Ankylosing Spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine and the sacroiliac joints, where the spine connects to the pelvis. This condition causes pain and stiffness that severely disrupts a person’s life, especially during rest. Nocturnal pain and morning stiffness are signature symptoms of AS, often waking individuals in the early hours. This night-time discomfort is due to the accumulation of inflammatory fluid around the joints when the body is immobile. Successfully managing sleep with AS requires adjusting sleeping positions, choosing the right equipment, and implementing specific pre-sleep routines.
Optimizing Sleeping Positions
Maintaining a neutral spinal alignment is the primary goal when selecting a sleeping position. This prevents the spine from fusing in a compromised posture and minimizes stress on the joints while supporting the natural curves of the spine.
Lying on the back, or the supine position, is the most recommended approach for those with AS. Resting on your back keeps the spine in its natural, straight alignment, reducing pressure on the lower back. Use a thin, flat pillow or no pillow under the head to ensure the neck remains level with the spine, preventing hyperextension. Placing a firm pillow or wedge under the knees can also help maintain the natural curve of the lower back and reduce lumbar strain.
For individuals who prefer side sleeping, proper alignment is achieved by using a pillow between the knees and thighs. This keeps the hips and pelvis level, preventing the twisting of the lower spine that can occur when the top leg drops forward. The pillow used for the head should be thick enough to fill the gap between the neck and the shoulder, ensuring the head is level with the spine and not tilted up or down.
Sleeping on the stomach, or the prone position, is strongly discouraged for people with AS. This position forces the neck to twist and hyperextends the lower back, which can significantly aggravate symptoms. Prolonged periods in the prone position accelerate stiffness and inflammation, making morning pain worse.
Selecting Supportive Sleep Equipment
The surfaces used for sleep are important, as they provide the necessary physical support to maintain alignment. A medium-firm to firm mattress is recommended, providing enough support to keep the spine straight without allowing the body to sink too deeply. While extra-firm mattresses were once standard advice, they can create pressure points at the hips and shoulders, making a medium-firm option that conforms slightly to the body’s shape often better.
Pillow selection should support the cervical spine’s natural curve. Cervical support pillows, often contoured, can cradle the head and neck, which is beneficial for back sleepers. Side sleepers need a thicker pillow to bridge the distance between the head and the mattress, or they may use full-length body pillows for maintaining alignment down to the knees.
Getting into and out of bed can be a painful experience, especially with morning stiffness. Aids that minimize jarring movements are helpful. Using an adjustable bed railing or the firm edge of the mattress as a stable handhold reduces strain on the spine and hips when rising. This support allows the individual to transition from a lying to a seated position with greater control, minimizing the sharp pain associated with the first movements of the day.
Nightly Routines for Stiffness Reduction
The time preceding sleep should be dedicated to activities that prepare the body for rest by reducing stiffness and inflammation. Heat therapy is effective; a warm bath or shower one to two hours before bedtime helps loosen tight joints and muscles. The warmth promotes relaxation in the soft tissues and makes the body more pliable before settling down.
Gentle stretching before bed can reduce evening stiffness without causing overexertion. Low-impact movements, such as the cat-cow stretch or a gentle knee-to-chest hold, maintain flexibility and range of motion. These stretches should be performed slowly and deliberately, only moving within a comfortable range to avoid aggravating inflammation.
Managing medication timing is an important aspect of the nightly routine. Individuals should consult their doctor to ensure anti-inflammatory medications are timed to provide peak effectiveness during the night. Since nocturnal pain often intensifies in the second half of the night, proper timing helps suppress inflammation and prevent pain-related awakenings.
Controlling the sleep environment supports a reduction in night-time discomfort. Keeping the bedroom dark, cool, and quiet minimizes disruptions that could force the stiff body to move unnecessarily. A consistent sleep-wake schedule aids the body’s natural rhythms, promoting better sleep integrity and reducing the effects of chronic fatigue.