In the quest for a good night’s sleep, we often find ourselves inundated with advice on the best sleeping position. Whether it’s from a physiotherapist, chiropractor, or well-meaning friend, everyone seems to have an opinion. But amidst the conflicting recommendations, what’s the truth about the ideal sleeping position for preventing spinal problems or promoting overall health?
“Sleeping on your back is the best.” – This has been proven to be false, especially for people with sleep apnea. It also seems to make certain types of neck and lower back pain worse. However, according to the literature, this is a position in which more people seem to initiate sleep more easily. (1)
“Ideally sleep on your side with a pillow between your legs.” – Great for some people, horrible for others. Places more pressure on the shoulder complex and can exacerbate rib head irritations, as well. Might be helpful for people with gastroesophageal reflux. (1)
“Sleeping on your belly is horrible and will ruin your spine.” – Some studies show that prone sleeping can increase pressure on certain parts of the spine and exacerbate certain pains. It also requires you to lay with your head rotated to one side asymmetrically which, if this causes a bit of a stretch for you may create pain after being in that position long enough. I don’t often recommend people sleep in this position, but if this is the only position someone can sleep in I wouldn’t start messing with it. Anyway, according to research this seems like the least common position and becomes less common with age for whatever reason. Maybe due to a slow progressive loss of mobility. (1)
“You need an ergonomic pillow to maintain the curve in your neck.” – Spinal curves are not easy to change and not likely going to change much during sleep. The amount of pressure you would need to improve your spine curve during sleep would make it uncomfortable enough to prevent you from sleeping. On top of this, you’re going to move during the night. Opting for a low pillow that supports you from your shoulders up is just fine. If you like these pillows and they help you relax then great, but not everyone needs them and not everyone will find them comfortable. (1) (3)
Each of these recommendations seems to come with good intentions but lacks context so here is what you need to understand…
1. The ideal sleeping position for humans can vary depending on individual preferences, comfort, and specific health conditions or states. Someone with sleep apnea may benefit from a side-lying position while someone with shoulder pain may do better in a supine. Someone with sacroiliac pain may enjoy a pillow under their legs. Someone with low back pain may enjoy a half-side lying with a leg elevated position for part of the night. (3)
2. The average adult changes position around 15-30 times during an 8-hour night. No matter what position you start in you’re probably not staying there the whole night, rather you’ll be shifting around to different positions and making frequent minor changes in posture. If you’re in pain upon waking you may need to investigate what may be contributing to that issue while you’re awake. Often the things we feel upon waking were created the day before. Sitting all day at work, poor diet choices, and not exercising is a pretty good recipe for mobility problems and pain. Add in smoking alcohol or emotional stress and your chances go up. (3)
3. Interestingly, some research has reported that more people who were frequent side sleepers (lateral position), specifically on their right side, reported waking up less, less snoring, and more deep sleep. These people also moved during the night but spent more time in this position (1). Some might suggest that this could be the weight of the liver working on the stomach and the lungs when sleeping on the left side. Other research has reported that active seniors felt less pain while sleeping on their side with pillows between the legs and arms to prevent spinal torsion (2).
4. Pillows: The curves in your spine are not likely going to be significantly altered in the long term due to your sleeping position. Expensive ergonomic pillows with fancy curves in them may not be all that beneficial. Find a position that allows you to fall asleep comfortably and don’t worry too much about it. One caveat to this is sleeping with an asymmetrically tilted neck seems to be a factor for neck pain. Imagine sleeping on your side or back or front with your head raised by pillows to an uncomfortable height. No one sleeps like this, but if you do it may be why you wake up with pain, or might eventually. Make sure your pillow offers support all the way through the neck down to the shoulders. You want to be fully supported throughout the neck and head without the head being too far out of position compared to the neck. I recommend pillows that are supportive and can mold a bit to your head pressure but do not deform dramatically during the night. Down pillows seem to deform, and memory foam a bit less so. Use what works best for you.
5. Use your day to make sure you sleep comfortably: If you have poor mobility and abnormally high amounts of tension in your soft tissues then the chances of you waking up with more discomfort from spending the night in a slightly out of neutral position are higher. Try to get regular exercise in and add in a short mobility routine and stretching before bed and/or upon waking can be helpful.
6. Seeing your chiropractor regularly is a simple way to ensure better spine mobility significantly reduce inflammation and improve balance in the autonomic nervous system, creating more restful sleep.
Ultimately, the best sleeping position is one that allows for restful sleep without causing discomfort or exacerbating any existing health conditions. Experimenting with different positions and using pillows or mattress adjustments to support your comfort and alignment can help find the most suitable sleeping position for your individual needs.
And, in order to improve your body mobility, schedule an evaluation and further discuss this with our doctor by clicking here.
References:
1. Sudelska, K., Sawińska, Z., Tarsa, G., Kępka, P., Łokczewska-Bojar, A., Kuziemkowska, D., Kużma, J., Rhaiem, R., Skotalczyk, M., & Łącka-Majcher, A. (2023). Health significance of body position during sleep – literature review. Journal of Education, Health and Sport. https://doi.org/10.12775/jehs.2023.16.01.015.
2. Desouzart, G., Matos, R., Melo, F., & Filgueiras, E. (2015). Effects of sleeping position on back pain in physically active seniors: A controlled pilot study. Work, 53 2, 235-40. https://doi.org/10.3233/WOR-152243.
3. Oksenberg, A., & Gadoth, N. (2016). Breathe well, sleep well: avoid the supine and adopt the lateral posture. Sleep health, 2 2, 90-93. https://doi.org/10.1016/j.sleh.2016.02.001.
