Best Sleeping Positions

Best Sleeping Positions

latspnlcrvsMany patients ask what position is the best to sleep in for their particular problem. This often also leads to discussion on which are the best pillows and which are the best mattresses. Lets begin by looking at the body’s natural curves- because the best position is usually one that supports these curves appropriately. On the drawing to the right it can be seen that there are three main curves in the spine when looked at from the side. The neck (cervical spine) and low back (lumbar spine) curve backwards and are called lordoses, while the mid back (thoracic spine) curves forward. Click on the links for a review on common postural distortions and scoliosis.


Sleeping in a position that supports these curves and maintains a neutral position would be ideal, however the condition and type of mattress you sleep on as well as the type of pillow you use will also influence this. Lets look at each position in turn.

Sleeping on your back

When you sleep on your back the main aim is to have your head in a position such that your ears are in line with your shoulders. Many people have a neck posture that causes their head to be forward thus reducing the neck curve and exposing the neck to greater risk if strain and degeneration. Sleeping on the back minimises this strain and allows the head to lie back onto the mattress restoring the curve in the neck. A pillow that has a curve to support this neck lordosis can also help, but be sure not to have one that is so thick that it props your head up too much otherwise the curve will not be properly supported.


pllwslpThis position can, however cause strain in the low back in people who have arthritis in their back (spondyloarthritis, disc degeneration) because the tension in supporting muscles such as the psoas muscle can make this curve deeper when lying on the back. A solution is to put a pillow behind the knees allowing them to bend a little, which will allow some tension in the back to slacken and give relief in this sleeping position. Be warned however that this will allow the muscle to contract over the long term and make this problem more obvious. It is important to make sure you have a good stretch routine before bed and upon waking to keep the supporting muscles in good condition. Some good stretches for chronic back problems can be found in our exercise section on chronic back pain. It should also be pointed out that the mid back curve becomes somewhat compressed when sleeping on the back, so if you suffer from a hunch or arthritis in the mid back it can also be very difficult to sleep on your back. It was thought for many years that a firm mattress is better than a soft one, however this does not appear to be case anymore, with improved materials and production quality meaning that personal comfort is a more important variable. A general idea is to not change the softness of the mattress or the design of your pillow too radically if you suffer from arthritis because the change in position can lead to aggravation of your condition.


A further consideration is the respiratory and visceral effects of sleeping on your back, where a shift in jaw and soft palate position can lead to airway obstruction and be a factor in snoring and sleep apnoea. Pregnant women and obese people generally also can find it difficult to sleep on their back, due to the pressure of their abdomen on the vena cava and aorta causing circulation problems and discomfort. Patients with acid reflex and other gastric or oesophagus problems such as hiatus hernia may also find back sleeping difficult unless propped up by several pillows. So while sleeping on your back has been a recommendation by the medical world for years, studies are now beginning to show that it is not the optimal sleeping position.



Sleeping on your side

Side sleeping is meant to keep the spine straight and neutral, in order to reduce strain on spinal muscles. There is a lot of evidence emerging in the research literature that suggests side sleeping benefits include better airway function, reduced risk of sleep apnoea, better quality of sleep (brainwave activity) and better brain circulation. When the spine is straight on its side, it also minimises strain on spinal nerves and is thought to reduce symptoms of tingling and numbness in people with nerve root compression. Anthropological studies also show side sleeping to be most common in tribal hunter gatherer societies. Interestingly, many of these groups did not use pillows or other head supports when sleeping on their side, which one might expect to be necessary to properly support the head. While it is often recommended to avoid sleeping on multiple pillows or no pillows because of the risk of neck strain, the best practice is one that feels comfortable. Similarly, side sleepers also sometimes complain of shoulder strain either due to compression of the one below or chill on the one above. Sleeping on the side also causes some stress to the hip and pelvis on the upper side, such as iliotibial band syndrome, which can be alleviated by placing a pillow between the knees. The jaw or TMJ can also become strained lying on your side, particularly if you put your hand or fist under your chin.


slpspnePeople with liver disease often find sleeping on the right side more comfortable because it reduces gravitational strain on the liver, as do people with stomach problems and hiatus hernia who also find lying on the right side reduces reflux of acid into the oesophagus. A soft mattress may allow the shoulders to sink into the mattress somewhat more, relieving the strain on frozen shoulder, bursitis or rotator cuff tears, as would people with hip arthritis, trochanteric bursitis or capsular tears. So while it may seem logical that lying on the side on a firm mattress would provide for a neutral and supported spine, side sleeping also has its potential limitations.



Sleeping on your stomach

Stomach sleeping has always been criticised as being the most detrimental- particularly for neck pain sufferers and low back pain sufferers. The twist in the neck that results from lying3psnslp face down certainly may upset the neck joints and irritate symptoms of pins and needles, tingling and numbness in the hands, which the low back often ends up being arched and feeling jammed upon waking. Usually, this position also causes either or both arms to be raised above the head which can lead to shoulder strain and circulation problems into the hands. Like side sleeping, stomach sleeping can also upset or strain the jaw or TMJ so be aware of any pressure being placed on your chin. It would seem strange that a person would want to sleep in such a strained position, however anthropologists and psychologists have suggested that there may be an emotional comfort that is gained by sleep in this position, which causes the vulnerable abdomen and chest to be pressed into the mattress – in a sense to be supported and protected. Think of a new born infant or toddler who is cuddled or nursed by their mother at the breast or comforted through a hug when upset. Hugs feel good, and sleeping on the stomach may psychologically be a type of “hug” that gives comfort to the sleeper in spite of the strain on their neck and back.


Nevertheless, this position can be modified to minimise strain on the neck and back, in what the ancient Chinese called the “crouching tiger” position. This is where a pillow is placed under the shoulder and thigh of the side the head is turned towards, which elevates them and untwists the spine, making it essentially neutral. A body pillow can be a useful addition to your normal pillow in this case. If you are a stomach sleeper by preference yet suffer from strain as a result, try propping yourself in the manner described above.




Each sleeping position would appear to have some pros and cons. Listen to the advice of your health care provider, but in the end sleep in the position and choose a pillow and mattress that make you feel comfortable.





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