Interview with Michael Angelo, PT: Why Sleep Transitions Cause Pain

We sat down with the very experienced physical therapist Michael Angelo, the owner at Michael Angelo Physical Therapy and Wellness in Tucson, AZ , to talk about a problem many people struggle with - tossing and turning about leading to pain while rolling over or changing positions in bed.

In this conversation, he explains why movements during sleep often hurt more than lying still, how to set yourself up to minimise discomfort, and some practical tricks anyone can try tonight to minimise tossing and turning.

How To Stop Moving About In Bed

Charlotte: Most sleep content focuses on the best position. From your perspective, why do you think how we’re moving in bed is just as important, if not more important?

Michael Angelo:
It’s really a combination of all those factors. In my practice, I’m very hands-on. I do a lot of manual therapy, and people come in with tightness, knots, and soreness. We work those things out, but often people come back with the same issues. They find themselves in continuous patterns: waking up sore, having difficulty staying asleep, or waking multiple times a night.

When your pillow isn’t set up right, your sheets are uncomfortable, or your mattress is too soft or too firm, your body isn’t supported. You’ll toss and turn without even realising it. Even small amounts of tension can backfire over the long term. Setting yourself up in a tension-free position at the start of the night is key.

Charlotte:
That makes sense. Why do movements like turning over or rolling from side to side tend to provoke more pain than just lying still?

Michael Angelo:
That’s a great question. At the very low part of your back are your SI joints, the sacroiliac joints, where your pelvis connects to your spine.

Those joints only move about five millimetres. If they’re inflamed or unstable, rolling can cause really sharp pain. That’s why so many people wake up when they roll.

It’s not just the SI joints, people also get mid-back or hip pain when rolling, but those joints are particularly sensitive. When they aren’t stabilised, rolling catches them and triggers pain almost every time.

Charlotte:
I think I might have that!

Michael Angelo:
A lot of people do. Once you hit 30, almost everyone wakes up with back pain at some point.

Why Your Neck Hurts When You Change Positions At Night

Charlotte:
So what about the neck or shoulder? What’s happening there during those brief moments?

Michael Angelo:
Those little joints in your neck are stacked very closely together. If your neck is slightly kinked and already inflamed, moving can pinch them more sharply. It’s not a dull ache, it’s aggressive.

That pain can spread down into your shoulder blades. Your body then locks down muscles as a defense, but that creates even more pain. It’s a cascade effect that often spreads to the mid-back, shoulders, and hips.

How To Stop Moving So Much At Night

Charlotte:
Can you walk us through tricks for pain-free turning in bed?

Michael Angelo:
Ideally, I want you set up with so little tension that you don’t turn at all. Most people think that’s impossible, but it can happen.

The Groove Pillow, which I use every night, helps keep your head and neck in the right position when you roll. It’s designed to contour without getting in your way, unlike big feather pillows.

Even more important, if you feel even a slight pull or kink when you get into bed, adjust your pillow until you don’t. The goal is to eliminate tension so you’re not fighting your body all night.

Charlotte:
That’s probably the big takeaway, it’s all about setting up the pillow, mattress, and even the sheets right.

Michael Angelo:
Exactly. If your bedding isn’t right, you’ll toss and turn. Even climate matters—thin sheets in cold places, lighter cotton in hot ones. Comfort matters because tension leads to more movement, and movement leads to pain.

The 90-Second Bed Audit

Charlotte:
You’ve mentioned the “90-second bed audit.” What is that?

Michael Angelo:
It’s just a quick check before bed. Take 90 seconds to make sure your pillow, sheets, and blankets are positioned correctly. Lie down and notice: do you feel tension in your neck, hips, or back? If so, adjust. A towel under your waist or the right pillow between your legs can make a big difference.

Charlotte:
So why do gaps under the waist, neck, or knees make transitions more unstable and painful?

Michael Angelo:
Because your spine isn’t designed to be unsupported. Gaps cause your body to sag, which increases tension and pain. Over time, that pain takes longer to recover from. Supporting those gaps prevents that downward spiral.

Charlotte:
What supports or tools can people use to close those gaps?

Michael Angelo:
Flat supports like folded towels work well. I don’t want your spine bending over anything rounded, neutral support is the goal. For legs, the Groove X Pillow is great between your thighs.

Some people prefer using the original Groove Pillow between their legs for more support. Either way, filling the gap stops your knees from pulling your hips and back out of alignment.

Charlotte:
That makes sense, head-to-toe support.

Michael Angelo:
Exactly. It sounds like a lot, but really it’s just two pillows and a towel. Those little adjustments make a huge difference.

Importance Of Sleep Hygiene In The Day

Charlotte:
Some people think pain is just about the wrong sleeping position. What would you say to that?

Michael Angelo:
Pain is complicated. Sleep setup is one part, but daily habits matter too, stretching, posture, activity, hydration, nutrition.

Sleep is critical, but it’s only one piece of overall musculoskeletal health.

Charlotte:
If someone feels sore every time they roll in the night, what’s the first step you’d recommend?

Michael Angelo:
Do the 90-second bed audit. And if you’re already inflamed, learn to roll correctly. Instead of arching backward, roll in more of a crouched or fetal position. Bring your knee and shoulder forward together, almost like a crunch. That engages your core, braces your spine, and reduces pain.

Charlotte:
Crunch and roll. I like that! Any final advice?

Michael Angelo:
Know that you’re not alone. I hear about sleep pain every day. The key is small adjustments: a proper pillow, filling gaps, stretching, and moving with your core. You don’t need to spend hundreds of pounds or dollars, just set yourself up for success with the right support.

Charlotte:
That’s encouraging. Mike, where can people find you?

Michael Angelo:
My website is michaelangeloptw.com, and you can also find me on Instagram at @michaelangeloptw.

Charlotte:
Thanks so much, Mike, I’ve learned a lot, and I’m sure our listeners have too.