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.
Unfortunately 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?”
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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
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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
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 
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
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
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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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