Best position to sleep in hospital bed

If the pressure injury is on the person’s bottom and/or contacts the sitting surface of the wheelchair, immediate 24 hour bed rest is usually required to remove or relieve pressure from the wound effectively. Identify the positions in which a person can lie so that there is no or minimal pressure on the wound and alternate between these positions in order to avoid prolonged pressure on another part of the body.

Monitor for complications of bed rest including respiratory complications and contractures.

Downloadable Tools and Forms

• SAMPLE  Positioning Plan
• Daily Skin Check Guide

Positions.20 Determine the range of positions in which the pressure injury/injuries are free from pressure using the SAMPLE Positioning Plan.

Mattress. Ensure the mattress is providing adequate pressure redistribution. Check areas of excessive pressure or possible ‘bottoming out’ on mattress by sliding hand between the person’s bony prominence and the mattress. Use a plastic bag as a glove to reduce friction and slide hand between the mattress cover and the mattress. If hand cannot easily fit through between the person’s body and the base of the mattress consider a different position and the need to ‘upgrade’ the mattress. Also refer to Manage Mechanical Factors: Mattress upgrade and selection in this Toolkit.

Prevent additional PIs. Protect all bony landmarks using cushions and positioning aids and consider precautions required in each position.

Prevent contracture. Use positioning aids and a range of motion program to prevent upper limb and lower limb contractures.

Repositioning. Reposition every 2-4 hours. Consider the use of slide sheets to change positions. Do not leave slide sheets or hoist slings in place under the person.

Trial. Trial any new position for 2 hours during the day and gradually increase to overnight depending on skin checks, comfort and safety.

Collaborate and communicate. Develop a practical and realistic positioning plan with the person and their carers. Display (if appropriate) and circulate the plan to carers with consent from the person.

Re-assess the positioning plan. Re-assess regularly, at least weekly, and check for complications such as deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia, secondary pressure areas, dehydration / malnutrition, contractures, deconditioning, muscle weakness, altered sleep patterns, psychological deterioration.

Refer to table: Preventing complications of bed rest in the above section “Minimise sitting and consider bed rest

Positions

Semi (30o) Side-lying

The semi (30o) side-lying position allows most bony landmarks to be free of pressure and avoids putting pressure directly on the greater trochanter (hip).20

Precautions

• Do not position directly on hip (GT) and shoulder
• Pillow or wedge behind back
• Pillow between legs and knees
• Position feet to protect bony prominences and minimise risk of contracture
• Consider placing top leg over bottom leg instead of on top of bottom leg if it does not increase pressure on the hip

• Use wedges, pillows and positioning aids (avoid closed cut outs or doughnut-type cushions).

  
  This is a side-lying wedge designed to support the 300 side lying position by removing pressure from the PI without increasing pressure on the weight-bearing shoulder and hip underneath.

  It consists of layers of foam including a firm layer to provide support and a soft layer on the surface to provide pressure redistribution.

  A Dartex cover and weldable seams are used for infection control.

Prone Lying

• Pillow under the abdomen to support lower back
• Pillow under chest/shoulders (e.g. two pillows in an inverted V or a boomerang pillow)
• Pillow under shins to raise toes off the mattress
• Prone face pillow to allow a face down position
• If using a hospital bed, use trendelenburg function to tilt the bed

Precautions

• Prone lying may not be possible for many people and it is not advised if it compromises respiratory function or is not safe.
• Consider liaising with the tertiary SCI and SB service to facilitate safe prone lying.

Supine

Precautions

• Ensure respiratory function is not compromised when lying flat or <30o.
• To reduce shearing forces on the sacrum, avoid raising the bed head above 30o. Use the bed knee break to minimise sliding down the bed.
• Ensure the person’s heels are free from pressure and shearing forces.

Keep bed head at less than 30o

Ensure respiratory function is not compromised when lying flat or <30o.

Offload the heels and prevent contracture

• 

  This heel wedge is designed to adequately lift the lower leg and free the heel from pressure without causing knee hyperextension which can cause popliteal vein obstruction (predisposing to DVT).

A Dartex cover and weldable seams are used for infection control.

A pillow is positioned against the foot end of the bed here to prevent planter flexion contracture.

• 

  Products such as boots which lift the heel and support the foot in a neutral position may prevent contracture when the person is lying on their side. Ensure the device has maximum padding and can move with the person if the person experiences leg spasms.

Refer to an OT for a clinical assessment of safe and effective positions that the child can use when in bed. Trial all positions and check skin for new PIs before implementing a positioning plan.

Effective positioning plans involve a variety of positons, equipment, positioning aids and prone mobility. Postural support requirements (such as wearing TLSOs) in and out of bed should be assessed and monitored closely. Strategies to play in bed without pressure or shear over the PI should be devised, see section above “Minimise sitting and consider bed rest”.

Commercially available equipment such as electric beds, mattresses and sleep systems are made for adults and do not accommodate a child’s smaller size, weight or body proportions. Some commercial sleep systems can be used or modified to create positioning supports.

Clearly define the degree of recline (bed head raise) for sitting up in bed and the recommended time period (usually less than 20 mins). Assume that an unsupervised child will ‘break the rules’ if they have the capacity to sit up. Engage carers with strategies to manage the restrictions.

Everybody has a favourite sleeping position. Regardless of whether you sleep on your back, on your side or with your head raised, an adjustable bed can suit all preferences. The question is: which position is best for you?

Different adjustable bed sleeping positions can have a big impact on how well we sleep. Here is our guide on which position is best for you:

Side Sleeping on an Adjustable Bed

Side sleeping is one of the most popular sleeping positions in the UK and more that 60% of people side sleep, particularly among those over the age of 65. The flexibility of our spine decreases as we age which is why the side sleeping position is more popular in older adults.

If you suffer from conditions such as lower back pain, hip pain, acid reflux or sleep apnoea, you could benefit greatly from sleeping on your side.

There is often a misconception that you can’t sleep on your side in an adjustable bed, however, this is far from the truth.

Side sleeping on a conventional bed can cause strain on your shoulders, neck and hips which can trigger aches and pains. However, our beds can adjust you into a comfortable side sleeping position at the simple touch of a button, meaning less strain is put on your joints. This has a number of benefits including:

• Raises your head and feet, alleviating pressure from your hips, helping to temporarily relieve pain
• Allows you to sleep better without tossing and turning to get comfortable
• Regulates blood flow since your body is supported without obstruction

Sleeping on your back in an Adjustable Bed

If you regularly suffer from backache, sleeping on your back with your adjustable bed in the contour position is for you.

It is unknown to many that back pain can be regularly triggered by poor posture, and conventional beds can actually worsen back pain. This is because they place excessive pressure on vulnerable areas such as your spine and hips. Sleeping on your back enables your spine to align correctly

Unlike conventional beds, adjustable beds can be adjusted to contour to the natural ‘S’ shape of your spine, offering extra support to your knees, spine and hips. This helps to temporarily relieve pain, and ultimately, you will be provided with a relaxing nights rest!

Often pillows can be used as a method of pain relief and spinal support. Although this is an ideal quick fix, these pillows can move around as you do when you are asleep. Furthermore, pillows can offer an uneven amount of support to your back, which could cause additional pain. An adjustable bed and sleeping on your back in the contour position is certainly a better, more long term solution.

Sleeping with your head raised on an Adjustable Bed

Ultimately, sleeping with your head raised is great for your breathing. It helps to alleviate heart and sinus congestion, lessen shortness of breath and relieve migraines and stuffiness in the head.

Not only this, sleeping with your head raised can also help to prevent snoring and sleep apnea. This is because pressure is alleviated from your throat, helping to prevent blockages in your airways.

As well as these health benefits, being able to raise your head at the touch of a button can offer you maximum comfort when you are relaxing in bed with a book or watching the television!

Health Benefits Of An Adjustable Bed

No matter what position you decide is the best for you, sleeping on an adjustable bed can have an abundance of health benefits for everyone. These include:

• Temporary positional back pain relief
• Alleviation of sleep apnoea and snoring
• Temporary relief from arthritic pain
• Sleeping with your feet raised can help to improve your blood circulation
• Easing of insomnia

Adjustable beds can also help you to improve your independence in your home. By lowering and raising you at the simple touch of a button, you are less likely to need assistance getting into and out of your bed.

Frequently Asked Questions Adjustable Bed Sleeping Positions

1. What is the best position to sleep in an adjustable bed?

We all have a favourite position to sleep in so the answer is simple, whatever suits you and your sleep needs best. We would just advise that  If you wake up with aches or pains then you may benefit from changing your adjustable bed sleeping position.

2. Are adjustable beds good for back pain?

Yes! The best adjustable bed sleeping position if you suffer from back pain is sleeping on your back with your knees and hips slightly raised. This allows your spine, muscle and joints to rest in a neutral position.

3. What are the best adjustable bed mattresses for side sleepers?

While mattresses types ultimately boil down to your personal preferences, in our experience it is better to opt for a softer mattress (between soft or medium grade) if you sleep on your side. This is because a lot of weight is applied to specific pressure points on your side

4. Is it OK to sleep with your feet elevated?

Yes, it's perfectly OK to sleep with your feet elevated. Simply raise the foot section of your bed and you're good to go. Using an adjustable bed to elevate your feet can help with a number of conditions.

• It improves blood circulation
• Reduces swelling in the legs and feet
• Reduces blood pressure
• Prevents deep vein thrombosis

Ready to experience better sleep?

If you would like to discover how an adjustable bed could help you to- sleep better at night, get in touch today, or request a free brochure on the form on this page.