When it comes to patients waking up with pain, quite often it may be due to poor sleeping position. Even if the patient has a neck problem that requires treatment, laying misaligned for hours each night can be a constant exacerbating factor. Typically these patient’s wake up with more pain then they do going to bed. There are 3 types of sleeping position: side, back or belly. Each has there own distinct pros and cons as one person may snore and the other may not. However, from a structural standpoint belly sleeping causes too much rotation to the neck and should be avoided. As common as this position is, and as much as some people enjoy laying on there stomach it should be avoided to prevent neck pain. The next position is side lying, where ideally ones head should be level with their sternum (chest plate). If the pillow is too tall the head will be propped up too high. If the pillow is too small in this position the head will drop down below neutral. In this case many people feel the need to stick their arms under their head for support, only to find they wake up with numbness or tingling in the their hands due to compressing the nerve bundles in that position. Side sleeping should be a customized position as everyone’s shoulder depth varies. There is no generic pillow for this, but something as simple as sticking a towel under the pillow if its too small may get it to the appropriate level. Quite often our patients take pictures of their pillow position relative to their heads and the doctors will assess if it looks good or not. The last position is back sleeping where you would not want a big pillow pushing your head forward. It may feel ok watching tv for a short period of time, but wouldn’t be a good way to sleep in that position throughout the night. Generally smaller pillows do well here or even more ideally a cervical pillow that allows for the contour of the head to promote the natural curve of their neck. There are a lot of factors to preventing neck and back pain, but the initial starting point should be a consultation to review their history and even sleeping position with a Chiropractor!