Ask the doctors: Waking with numb limbs often the result of sleep position
Q: My wife often wakes up with one of her arms completely numb. As feeling returns, she experiences excruciating pain. Could this be due to her sleeping position, or does it suggest a problem with the nerves, neck or shoulder? Is there a way to prevent it?
A: Recurring arm numbness can have a range of causes. Compression of a peripheral nerve, conditions that affect the cervical spine, neuropathy and certain metabolic disorders can all affect nerve function.
But because your wife's symptoms develop while she is lying down and resolve when she changes position in the morning, temporary nerve compression due to her sleeping position comes to mind.
It is surprisingly easy for peripheral nerves to become compressed during sleep. As we drift off, our muscles relax and gravity takes over. This opens the door for prolonged pressure on a nerve, or for the position of a limb or joint to interfere with that nerve's normal function. The initial result is numbness.
When sleep ends, compression ends. Blood flow is restored and nerve function returns. The recovering nerve can then send bursts of abnormal signals, which result in the pins-and-needles feeling. When it's been compressed for a long time, like during sleep, the return of sensation can be painful.
The first thing to check would be your wife's sleep posture — and because we shift during the night, your input can help with this task. Someone who develops arm or hand numbness during the night should avoid sleeping face down or on their affected side. They should also avoid sleeping with their arm under their body or overhead. These positions can adversely affect spine alignment and put pressure on the shoulders.
It can be hard to change sleep positions. Giving it a try can help narrow down the cause of her arm numbness. With side and front sleeping being possible culprits, it would be useful to see if sleeping on her back helps.
Some people also find stretching before bed helps. A series of gentle back, side and arm stretches can reduce tension and improve circulation.
Sleeping surfaces can also affect spine alignment. When a mattress is too soft, gravity can tug at the hips and shoulders enough to lead to nerve compression. If a mattress is too firm, it can create pressure points that place excess stress on the shoulder, hip or arm.
A pillow that is too high can do the same to the neck. And it may be counterintuitive, but a pillow that is too low can also put the neck into an awkward position.
If changing sleep position doesn't help, we recommend she see her healthcare provider. They can evaluate her for a herniated disc, arthritis or other conditions that can affect the cervical spine.
If the numbness ever fails to resolve after moving positions or comes with weakness in the limb or hand, facial weakness or loss of coordination, she should seek a prompt medical evaluation.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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