According to many chiropractors, it’s acceptable to sleep on your front, back or side – as long as you practice good ‘sleep posture.’ Indeed, supporting the spine’s natural curve should be top of your agenda when you settle down to sleep.
Nonetheless, if you’re experiencing a particular health complaint, or you’re pregnant, certain sleep positions will serve you better than others. In this guide, we’ll explore which sleep position will work best for your needs – the front, the back or the side.
Also, we’ll show you how to support the spine in each of these sleeping positions so that you can develop a healthy ‘sleep posture.’
Sleeping Positions and Health Concerns
Approximately 60-70% of the population sleep on their side (lateral). The remainder sleep on their front (prone), or on their back (supine).
The position you sleep in can have an impact on the following factors:
- Breathing – sleep apnea and snoring
- Acid reflux and gastric health
- Muscle, joint and nerve pain
- Blood circulation
- Stress levels and psychological wellbeing
As such, modifying the pose you sleep in can alleviate the symptoms of certain medical conditions and positively impact your overall wellbeing.
When modifying your sleeping position, you don’t necessarily need to change the position entirely. Instead, you can make small adjustments to your posture, to mitigate the above symptoms. In this article, we’ll show you how to make these modifications.
How to Choose the Best Sleeping Position
When modifying your sleeping position, you’ll need to consider the following factors:
- Underlying Health Issues – As mentioned above, sleeping positions can aggravate or alleviate certain health conditions – so you’ll need to choose wisely when tackling your unique health concerns. Moreover, if you’re pregnant, you’ll need to take extra care when choosing a sleep position.
- Your Body Shape – Women with an hourglass figure are more susceptible to body pain if they sleep on their side without supporting the spine. Also, people who are overweight may find it challenging to sleep in certain positions without making certain adjustments.
- Current Sleep Posture – You’ll need to work with what you’re used to. Most people find it hard to change their sleeping position completely. Incorporating healthier habits into your current sleeping arrangement is usually a more realistic goal.
- Mattress and Pillows – If you have a very soft mattress, you’ll need to use more pillows to help support your spine. Think about the ‘tools’ you have to work with, and whether you’re willing to invest in an orthopedic pillow or specialist mattress to support your sleeping posture. Investing in additional items is not always necessary, sometimes you can use your existing pillows in different ways.
What Is the Midline Position?
Given that we spend so much time asleep, it makes sense to consider our ‘sleep posture.’ Our sleep posture can affect our waking posture and vice versa.
If we want to develop good orthopedic health, we need to look after our spine. When the spine is functioning correctly, it forms a natural ‘C’ curve or lordotic curve. The spine should be aligned with the neck in a ‘neutral’ position to respect the spine’s natural ‘C’ curve. Chiropractors call this the ‘midline position.’
The easiest way to achieve the midline position is to sleep on your side, with your neck adequately supported. You can also maintain the midline position when sleeping on your front or back – as long as you support your neck and back appropriately.
Let’s explore the three sleeping positions in a little more detail and demonstrate how to support the spine in each of these positions.
Sleeping on Your Front
Sleeping face-down in the prone position can provide comfort and relaxation for some people. Approximately 10 – 20% of the population sleep on their front. Out of the three sleeping positions, the prone position is the least favorable because it can place a strain on the neck and the upper back.
If you’re overweight, you should be particularly wary of sleeping on your front, as you’re more likely to place a strain on the neck. There are things you can do to mitigate the risk of neck strain.
If you sleep on your front, you’ll potentially place pressure on the following parts of the body:
- Acromion (the ends of the shoulders)
- Hip bones
- Chin and ears (depending on whether you put your head to the side)
If you tend to experience aches or pains in the above areas, this could be due to sleeping on your front.
Support the Spine
If you must sleep on your front, you should think about where you are placing your arms. Some people default to the ‘freefall’ position (both arms above the head), whereas others keep both arms close to their hips.
The best thing to do is sleep with one arm slightly above the head, and one arm close to your hip. The aim is to keep one shoulder slightly back and raise the other, so you’re making a very small quarter-turn in your shoulder. Placing a pillow under the stomach helps achieve this position.
If you follow these steps, your neck will be less likely to ‘lock’ during the night.
According to physiotherapists, if you sleep on your front, it’s critical to sleep on a medium or firm mattress. Sleeping on a very soft mattress can play havoc with the alignment of your spine.
As a temporary fix, you can try placing pillows under the pressure points on your body, though purchasing a firm mattress would be the better choice in the long-term.
Sleeping on Your Back
Approximately 10-20% of the population habitually sleep on their back. Sleeping in the supine position may be particularly suitable for people with certain types of back pain. However, as we’ll explore, this position is not suitable for women in the late stages of pregnancy, or specific other groups of people.
It’s essential to support the neck when you’re in supine position, as this will help to respect the spine’s lordotic curve.
- Scapula (shoulder blades)
- Sacrum (bone in the lower back)
People who sleep on their back with no pillow can sometimes put pressure on the sacrum, causing a dull ache in the lower back.
Support the Spine
To keep the backbone and neck in alignment, make sure the height of your pillows is correct. The neck should not feel strained but should not drop down into the mattress either. Some people find sleeping on a memory foam pillow helps keep their neck and back aligned because these pillows are quite firm and less likely to move around in the night.
If you don’t want to purchase a memory foam or orthopedic pillow, you can try this inexpensive trick at home:
- Roll up a large towel and place it inside your pillowcase, so that it lines up with the long edge of your pillow.
- Place the pillow on your bed so that the edge with the rolled-up towel is facing towards the foot of the bed.
- Relax your head on the pillow; this should provide adequate neck support.
If you habitually sleep in the supine position, you may develop lower back pain. To protect the lower back, place a pillow underneath your knees. This will help to maintain the ‘C’ curvature of the spine.
People with flu or digestive issues are sometimes advised to sleep on their back but prop themselves up at night. If you want to sleep propped-up, it’s essential to support the spine. A little later in this article, we’ll discuss how you can achieve this safely.
Sleeping on Your Side
More than half of the population sleep on their side (lateral position). Side-sleeping mimics the fetal position; arguably, it’s the most ‘natural’ of all the sleeping positions. It’s often easier to keep the spine in neutral when sleeping on your side.
- Trochanter (a protruding bone in the thigh area)
- Malleolus (bony protrusions at the ankles)
It’s not unusual for the ends of the shoulders (acromion) to become sore when sleeping on our side, particularly if we are not well-supported by our pillows.
Support the Spine
As mentioned, the natural structure of the spine is a very shallow ‘C’ curve. Try not to bring your head too close to your knees (especially for long periods) as this could over-stretch the spine. Choose pillows that are reasonably firm, and make sure they are high enough, to prevent this issue.
To encourage the midline position, it’s a good idea to place a pillow between your knees. This is a good tip for anyone trying to ‘transition’ to sleeping on their side, as it will remind them to stay in this position.
Finally, if you have an hourglass figure, place a pillow under your waist to fill in the gap between your waist and the mattress. This will support your waist and middle-back and take any pressure off the ribs.
Mattress and Pillows
If your mattress is too firm, it may cause pain to the ribs, hips or ankle bones. At the same time, a mattress that is too soft could cause asymmetry in the spine or cause the shoulders to dip too much. So, if you’re a side-sleeper, a medium or medium-firm mattress will be the best option.
As long as you don’t curl too tightly into the fetal position, the neck is generally well supported in the side-sleeping position. This means that orthopedic or specialist pillows are not usually required. Nonetheless, if you find yourself waking up with a stiff neck, you could try sleeping on a memory foam pillow to see if this makes a difference.
There is some debate over whether sleeping on the left or right-hand side is better for health. There is a very small body of research which suggests that sleeping on your left side is preferable to sleeping on your right. Read on to see which health conditions might benefit from left-side sleeping.
Which Sleeping Position Is Best During Pregnancy?
Recent research suggests that sleeping on the back (supine) during the late stages of pregnancy can negatively impact the health of the baby. Indeed, this research led to a public health campaign in the UK called the Sleep on the Side Campaign. The American Pregnancy Association also recommend SOS (sleeping on the side) during the third trimester of pregnancy.
Researchers predict that side-sleeping is healthier for the mother and baby because, when the mother lays on her back, the weight of the baby puts pressure on the body vessels, restricting oxygen supply to the baby.
Other research has also shown that sleeping in the supine position may cause breathing irregularities. If the mother’s breathing is altered during sleep, this could significantly impact the baby’s health.
Also, sleeping on the back may cause the mother to develop hemorrhoids, backache, and poor digestion.
Left Side or Right Side?
Research from the Sleep on the Side Campaign does not specify that sleeping on the left is any better than sleeping on the right. However, a small study from the British Medical Journal found that sleeping on the left side was preferable for preventing still-births.
This could be due to the anatomy of the uterus. It seems more pressure may be placed on the blood vessels (aorta and vena cava) when the woman lies on her right side.
There is currently little evidence to say for sure whether left-side sleeping is better, though there seems to be good evidence to suggest that side-sleeping is preferable to sleeping on your back.
How to Sleep Better on Your Side
According to the Sleep on the Side campaign, pregnant women in their third trimester should spend all ‘sleep’ time on their side – whether they are napping, settling down for the night or having a lie-in.
If you’re used to sleeping on your back, getting used to side-sleeping can be a challenge. These tips may be helpful:
- If you have long hair, tie it in a low bun/ponytail. This can help remind you not to roll onto your back, as it will feel less comfortable to sleep in this position.
- Alternatively, place some pillows behind you (stacked 2 or 3 high) so you’ll be discouraged from sleeping on your back.
- If you have a television in your bedroom, make sure the TV is positioned in such a way that you can comfortably rest on your side to watch it.
- If you wake up on your back, or on your front, don’t worry; alter your position back to side-sleeping.
- Ask a family member to remind you to sleep on your side.
Best Sleeping Position to Prevent Snoring
Snoring can be extremely disruptive for those around you. Thankfully, changing the position you sleep in can make a lot of difference.
Snoring is most often caused by an obstruction of the airways (nasal passage or throat). Sleeping on your back (supine) can obstruct the airways – especially if you do not take adequate steps to support the neck and throat passage.
For example, when we sleep flat on our back, the tongue tends to collapse into the throat, partially obstructing air flow. Also, if we are suffering from a blocked nose (or sinusitis), sleeping flat on our back encourages the sinuses to stay blocked, leading to snoring.
How to Prevent Snoring
Propping yourself up should prevent the tongue from collapsing in the mouth and promote sinus drainage – thereby clearing your airways. Later in this article, we’ll explore ways to prop yourself up safely at night.
Also, studies have shown that sleeping on your side (with the neck supported) can help unblock the airways and prevent snoring.
You can also make life easier for your partner with earplugs for people who snore loudly.
Does Sleep Position Affect Sleep Apnea?
A study in the Journal of Sleep found that men with sleep apnea had fewer periods of irregular breathing when they slept on their side (compared to their back). Let’s explore why sleeping on the back could make breathing more difficult for people with sleep apnea.
The risk factors for developing obstructive sleep apnea include:
- Being overweight
- High blood pressure and smoking
- Having a larger than average neck, or deformity in the throat, neck or chin
These factors are possibly aggravated by sleeping on the back.
Being overweight, having high blood pressure, and smoking too much can all lead to poor blood circulation. Studies have also shown that, when we sleep on our back (as opposed to our side), blood circulation is less efficient. So, if people with sleep apnea regularly sleep on their back, they could be aggravating their poor circulation.
People with a large or irregular neck or a receding chin (retrognathia) are more likely to develop sleep apnea.
When we sleep on our back, a pressure is placed on our shoulder blades, and the neck tends to collapse in towards the shoulders. In turn, this can block the airways and lead to obstructive sleep apnea.
How to Sleep Better with Sleep Apna
You should try your best to sleep on your side. If you’re used to sleeping on your back, changing your sleep position can be very difficult. Consider the following tips:
- Purchase a body pillow. This is a long pillow you ‘hug’ at night, making side-sleeping more comfortable.
- If you find your skin is rubbing together, wear thin, breathable pajamas to make yourself more comfortable.
- Ask a family member to remind you to sleep on your side.
In cases where side-sleeping is not working, some people opt for Mandibular advancement therapy. This therapy involves using mouth guards to open the airways manually.
How to Sleep Better During Menstruation
The best sleeping position for alleviating menstrual cramps is the fetal position. This is because the closer the legs are to the chest; the more pressure is taken of your mid-section. Remember, it’s essential to support the neck when you sleep in the fetal position.
Sleeping on your front is not recommended as this will place a lot of pressure on the pelvic bones, perhaps leading to more pain. If you do sleep on your front, remember to raise one shoulder to prevent neck pain setting in.
- Just before your period arrives, estrogen and progesterone level drops, making you feel sweatier at night. As such, use comfortable, light bedding and keep a glass of water at your bedside.
- Calorie intake raises by as much as 500 calories during menstruation. Don’t eat too close to bedtime as this may disturb sleep.
- Some women get migraines during their period. Soft pillows are the best choice for alleviating migraines and headaches.
Sleep Positions After Surgery
When recovering from a surgical procedure, the body pain usually worsens at night. Depending on where the pain is located, it can be challenging to maintain your regular sleeping position.
Being faced with a new sleep position is irritating and could contribute towards post-surgery insomnia. For this reason, it’s important to use all the tools at your disposal (i.e., pillows, painkillers, chiropractic devices) to find a sleep position that’s manageable.
How to Sleep After a Hysterectomy
As mentioned, over half the population prefer to sleep on their side. After a hysterectomy operation, sleeping on the side becomes very difficult. Sleeping on the front also becomes difficult because the abdominal and pelvic area will be extremely sore.
Some women do their best to sleep on their back, or they find ways to adapt to side-sleeping positions to make them more manageable. For example:
- Try rolling a towel and placing it between your legs, and then roll into a semi-fetal position. This should take some pressure off the pelvic muscles and bones.
- Alternatively, try a body pillow. Hugging a long pillow can make side sleeping a lot more bearable.
- If you do sleep on your back, try placing a soft pillow under your back to ease neck and back pain.
Sleeping After Foot Surgery
Foot and ankle surgery is a relatively common procedure. Sleep may be disturbed for weeks or months after surgery. For at least one week after surgery, it will be beneficial to raise your leg, to promote blood circulation and healing. Your doctor may recommend a ‘leg wedge’ you can place at the end of your bed to elevate your legs.
Trouble Sleeping After a Hip Replacement
Hip replacement surgery is an invasive procedure that can disturb sleep for 1-2 months. However, studies have shown that, once patients have recovered, sleep improves significantly.
During the recovery period, it probably won’t be comfortable to sleep on your side. Some physicians recommend waiting at least three weeks before even attempting side-sleeping, though this could vary according to the type of operation.
Instead of sleeping on a bed, some people find it more comfortable to sleep in a reclining chair. When/if you start to sleep on the side after recovery, be sure to place a pillow between your knees for support.
Sleeping Better with Neck Pain
Most of us experience neck pain at some point in our lives. To prevent neck strains, we should try our best to respect the neck’s curvature during sleep.
What is Neck Lordosis?
Neck lordosis – or cervical lordosis – refers to the natural curvature of the neck. The curve of the neck is important for strength and flexibility. If the curve becomes straightened, aches and pains will develop in the neck. Moreover, orthopedic problems are likely to occur elsewhere in the body.
What Causes a Loss of Neck Lordosis?
Many different factors can cause the neck to become unnaturally ‘straightened.’ These include:
- Road traffic accidents (whiplash)
- Always looking down (i.e., at a phone or computer)
- Poor posture (perhaps caused by a heavy bag)
- Sleeping on your front (and not lifting one arm/shoulder to protect the neck)
- Sleeping on your back/side without supporting the neck
Which Sleep Position Helps Neck Pain?
Sleeping on the back or the side is best for neck pain, but only if the necks ‘C’ curve is supported.
According to a study on Science Direct, the most effective way to support the neck is by sleeping with a cervical pillow. According to this particular study, rubber pillows were the most effective at alleviating neck pain. Rubber pillows are similar to memory foam pillows but are slightly softer.
Cervical pillows can be prescribed by your chiropractor or bought directly. If you have neck pain, it’s a good idea to use a portable version of these pillows when you’re traveling to alleviate pain.
How to Sleep with a Trapped Nerve
Sleeping with a trapped nerve can be extremely painful. Improving your posture can help relieve a trapped nerve (this includes your ‘sleeping posture’). So, modifying your sleeping position could speed up your recovery.
Sleeping with Sciatic Pain
Sciatic pain starts from the base of your spine and shoots down the backs of your legs towards your feet.
- To ease the pain in your legs, place a pillow under each of your knees. This should keep your body in the midline position.
- If you can’t avoid sleeping on your front, it may be useful to place a pillow under the tops of your thighs – for pain relief.
- Some people find sleeping on their side is easier – though If you tend to swap sides regularly throughout the night, this is likely to flare-up sciatica.
Sleeping with Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is caused by a painful trapped nerve in the ankle. Paying attention to the positioning of your feet could help alleviate nerve pain.
According to a study published by Sage Journals, pain from tarsal tunnel syndrome is worst when the foot is everted or inverted. Inversion is when the foot points inwards, and eversion is when it points outwards.
To prevent pain, and encourage healing, you should sleep in a position that keeps the foot in a neutral position. To do this, avoid sleeping with heavy bedding or multiple layers of bedding that could become tangled.
Also, place a pillow under your feet to remind you to keep your feet pointing straight upwards. You could also consider purchasing a compression brace to keep the feet in a neutral position.
Gastric Reflux Sleep Positions
We know that modifying our diet can significantly improve gastric reflux and heartburn, but can sleep positions make a difference?
According to a review on Jama Network, sleeping on your back, flat to the bed, can encourage gastric reflux, because the contents of the stomach can easily ‘reflux’ into the esophagus. Researchers found patients who slept in elevated positions had fewer gastric symptoms.
Also, the researchers found that sleeping on the left side seemed to improve the symptoms of gastric reflux. Sleeping on the right-hand side did not have the same effect. When we sleep on our right side, it appears the lower esophagus comes in closer contact with the stomach – facilitating acid reflux.
So, if you’ve eaten too much dinner and you’re struggling to digest your food, dozing off on your left, or sleeping at an incline, could be helpful. Sleeping at an incline can cause its own set of back-aching problems so let’s learn how to do it properly.
How to Prop Yourself Up Safely in Bed
Generally speaking, you should avoid piling thin or soft pillows on top of each other as they won’t provide much support and will probably slip down in the night. This could make your acid reflux or neck pain a whole lot worse.
Instead, consider these options
- Sleep on a memory foam wedge – These can be prescribed by your chiropractor or bought directly from many stores. The memory foam is firm enough to keep you elevated throughout the whole night, but also molds to your shape, offering comfortable support.
- Purchase an adjustable bed – These can be adjusted according to your changing requirements.
- Insert an adjustable bed riser to the top part of your bed – This is an inexpensive way to raise the bed.
- Sleep in a recliner chair – If you need to sleep in the elevated position for a couple of nights only (i.e., when recovering from an operation), this could be a good option.
All of these options will provide support to your neck and your back.
Stress and Sleep Positions
The link between stress and poor sleep is well known. Stress can cause our muscles to seize up, leading to poor posture. Perhaps this is why we find it so difficult to get a good night’s sleep when we are stressed.
Sleeping on your back, or on your front (in the ‘freefall’ position) will give you the greatest opportunity to relax. However, as discussed, it’s important to support your neck and spine in these positions.
If you are sleeping on your side in a fetal position, ensure you’re not tensing your shoulders or legs too much as this could lead to muscle cramping or orthopedic complaints.
Try to make sure your muscles are completely relaxed before going to bed. This will allow you to get into a comfortable sleeping position. To relax the muscles, try:
- Gentle Exercise (but not too close to bedtime)
- Massage – using your hands, or a foam roller
- A hot bath
How to Get Out of Bed Safely
When you wake up in the morning, you should avoid standing up too quickly, as this could lead to injury. The discs in your back are very hydrated in the morning. The more fluid in your discs, the more susceptible you are to stiffness. Follow these steps to get out of bed safely:
- After waking, roll on to your side
- Bend your knees and lower your legs slowly on to the floor
- Use your hands to hold on to the bed
- Stand up slowly
This should stop any back pain from developing.
What Is the Best Sleep Position for Me?
To conclude, it seems that sleeping on the side is the healthiest sleep position for most people. If you’re pregnant or suffering from sleep apnea, side-sleeping should be top of your agenda.
If you’re a habitual back-sleeper or front-sleeper, you don’t necessarily need to change your ways, though you should slightly adjust these positions to make them healthier for your spine.
Indeed, whichever way you like to sleep, make sure you keep your body in the midline position to enjoy long-term orthopedic health.