The Rest of the Story
Why sleeping position matters
By Robert G. Silverman, DC
How do feel when you wake up in the morning? Refreshed, rested, and ready to go? Or stiff, achy, and wishing you could go back to sleep for another few hours? The difference may depend on your sleeping position.
Sleeping on your back
Most experts agree that sleeping on your back is the ideal position, but it’s not for everyone. When you sleep on your back, you stretch your body out evenly on the mattress. Your head, neck, and spine are aligned in a neutral position—there’s no extra stress on any part of your body. As a chiropractor, I recommend back sleeping, because it puts the least amount of pressure on the vertebrae and discs of the spine.
If you have trouble with acid reflux, lying on your back with your head elevated a bit by your pillow is a good way to keep acid from coming up. But sleeping on your back has one big drawback: snoring.
If you already snore, lying on your back makes it louder. This is the most likely position to trigger “Honey, roll over” from your bed partner. It’s also the worst position for sleep apnea, a sleep disorder that makes your breathing repeatedly stop and then start again, sometimes with a loud snorting or choking sound, usually because the throat muscles relax during sleep and block the trachea.
Sleep apnea is linked to heart disease and high blood pressure (among other problems), and can even be fatal. If you’re a heavy snorer, talk to your doctor about doing a sleep study to detect sleep apnea.
Sleeping on your side
The side position, with your torso straight and legs stretched, keeps your spine elongated and unstressed. If you tend to wake up with back and neck pain, try this position—after a few days, you’ll notice a positive change in how you feel in the morning. It’s also a good choice if you snore or have sleep apnea, because it helps keep your airway open.
If you have acid reflux, sleeping on your side keeps the acid from coming up. Sleeping on your left side works better for this, because in that position, the stomach is below the esophagus; gravity keeps the acid in the stomach where it belongs.
During pregnancy, many women find that sleeping on their side is the most comfortable position for breathing comfortably and relieving backache. If you can, sleep on your left side to increase the amount of blood that flows to the womb and nourishes the baby. For added comfort and support, put a pillow between your legs.
The fetal position
Curling up on your side, much as babies and small children do, is perhaps the ideal sleeping position. With your torso and legs bent, you’re putting as little stress as possible on your spine while you sleep. This is a great position for reducing snoring and preventing acid reflux.
The drawback is that it can be tough on the joints if you have arthritic hips or spinal stenosis—you might wake up feeling stiff and sore. Put a pillow between your knees to reduce the risk of lower back pain or stiffness.
If you regularly sleep on your side, your pillow matters. You want a pillow that will support your head in a neutral position and avoid putting stress on your neck. Side sleepers who wake up with neck pain or stiffness should take a good look at their pillow. Ideally, it will be firm enough to comfortably support the head and neck. Position yourself so only your head and neck—not your shoulders—are on the pillow.
Sleeping on your stomach
Ordinarily, you would be inclined to tell your patients to sleep in whatever position is most comfortable for them. There’s one exception, however: sleeping on your stomach. This position puts a lot of pressure on the back and neck. Because you have to turn your head to one side to breathe, you’re likely to wake up with stiff and sore neck and shoulder muscles; you might even wake with numbness and tingling in your arms. Sleeping on your stomach also puts a lot of pressure on the lumbar (lower) spine, so you could wake up with lower back pain.
Sleeping on your stomach also puts pressure on your digestive system, heart, and lungs. If you snore, you’ll snore more sleeping on your stomach. And if you have sleep apnea, it will be worse when you sleep on your stomach.
If you’re a stomach sleeper, I suggest trying to alter your sleeping habits and sleep on your side instead. To help you get used to the new position, lie on your side and put a pillow next to you near your abdomen. It will help keep you from rolling onto your stomach.
Choosing the right pillow
Your sleep position is crucial for waking up feeling great, but other factors come into play. Your pillow is critically important for supporting your head and keeping your head and neck aligned while you sleep. Choose a pillow that matches your favorite sleeping position.
Back sleepers usually do best with a medium-soft pillow that supports the natural curve of the neck. If you’re a snorer, elevating your head may lower the volume and help with sleep apnea. Try using two or three firm pillows or a wedge pillow to raise your head, neck, and shoulders.
Side sleepers should look for a firm or even extra-firm pillow that will keep your head and neck aligned. If you must sleep on your stomach, look for a thin soft pillow that won’t bend your neck out of its natural curve. For your patients with neck pain, recommend a cervical pillow.
Pillows are filled with all sorts of materials: latex, polyester, down, even buckwheat hulls. Many chiropractors feel the best choice of material by far is memory foam. The foam adapts to provide pressure-free support for the head and neck and helps keep the spine in alignment during sleep.
Nevertheless, good sleep position won’t make up for a bad mattress. Anecdotal reports from patients that suggest the ideal mattress is made of memory foam. A memory foam mattress contours to the spine’s natural curves and distributes body weight evenly. With no pressure points or sags, memory foam mattresses promote comfortable sleep through the night.
- Børge Sivertsen, Tea Lallukka, Keith J Petrie, Ólöf Anna Steingrímsdóttir, Audun Stubhaug, Christopher Sivert Nielsen. Sleep and pain sensitivity in adults. PAIN, 2015; 1.
- Arie Oksenberg, Ph.D., Elena Arons, Ph.D., Khitam Nasser, PSGT, Tatiana Vander, M.D., and Henryk Radwan, M.D. REM-related obstructive sleep apnea: the effect of body position. J Clin Sleep Med. 2010 Aug 15; 6(4): 343–348.
- R.M. Khoury, L. Camacho-Lobato, P.O. Katz, M.A. Mohiuddin, D.O. Castell. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol. 1999 Aug;94(8):2069-73.
- Jennifer N. Felder; Rebecca J. Baer; Larry Rand; Laura L. Jelliffe-Pawlowski; Aric A. Prather. Sleep disorder diagnosis during pregnancy and risk of preterm birth. Obstetrics & Gynecology. 130(3):573–581, 2017.
- R.A. Lavin, M. Pappagallo, K.V. Kuhlemeier. Cervical pain: a comparison of three pillows. Arch Phys Med Rehabil. 1997 Feb;78(2):193-8.
- A. Radwan, P. Fess, D. James, J. Murphy, J. Myers, M. Rooney, J. Taylor, A. Torii. Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials. Sleep Health. 2015 Dec;1(4):257-267.