Sleep plays an important role in our daily functioning. It helps to restore and restore our body from wear and tear on its overall structure from daily activities. It plays a particularly important role in helping us repair and grow tissues such as nerves, muscles, and bones. For all these reasons, sleep may be the most important part of your day.
Sleep Orientation and Carpal Tunnel Syndrome Unfortunately, some people find it difficult to get restful sleep. They lie in bed trying to fall asleep and notice pain in their arms and hands, or numbness and tingling in their fingers. Sometimes they finally fall asleep but wake up with the same symptoms and think "what's going on here?"
Does this sound like you or someone you know? Maybe it's time to ask yourself some more questions. How are you sleeping? What is your sleeping position? Are your symptoms worst at night? These are all questions I ask my patients complaining of fingertip pain, numbness or tingling, which may be related to a pinched nerve problem called carpal tunnel syndrome. See below for more details on this common syndrome.
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a disorder that affects the median nerve in the wrist and hand. The median nerve starts at the cervical spine (neck) and runs through the upper arm to the hand. This nerve allows the muscles it innervates to activate and fire when we want it (i.e. when grasping and pinching). At the level of the wrist, nerves also provide sensation to the thumb, index, middle, and sides of the ring finger. The carpal tunnel is made up of the carpal bones at the bottom and sides and a fibrous band called the transverse carpal ligament at the top. Inside this tunnel are tendons that flex the fingers and the median nerve. When a person develops carpal tunnel symptoms, the pressure in this tunnel increases, putting pressure on the median nerve.
How Does Sleeping Position Affect Carpal Tunnel Syndrome?
Usually the symptoms of carpal tunnel syndrome are worst at night, when tissue fluid in the arm is redistributed when there is no active muscle pump. 1 In other words, we are not moving when we try to fall asleep, and the increased fluid can cause increased pressure in the carpal tunnel, which can lead to symptoms. Therefore, the goal of occupational therapists is to reduce carpal tunnel pressure through positioning rather than movement to minimize these symptoms. How the patient positions the wrist during sleep may be one of the factors that determines carpal tunnel pressure. In fact, one study found a strong link between people sleeping on their side and carpal tunnel syndrome. This is because side sleepers are more prone to fetal sleep. 2 This pose generally includes a rounded shoulder pose in front of the head, elbows bent, wrists bent, and fingers bent. Although placing all of these body parts in these specific positions is not ideal for a number of reasons, the position of the wrist is especially important in people with carpal tunnel syndrome because a change in wrist position as little as 20 degrees can significantly alter nerve compression symptom.
Sleeping Positions to Avoid:
sleep in fetal position
Not only does this pose increase the risk of carpal tunnel syndrome, but it also increases the risk of compression injuries to other nerves in the elbows, shoulders, and cervical spine. It also doesn't provide adequate back and hip support.
on your stomach
sleep on your stomach
This pose increases the risk of carpal tunnel syndrome by increasing the pressure on the wrist. It also increases the risk of compression injuries to other nerves in the elbows and shoulders, as well as possible irritation to the neck, back, and spine.
Preferred sleeping position:
Lying on your back in this position reduces stress on the cervical spine, and there is less risk of pinched nerves in the shoulders, elbows, and wrists. Supporting your legs can also reduce stress on your lumbar spine.
People who prefer to sleep on their side should gently hug the pillow or body pillow to prevent themselves from entering a fetal position that increases tunnel pressure. Those with signs and symptoms of carpal tunnel syndrome should also consider wearing a wrist brace to keep the wrist in a neutral position. The pressure in the carpal tunnel is lowest when the carpal tunnel is in a near neutral position.
When sleeping on your side, it may be beneficial to place a pillow between your legs to provide proper hip support and spinal alignment, as well as having proper neck support to ensure your cervical spine is in a neutral position.
Physical Therapy for Carpal Tunnel Syndrome
For early CTS, conservative treatment is recommended as the first step. Physical therapy can be effective in reducing your symptoms and helping you return to your daily activities.
Depending on the cause of the CTS, your physical therapy plan may include:
Patient education. Your physical therapist will teach you ways to improve your condition and prevent it from getting worse. This may include education about the importance of:
- Change wrist position (eg avoid flexing wrist position for extended periods of time).
- Correct neck and upper back posture (avoid forward head tilt or listlessness).
- Safety precautions when using sharp instruments, tools or other tools. This is especially important if your physical therapist detects changes in your feeling levels.
- Take "stretch breaks" in your work or routine.
- Stretching exercises. Your physical therapist will teach you gentle stretches to improve your wrist, hand, and finger flexibility.
- Strengthen your practice. Your physical therapist may teach you exercises to strengthen your muscles to help you maintain better posture. Once your symptoms are relieved, you can perform strengthening exercises for your hands, wrists, and forearms.
- splint. Your physical therapist may recommend that you use a splint at night to reduce discomfort.
Cold and heat treated. Your physical therapist may use cold or heat therapy, or recommend ice or heat for pain relief.
They may also recommend options for your work, family, and leisure activities as part of your treatment plan. These may include:
Job site assessment. If you are working at a computer while sitting at a desk, it is important to align the keyboard properly to avoid working in a bent wrist position.
- Increase the size of tool and utensil handles by adding extra material for a more comfortable grip.
- If vibration is a factor in your workplace, use special gloves or wrap tool handles to reduce vibration.
- Wear gloves to keep wrists and hands warm.
- Reduce or stop activities that increase symptoms until they are less frequent or intense.
The goals of physical therapy are:
Symptoms can be relieved without surgery.
- Make you as active and functional as possible.
- Helping you get back to normal work, family and leisure activities.