is in the same position for a long time, so you\u2019re not getting the benefits of movement like you do throughout the day.\u00a0<\/p>\n\n\n\n Researchers haven\u2019t found evidence that sleeping position changes the shape of the spine over time. <\/p>\n\n\n\n But posture during sleep is still critical for AS patients: Holding the spine and neck in strained positions for hours on end can make morning pain and stiffness worse.\u00a0<\/p>\n\n\n\n That\u2019s why Behenna doesn\u2019t recommend stomach sleeping<\/a>.<\/p>\n\n\n\n \u201cThat puts not only the lower back in an arched position for a long period of time, but then it puts the neck at an end range of rotation,” she says. “The fact that the head has to stay turned one way or the other for so many hours at a time, that can be really painful.\u201d<\/p>\n\n\n\n She also explains that sleeping on your stomach can increase your lordotic curve<\/a>\u2014the inward curve of your neck and lower back. When this curve becomes too exaggerated, you\u2019re going to experience additional pressure on your spine and worse pain.\u00a0<\/p>\n\n\n\n Sleeping on your back might increase your lordotic curve too. <\/p>\n\n\n\n \u201cSometimes the weight of the legs and the femurs as they attach into the pelvis, that can kind of draw the pelvis down,\u201d says Behenna.<\/p>\n\n\n\n To mitigate that, place one pillow underneath your femurs all the way up to where your thighs meet buttocks and another pillow down on the weight of your lower legs. This can help keep your \u201csit bones\u201d from rolling forward and arching the lower back.\u00a0<\/p>\n\n\n\n If you like to sleep on your side<\/a>, be mindful of the area between your pelvis and waist that\u2019s not supported. The pelvis can tip down toward the bed, causing your spine to curve.\u00a0<\/p>\n\n\n\n \u201cI usually recommend a hand towel, scrunched up, to fill in that little space where the narrowness of the waist is,\u201d says Behenna. <\/p>\n\n\n\n While everyone\u2019s body responds differently to different mattresses, the best mattress for ankylosing spondylitis is most likely a moderate firmness with added postural supports while sleeping (like the pillows under your legs or the hand towel). <\/p>\n\n\n\n \u201cTake your time when you\u2019re in a mattress store,\u201d Behenna advises. \u201cReally try to lay on something for long enough to see, OK, can I lay on here for three to five minutes and start feeling any kind of inflammatory response to that?\u201d<\/p>\n\n\n\n A soft memory foam mattress<\/a> may not provide the support you need when you sleep. Getting out of bed also could be more work than what it\u2019s worth. <\/p>\n\n\n\n But a mattress that\u2019s too firm will be trying to push the body into a straighter position than what your spine currently allows.<\/p>\n\n\n\n \u201cSo really, you want something kind of right in the middle,\u201d Behenna summarizes. <\/p>\n\n\n\n When choosing a pillow<\/a>, make sure to pick something that will support not only the weight of your head but also the curve of your cervical spine. <\/p>\n\n\n\n Look for a pillow that’s not<\/em> been pre-contoured. Everyone\u2019s body is different, and these pillows are usually made in a one-size-fits-all factory.<\/p>\n\n\n\n Shredded memory foam<\/a> is another helpful pillow feature to look for.<\/p>\n\n\n\n \u201cRegular memory foam is going to push back against the head and neck just a little bit more than what we want,” says Behenna. “We really just want the weight of the head accepted, not pushed back on. But the shredded memory foam gives you that similar density, like a good support.\u201d <\/p>\n\n\n\n In regards to pillow thickness<\/a>, your goal is to support your head where your neutral is. When you\u2019re lying on your side, you should be able to draw a straight line from the top of your head down through your face and down the middle of your body.\u00a0<\/p>\n\n\n\n Whatever pillow you end up with, you can also take the corners of the pillow and pull them in front of your shoulders instead of leaving them behind your back. That can help fill in the space between the back of your neck and the pillow.\u00a0<\/p>\n\n\n\n Incorporating some gentle movement<\/a> before bed can help calm down anything that\u2019s feeling extra irritated after a long day. <\/p>\n\n\n\n Behenna recommends the following nighttime stretches for ankylosing spondylitis:<\/p>\n\n\n\n If you tolerate heat well, you might find that a thermal pad, heated bed pad, or ThermaCare patches can help keep your joints warm<\/a> overnight (make sure to follow the manufacturer\u2019s safety recommendations). Another option is a hot shower or warm bath before getting into bed.<\/p>\n\n\n\n \u201c[Heat] also just gives the brain a break from painful signals, which it\u2019s constantly bombarded with in cases of spinal inflammatory conditions like ankylosing spondylitis,\u201d Behenna points out.<\/p>\n\n\n\n Stretching and heat can help alleviate morning stiffness too. Behenna recommends spinal rotations in particular \u201cto get everything loosened up a little bit.\u201d<\/p>\n\n\n\n Speak with your doctor if you\u2019re experiencing any of the following:<\/p>\n\n\n\n Your rheumatologist may want to prescribe a new medication or change the medications you\u2019re already on.<\/p>\n\n\n\nUnderstanding ankylosing spondylitis (AS) and nighttime spinal stiffness<\/h2>\n\n\n\n
Recommended sleeping positions (back sleeping vs. side sleeping)<\/h2>\n\n\n\n
Mattress and pillow selection for inflammatory arthritis\u00a0<\/h2>\n\n\n\n
Evening warmth routines to reduce morning ankylosis\/stiffness<\/h2>\n\n\n\n
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When to discuss sleep pain with your rheumatologist\u00a0<\/h2>\n\n\n\n
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