Tanya Coats Occupational Therapy

How Sleep Positions Affect Your Hands

Sometimes we can do a great job taking care of ourselves during the day, but our sleep positions can undo all our hard work. Many of the problems that hand therapists treat, such as carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, arthritis, or even tendonitis can be exacerbated by pressure while we are sleeping. This pressure can worsen symptoms like swelling, numbness, tingling, and pain.

How does this happen?

Sometimes the positions in which we sleep place our spine, joints, and soft tissues under compression, tension, or both. Our nerves are especially sensitive to this. For example, when we sleep in a “fetal position,” the nerves in our wrists and elbows can be compressed at the point where our arms and wrists bend. They can also be put under tension which can cause irritation and aggravate symptoms like numbness, tingling, and/or pain. Another example is when a pillow causes the neck to be bent in a position that can compress the nerves that travel from the spine into the arms and hands.

How can I prevent it?

Fortunately, this does not always mean that we need to go buy an expensive mattress or pillow. There are some simple changes that we can make at night to better position ourselves for success during the day. See below for some helpful tips with photos.

Back Sleepers

For back-sleepers, the goal is to maintain the natural curves in your spine from head to your hips. You want a pillow that naturally cradles the neck without placing the head too high or too low. This protects the nerves that travel from the neck into our arms and hands. A small pillow under each elbow allows the shoulder to naturally fall back against the mattress, the arms to rest in a neutral position, and lessens the urge to put your arms up over your head. This decreases pressure or tension on the nerves as they travel through the shoulder and elbow. A pillow under your knees maintains the curve at the base of the spine and decreases pressure on your lower back and knees. This also can alleviate pressure on the nerves that arise from our lower spine and travel into our legs and feet.

back sleeper

Side Sleepers

For side-sleepers, the goal is to maintain the spine in a level line from neck to hips. Your pillow should cradle the neck without positioning the head too high or too low. On the mattress side, your shoulder blade should be lying flat on the bed rather than having your arm curled underneath you. Your top arm should be lying on and cradling a pillow to prevent compression in your shoulder, elbow, and wrist. A pillow between your legs decreases pressure on the low back, hips, and knees.

Side sleeper

How can my hand therapist help me?

Your hand therapist can provide further education on sleep positions and even help you practice finding the most comfortable position for you in the clinic. For some conditions, he or she might also provide an orthosis to help maintain certain joints in positions of comfort or to improve the health of a joint, muscle, or nerve.


Kimberly Masker, OTD, OTR/L, CHT, is a Certified Hand Therapist, and is a member of the American Society of Hand Therapists and an affiliate member of the American Society for Surgery of the Hand.

If you need assistance with this, please contact me or book and appointment.

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