When You Wake Up With Neck Pain, What’s to Blame?

Heather Jones
·10 min read
1

Medically reviewed by Katrina Carter, DPT

If you have ever "slept wrong" and woken up stiff and sore, you know that sleep posture strongly influences the quality of your sleep. Poor posture when sleeping can lead to neck pain, and you may also have a headache, arm pain, and shoulder blade pain. There are ways to help improve sleep posture for a more restful sleep and a more comfortable morning.

This article will discuss why your neck may hurt when you wake up, how to relieve and prevent neck pain that results from sleeping, the best positions to sleep in to avoid neck pain, what to look for in a pillow, and what to do if your neck pain is persistent.

<p>Nes / Getty Images</p>

Nes / Getty Images

Why Your Neck Hurts When You Wake Up

Neck pain in the morning is typically a result of muscle spasms (sharp muscle contractions) caused by muscle strain.

Poor posture, both during the day and at night, can lead to these muscle spasms. Physical and emotional stress, and injuries to the muscle from sport, a motor vehicle accident, or other causes, may also cause neck pain.

Sleeping problems other than posture, such as trouble falling and staying asleep, waking early in the morning, or non-restorative sleep, can also increase the likelihood of neck pain.

One study of 4,140 people found that compared to the participants who did not have sleep problems, those who reported moderate to severe difficulties with at least three of those four sleep problems were significantly more likely to develop chronic musculoskeletal pain after one year.

This may be due to the disruption of muscle relaxation and healing that typically occurs during sleep and the vicious cycle of pain disrupting sleep and disrupted sleep causing pain.



Other Symptoms You Might Have Upon Waking

Pay attention to how you feel when you wake up, as it can give you clues to certain health concerns. For example, those with a sleep apnea (when breathing stops and starts during the night) may experience symptoms upon wake-up such as:



How to Get Rid of Neck Pain From Sleep

It is important to take steps to both treat the current neck pain, and prevent it from happening again. This may include:

Sleep In a Neutral Position

The key to good sleep posture is alignment. Sleeping in a neutral position reduces the strain on your neck and back, helping to prevent pain.

In a neutral position, your ears, shoulders, and hips are as aligned as possible. Some ways to help achieve better alignment include:

  • Use pillows or props: If sleeping on your back, tuck a small pillow under the back of your knees. If sleeping on your side, slip a firm pillow between your knees. If sleeping on your stomach, place a flat pillow under the stomach and pelvis area. Insert pillows or rolled towels into gaps between your body and the mattress (such as at the waist) when side sleeping.

  • Stay aligned even when moving: Move your entire body as one unit when turning in bed instead of twisting or bending at the waist. Keep your ears, shoulders, and hips aligned, pull in and tighten your belly, and bend your knees towards your chest as you roll over.

Choose the Right Mattress

Choose a mattress that supports the natural curves of your spine and that you find comfortable. You mattress should allow you to wake up feeling rested and without pain or soreness.

Other mattress tips include:

  • Try to replace your mattress every six to eight years.

  • If you sleep with another person, look for a mattress large enough that you both can move and sleep in comfortable positions.

  • If you have a health condition that requires a certain type of mattress, such as a back or neck condition, talk to your healthcare provider or physical therapist about what you should use.

Choose the Right Pillow

The right pillow helps to keep your spine in the proper position. When choosing a pillow for your head, look for one that:

  • Comfortably supports the natural curve of your neck

  • Keeps your neck aligned with your chest and lower back

  • Is not too high (a pillow that is too high can cause muscle strain on your neck, shoulders, and back)

  • Is adjustable or versatile so that you can sleep in different positions

  • Can be replaced about once a year

Apply Cold or Heat

For the first two days after straining a muscle in your neck, you can apply cold compresses, such as a cold pack, ice wrapped in a wet cloth, a frozen towel, or a bag of frozen vegetables. When using cold on your neck:

  • Apply it for 10 to 20 minutes at a time.

  • Repeat as needed every two to four hours until symptoms improve, or for up to two days.

  • Do not apply the cold source directly to your skin; wrap it in a thin, dry cloth first.

If your neck is still sore after 48 hours, you can try applying heat to increase blood flow and help improve healing. When applying heat:

  • Use a heating pad, heat pack, warm wet washcloth, shower, or warm bath.

  • Apply heat for 10 to 15 minutes and repeat as needed.

  • Be careful not to make your heat source too hot, as this can cause burns or skin injury.

Do Gentle Stretching and Strengthening Exercises

Stretching and strengthening exercises can help relieve current neck pain, and prevent neck pain from happening in the future.

Types of exercises you might try include:

Try Medication

If other measures are not bringing you relief from your neck pain, talk to your healthcare provider or pharmacist using over-the-counter (OTC) medications (those not requiring a prescription) that might help. These may include:

  • Tylenol (acetaminophen)

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen), Aleve (naproxen), or aspirin

Never give aspirin to children or teenagers without first checking with your healthcare provider, as doing so has been linked to a rare but serious disorder called Reye's syndrome.

If OTC medications are still not effective, talk to your healthcare provider about prescription options.



Managing Chronic Neck Pain

Some things that may help with chronic neck pain include:



Sleep Positions With Neck Pain

Sleep position is about more than comfort.

Back

The best sleep position for avoiding neck pain is on your back, although most people find this position too uncomfortable to get a deep sleep.

When sleeping on your back, put a pillow under your head and neck and another one underneath your knees to help with spine alignment.

Avoid sleeping on your back if you are pregnant, as this decreases circulation to the heart and baby.

Side

Side sleeping is a good alternative for those who can't sleep on their back or who find it too uncomfortable. It also keeps airways open, making it a good position for those with sleep apnea or for people who snore.

While it is often comfortable to sleep in what is known as the fetal position, with legs curled up, this can make for an uneven distribution of weight and lead to back pain and sore joints. It can also lead to hip pain (hip bursitis) and shoulder pain, including shoulder bursitis.

If you can manage it, try to sleep with your legs straight out in a relaxed position and a pillow tucked between your knees. Untuck your chin as well.

Stomach

Avoid sleeping on your stomach. This position causes you to sleep with your neck turned, which can lead to pain in the upper back and neck. It also affects the natural curve of the spine, putting more pressure on the spine's muscles and joints than other sleeping positions.

How Pillow Texture and Shape Improve Neck Pain

You can enhance the quality of sleep by using a good pillow that is suited to your needs and sleep habits and properly supports your neck.

Although it sounds counterintuitive, using your initial perception of comfort to choose a pillow can be misleading and end up causing more neck pain.

Soft pillows tend to rank higher for initial comfort but become more uncomfortable later. Firm pillows, on the other hand, can seem less comfortable at first, but help in the long run by stabilizing the spine and reducing spinal distortion.

While firm pillows can help, avoid pillows that are too stiff or too high, as this can keep the neck flexed leading to pain and stiffness.

Which pillow to choose is influenced by your sleep position, including:

  • Back sleeping: Try a rounded pillow supporting the curve of your neck, with a flatter pillow under your head. Some pillows are shaped to accommodate both, such as a cervical pillow, or you can tuck a small neck roll into a pillowcase with a flatter pillow.

  • Side sleeping: Choose a pillow or combination of pillows that is higher under your neck than your head, which keeps the spine straight.

  • Sleeping outside of a bed: When traveling or sleeping in a chair, try using a horseshoe-shaped pillow to support your neck and prevent your head from dropping to one side. Be careful not to use one that is too large behind the neck, which forces your neck forward.

Texture matters too. Two options are:

  • Feather pillows: These conform to the shape of the neck, but they collapse over time and need to be replaced about once a year.

  • Memory foam: This also conforms to the contour of the neck and head. According to manufacturers of memory foam pillows, these pillows help with proper spinal alignment. Many traditionally shaped and cervical pillows are made from memory foam.

Neck Still Hurts in the Morning

In some cases, neck pain may mean more is at play than strained muscles from poor sleep posture, such as arthritis, a compressed nerve, an infection, or another underlying problem.

Talk to your healthcare provider if your neck pain is:

  • Severe

  • Persistent, lasting for weeks or longer

  • Drastically limiting your ability to move your head

  • Radiating into your shoulders or other areas

  • Worse in the morning

  • Concerning you

  • Accompanied by other symptoms, such as fever, weakness, numbness in the arms, signs of a heart attack or meningitis, or other symptoms that could indicate the need for immediate medical attention (get medical help right away if this occurs)

Your healthcare provider may suggest further treatment or refer you to a specialist such as a:

  • Rheumatologist (specialist in inflammatory conditions and autoimmune diseases such as psoriatic arthritis, ankylosing spondylitis, and lupus)

  • Neurosurgeon

  • Physical medicine and rehabilitation specialist

Summary

A stiff or sore neck in the morning is often caused by muscle strain that leads to muscle spasms. This can be caused by poor sleep posture and other sleep problems.

Some ways to help include sleeping in a neutral position, choosing the right mattress and pillow, applying cold or heat, doing gentle stretching and strengthening exercises, and taking medication.

Unless you have sleep apnea, are pregnant, or have a condition that prohibits it, the best position to sleep in to help prevent neck pain is on your back, with on your side a good alternative. Avoid sleeping on your stomach.

Choose a pillow that supports your neck and head and helps keep your spine in alignment. Use additional support pillows as needed, such as under or between your knees.

Talk to your healthcare provider if you have additional symptoms that suggest you need immediate medical attention or if your neck pain is severe, persistent, or concerning you.