sleep positioning carpal tunnel syndrome

Sleep Positioning and Carpal Tunnel Syndrome

by Mark Torres, MS, OTR/L, CHT26 Comments

Sleep plays an important role in our daily function. It helps to rejuvenate and restore our bodies from the wear and tear our daily activities put on integral structures. It specifically plays an intricate part in helping us repair and grow tissue, like nerve, muscle and bone. For all of these reasons, sleep can be the most important part of your day.

Sleep Positioning and Carpal Tunnel SyndromeUnfortunately some individuals find restful sleep difficult to achieve. They lay in bed trying to sleep and notice they have pain in their arms and hands or their fingers feel numb and tingly. Sometimes they finally fall asleep, but wake up with those same symptoms and think “What is going on?”

Does this sound like you or someone you know? Maybe it is time to ask yourself some more questions. How are you sleeping? What is your positioning like when you sleep? Are your symptoms worst at night? These are all questions I ask patients who have complaints of pain, numbness or tingling into the finger tips which may be associated with a nerve compression issue called Carpal Tunnel Syndrome. See below for more details on this common syndrome.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a condition affecting the median nerve at the level of the wrist and hand. The median nerve starts from the cervical spine (neck) and crosses through the upper arm all the way into the hand. This nerve allows the muscles it innervates to activate and fire when we want them to (i.e. during grip and pinch). At the level of the wrist, the nerve also supplies feeling to the thumb, index, middle and middle finger side of the ring finger. The base and sides of the carpal tunnel are composed of the bones of the wrist and the roof consists of a fibrous band called the transverse carpal ligament. Inside this tunnel lay tendons that bend your fingers and the median nerve. When one experiences carpal tunnel symptoms, there is increased pressure occurring in this tunnel that is putting pressure on the median nerve, which in turn can cause numbness and tingling into the affected fingers as well as a loss of strength and dexterity.1

How can sleep positioning affect Carpal Tunnel Syndrome?

Usually Carpal Tunnel Syndrome symptoms are worst at night due to tissue fluid in the arms being redistributed when there is no active muscle pump.1 In other words, we aren’t moving when we try to sleep and increased fluid leads to increased carpal tunnel pressure, causing symptoms to appear. Therefore the goal for Occupational Therapists is to decrease carpal tunnel pressure through positioning rather than movement to minimize these symptoms. How patients position their wrists during sleep can be one factor that determines carpal tunnel pressure. In fact, one study found a strong association between people sleeping on their side and Carpal Tunnel Syndrome. This is because people who sleep on their side were more inclined to sleep in the fetal position.2 This position generally includes a forward head and rounded shoulders posture, bent at the elbow, the wrist bent in the flexed position, and fingers flexed. While placing all of these body parts in these specific positions is not ideal for many reasons, wrist position with Carpal Tunnel Syndrome in particular is critical, as changes in wrist position by as little as 20 degrees can significantly alter nerve compression symptoms.1

Sleep Positions to Avoid:

The Fetal Position

sleeping in the fetal position
This position not only increases the risk of Carpal Tunnel Syndrome, but also increases the risk of other nerve compression injuries at the elbow, shoulder and cervical spine. It also does not provide adequate back and hip support.

On Your Stomach

sleeping on your stomach position
This position increases the risk of Carpal Tunnel Syndrome by putting increased pressure onto the wrists. It also increases the risk of other nerve compression injuries at the elbow and shoulder as well as possible irritation to the neck, back and spine.

Preferred Sleeping Positions:

On Your Back sleeping position: on your back
This position allows for less stress on the cervical spine with less risk of nerve compression also at the shoulder, elbow and wrist. Having the legs propped up also puts less pressure on the lumbar spine.

On Your Side

sleeping position: on your side
Individuals who prefer sleeping on their side should gently hug a pillow or a body pillow to prevent themselves from going into the fetal position that can increase tunnel pressure. Those who have signs and symptoms of Carpal Tunnel Syndrome should also consider wearing a wrist brace to keep the wrist in a neutral position. Pressure in the carpal tunnel is lowest with the wrist in a near neutral position.1

When side sleeping, a pillow in between the legs for proper hip support and spine alignment can be beneficial as well as having the proper neck support to ensure a neutral position of the cervical spine.

* Disclaimer: There are special considerations to take into account if you are pregnant. I recommend discussing these options with your medical provider.

Early Detection of Carpal Tunnel Syndrome

Early detection of Carpal Tunnel Syndrome is important. Those who suspect signs and symptoms of Carpal Tunnel Syndrome should follow up with an occupational/hand therapist for a free assessment at a nearby Athletico. At this screening, the therapist will be able to analyze the symptoms and provide information for further follow-up if needed.

Request a Free Assessment

Physical therapy is usually the thing you are told to do after medication, x-rays or surgery. The best way to fix your pain is to start where you normally finish – with physical therapy at Athletico. Schedule a free assessment in-clinic or virtually through a secure online video chat where our team can assess your pain and provide recommended treatment options.

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References
1) Evans, Roslyn B. “Therapist’s Management of Carpal Tunnel Syndrome: A Practical Approach.” Rehabilitation of the hand and upper extremity. T. M. Skirven  (2011). Philadelphia, PA, 2011. 666-677. Elsevier Mosby.
2) Mccabe, Steven J., Amit Gupta, David E. Tate, and John Myers. “Preferred Sleep Position on the Side Is Associated with Carpal Tunnel Syndrome.” Hand 6.2 (2010): 132-37. Web.

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26 Comments

  1. Vivian Lopez

    The post is very useful, I learned a lot from it. Luckily, I always have good positions while sleeping. Thanks for sharing!

  2. Rose

    I used to wake up with both my hands turned in wards – I got my chiropractor to adjust them with her activator and it’s been years since they have been much better! But the key is getting to it before it’s very bad and staying on top of chiro adjustments too.

  3. Rena Clements

    I find when I lay flat on my back with my hand flat against my leg that the numbness goes always

  4. Karen

    My bursitis lessened after my daughter left her teddy bear in my bed many years ago. So sleeping on my side while holding the bear is also good for avoiding carpal tunnel! What a relief to find I’m doing it right.

  5. Jeanne Carlisle

    If fluid accumulation causes numbness and pain at night, why is mine relieved by hanging my arm down over side of bed?

  6. Milicent

    I’m currently pregnant and I’m having hands cramps I have tried everything that can help to reduce this pain even to wear a bracelet nothing is helping me, I have tried different position when sleeping but is not helping , this pain is taking away my happiness of enjoying my pregnancy please help me

  7. Mark Torres

    All cases are different, but your symptoms may be due to proximal nerve compression (higher up towards the shoulder and neck) if you are seeing symptom relief from stretching your arm over the side of the bed.

  8. Mark Torres

    Pregnancy related carpal tunnel syndrome can be tough to manage due to increased fluid and edema related to pregnancy. A wrist brace that keeps your wrist neutral can help symptom relief at night. For short term relief, I have found some patients have success with performing contrast baths. You may benefit from a screening with your local OT to discuss symptom management.

  9. Karen Rodriguez

    Great article! I have carpal tunnel diagnosed +10 years ago, always had great results wearing my splints at night and for repetitive activities like driving. After many years of managing with PT and injections it has gotten unbearable this past year. I had surgery scheduled in March and was cancelled. I am allergic to Nsaids and all related, any medication, over the counter I could take to relieve night time pain and burning? My docs office is closed due to the pandemic. I am desperate.

  10. Mark Torres, MS, OTR/L, CHT

    Hi Karen,
    Unfortunately I am not a great resource for medication recommendations as your MD will be the better resource. Athletico is now offering telemedicine appointments. You can contact your local Athletico to possibly schedule a telemedicine appointment to review symptom/pain management, neural gliding, stretching techniques, etc.

  11. RICHARD HARRIS

    I have Carpal Tunnel very serious . I had injection 4 months ago.What a relief then but now it much worse.The splints don’t work at all.Different position don’t work at night at all. I have to get up and walk around.The pain is in my hands and left arm at a scale around 6 or so.With the virus going around doctors cant see me and wont do injections. What can I do???

  12. Daniel Mendoza

    I fall asleep on my side and when i wake both of my hands are numb and feel like they’re burning. Pain also goes up my forearms.

  13. Teresa

    Hi. I have been suffering with Carpel tunnel for almost 20 year. It got to a point that i could not get the feeling back in my hand. I have been operated on just a few days ago. I am in alot of pain still but i went to my doctor and got to go for the operation within a week. Luckily the covid did not stop the doctors from helping me…. great article though x

  14. Marina Vershubsky

    Hi Teresa, how was your operation? I know that I need one too at this point, but still am too scared!

  15. Jon

    I have found several things help with the pain:
    Take a break and massage the forearm-wrist-hand firmly for a couple of minutes.
    Hold the hand at head height to reduce pressure, flexing the fingers.
    When pain is bad panadol/ibruprofin works for me.
    A firm but not tight wrist brace, essential when driving for more than 20 minutes and sometimes for sleeping and whenever sudden sharp pains are happening.

    The carpal tunnel operation 4 weeks ago was a miracle. I still have periods when wrist is sore and some nights it is difficult to get to sleep but the pain does not wake me as it was doing before the operation. My grip is weak and if I don’t flex first, gripping is painful, but slowly improving as expected by the doctors.

  16. Sarah

    Hi I’ve been experiencing carpel tunnel pain for about a year now, it’s gotten worse over last few months, and now I have pain numbness and severe burning feeling in my ring and middle finger almost every night. The burning wakes me up, it feels like I’ve got a burn from hot oil or something and it feels so Much like burning In real life like I need to put my finger in cold water to relieve it. The way it feels is like holding onto dry ice and getting a burn, it’s like cold and burning at the same time,
    I also get the long pain shooting up my wrist along my elbow and in my right shoulder blade. I don’t know what to because it hurts when I drive and even when I’m trying to write this on my phone, my hand hurts and feels week and tingly

  17. Wenona Johnson

    I was diagnosed with PT in 2019, I was given a splint for my hand, but wasn’t told i hi ow bad this can get !!
    I had an appointment with a specialist and because of COVID- 19 it was canceled. I am losing sleep, and can’t work because of all the symptoms I am suffering and it goes up my arm, thru my neck, in my back and lower back, I am also starting to have symptoms in my left had !!!
    I feel so helpless . I just learned about the therapy and chiropractic thru this site and my neighbor told me about her father and his experience with this yesterday. I felt alone at first, I actually thought I was the only one in the world going thru this until now . I googled and searched PT and learned a lot, because my Doctors didn’t tell me much . I really need help, and I can’t work because of this . Thanks for all you guys help and especially for ATHLETICO . I need Physical Therapy ASAP !!!! Thanks

  18. Lois

    Very helpful posts. My Carpal Tunnel pain completely disappeared 14 years ago, after ingesting a heaping teaspoon of Turmeric every day for several months. 2 years ago the excruciating pain returned, mainly at night. As I am on baby aspirin, I can no longer take Turmeric. However, running very hot water over my palm for minute, provides instant relief and allows me to resume sleeping or daytime activities. None the less, I will be seeking a specialist for evaluation. It may be time for surgery and PT.

  19. Evelyn

    i have carpal in both hands with excursiating pain all the time. I wear splints at night, gloves during day . have gone to surgeon drs who said mine was wear n tear, surgery would not help. went to primary dr recently n she said to get another opion. so now i am scheduled surgery in Mar on my right hand. hopeflly i can have left hand done later also.. the pain is undescrible.exercise helps for a while but pain , numbness comes back.

  20. Lisa P Garza

    Surgery helped instantly. Dr Hardy a miracle worker. The surgery pain was nothing compared to the pain of carpel tunnel. Meanwhile ice packs help. Get surgery immeditally, it will only get worse. Those drs who said there was no help are quacks. See an orthopeadic surgeon.
    Dr Hardy is in Austin Tx.

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