Some patients are function very well throughout the day and only have complaints at night. Some of the first questions you should ask are
- are you watching TV in bed?
- The bed is only for 2 things, and TV watching is not one of them!
- what position are you sleeping in?
Depending on their condition, shoulder issues, lumbar derangement, they may have an easier time either sleeping on the involved side (possibly for derangements) or on the uninvolved side (shoulder/hip). I wrote a post a while back on instruction on lying positions.
For those patients who are worse at night, or are able to maintain Sx reduction throughout the day with different loading and unloading strategies, but are unable to at night, you shouldn't forget something as simple as the McKenzie Night Roll.
If you instruct patients to use a lumbar roll while sitting (and also avoid prolonged sitting > 20-30 minutes), why would you not consider the night roll? It has definitely helped more than a few of my patients; they had been able to centralize and abolish their radiating lumbar complaints during the day with HEP, but still had disturbed sleep at night due to unilateral lumbar, hip, or lower leg pain.
The concept is rather simple, the patient wears the roll like a belt. It goes 3/4 of the way around them, posteriorly and on the left and right sides. If they are sleeping supine on an unsupported mattress, their lumbar spine remains in neutral. If they are sleeping on their involved side, they do not sidebend away from the directional preference if they have a posterolateral or far lateral derangement. Alternatively, they may duct tape a towel roll around a belt and just wear that at night. Try this for your patients with persistent pain at night or who wake up worse in the morning!