03:10. You fell asleep eventually, and now you are awake, and you did not choose to be. The neck woke you. Maybe you rolled toward the lamp without thinking and it caught. Maybe it just aches, a hot band from the base of your skull into your shoulders. The house is quiet and the clock is loud.
Nights are often the worst part of the first week after a crash. You are not moving, so the stiffness builds. And every position you normally sleep in asks something of a neck that is not ready to give it. This page is about getting through those nights a little better, and about noticing the details the exam will want.
First, the nights that are not about sleep
If you woke with a sudden severe headache unlike any you have had, weakness or numbness on one side, trouble speaking, vomiting after a blow to the head, or confusion that is getting worse, that is not a pillow problem. It is an emergency room trip right now. The same is true for anyone else in the house who was in the crash and is hard to wake or not making sense.
The pillow is doing more than you think
A pillow's job is to hold your head roughly in line with the rest of your spine, so the neck is not bent forward, back or sideways for hours. After whiplash the height matters more than usual, because a strained neck complains about positions it would have shrugged off last week.
- Too high, often two stacked pillows, pushes your chin toward your chest when you are lying face up, and tips your head toward the ceiling when you are lying on one side.
- Too flat lets your head sag toward the mattress when you lie on one side, which bends the neck sideways all night.
- About right keeps your head level with your body: chin neither tucked nor tipped back when you are face up, and no sag or tilt when you are turned to one side.
You do not need to buy anything tonight. A folded towel under a flat pillow, or taking one pillow away, is a cheap way to test the difference. If a change makes it worse, undo it.
Back, one side, and the stomach problem
Most people find the first week easier face up or turned to one side. Stomach sleeping is the hard one: to breathe, your head has to turn fully to one side and stay there for hours, and a whiplash neck often cannot hold that rotation without paying for it by morning. If you are a lifelong stomach sleeper, a long pillow to half-hug can keep you rolled partway instead of all the way over.
Face up, a pillow under the knees takes some strain off the low back, which often hurts too. Turned to one side, a pillow between the knees keeps the hips and lower spine from twisting.
The couch arm and the car seat
At 3 a.m. the couch starts to look like a solution, because it is somewhere else and you are tired of the bed. The trouble is the arm of the couch, which props your head at a sharp angle for hours. Falling asleep sitting up with your chin dropped forward does the same thing, and so does dozing in the car seat or in a chair that lets your head roll to one side. People wake from those with a worse neck than the one they lay down with.
A recliner that keeps your head supported so it cannot flop sideways is a different thing, and some people find it the only place they can sleep for a few nights. If that is you, pad both sides of your head with a small pillow or a rolled towel, and mention it at the exam, because it tells a clinician something about how the neck is behaving.
Getting out of bed without the jolt
The moment most people feel it is sitting straight up, which uses the neck to lift the head off the pillow like a weight. The log-roll avoids most of that.
- Bend your knees with your feet flat on the bed.
- Roll to one side in one piece, shoulders and hips together, letting your head ride along on the pillow.
- Let your legs slide off the edge of the bed.
- Push up with your arms as your legs go down, so your arms do the lifting and your head comes up in line with your body.
Reverse it to lie back down. It feels slow, and it skips the lightning bolt.
The two-line sleep note
Bad sleep is part of the picture after a crash, and the details are gone by the time you are sitting in an exam. Keep two lines in your phone each morning:
- How many times you woke, and whether pain was what woke you.
- How you slept, face up, one side, recliner, and how the neck felt getting up compared with yesterday.
After three or four mornings that note says far more than "I haven't been sleeping great." It shows whether things are settling or not. A run of short nights also affects mood, attention and reaction time during the day; the NHLBI page on sleep deprivation explains why that is worth taking seriously, especially if you are driving.
Before you change anything big, ask
A new pillow, a new mattress, a week in the recliner, a neck collar you saw online, a new sleep aid: bring those questions to the exam instead of settling them alone at 3 a.m. Heat or ice, stretches from a video, and anything you take by mouth belong on the same list. The clinician who examines your neck can tell you what fits what they found. This page cannot.
What this page does know is the pattern. The nights are often worst early, and stiffness that keeps you awake is exactly the kind of thing to have looked at this week rather than lived with for a month. The first week, hour by hour walks through what tends to show up when.
Missouri Injury Clinic sees auto-injury patients at three offices. Tesson Ferry in South County and Hazelwood in North County are open 9 to 6 Monday through Thursday and 9 to noon on Friday. O'Fallon is open Monday, Tuesday and Thursday, with Wednesday and Friday by appointment. Every office closes from 12 to 2, so call in the morning or after 2. See someone this week, and bring the sleep note.