Sleep Positions and Habits

By: Dr. Seth Hosmer, DC


As a chiropractic physician, I’m often asked by patients about the healthiest, and unhealthiest, sleep positions. Many people are curious to know how various sleep positions might affect the immediate and long-term health and function of their spine and the role of sleep position in causing or alleviating their aches and pains. If you commonly wake up feeling stiff and sore, your sleep position—or other sleep-related factors—may be contributing to your health complaints. Neck pain, low back pain, headaches, and muscle and joint problems may all be caused or worsened by an inappropriate sleep position. Though sleep position can be a difficult habit to change, most people can, over time, make the necessary changes to adopt favorable and healthful sleep positions.

Sleep Positions

The four principle sleep positions are back, side, fetal, and stomach. Though numerous variations on these four positions exist, and though you may change positions several times throughout the night, most people prefer one of these general positions.

1. Back: According to natural health expert Joseph Mercola, an osteopathic physician, sleeping on your back may be one of the most beneficial sleep positions, as it keeps your head, neck, and spine aligned, minimizes your acid reflux symptoms, and may prevent facial wrinkles. A greater likelihood of snoring may be one of the few drawbacks of sleeping on your back. For optimal structural health benefits, consider avoiding the use of a pillow when sleeping on your back. Some people may require a fluffy, yet thin pillow to support their head during sleep.

2. Side: Side sleeping may be helpful in preventing spine-related pain and minimizing the symptoms of acid reflux. Sleeping on your side may also help prevent snoring. Side sleeping helps keep your spine in a relatively neutral position, which may help reduce or prevent back and neck pain or discomfort. Nerve compression and muscle tightness in your shoulders and neck are two possible musculoskeletal problems associated with side sleeping. Side sleeping, especially sleeping on your left side, is the recommended sleeping position for pregnant women. Consider placing a pillow between your knees if you prefer a side sleeping position. This pillow can help reduce your low back pain as well as the strain on your sacroiliac ligaments and is particularly beneficial for pregnant women.

3. Fetal: Sleeping in fetal position is considered a less optimal sleep position, due to the prolonged periods in which your body and spine are tightly curled. Fetal position is disadvantageous for preventing neck and back pain, although it may be a helpful sleep posture in reducing your snoring. It is also an acceptable sleep position for pregnant women.

4. Stomach: Sleeping on your stomach is generally considered the worst possible sleep position, due to the way it alters the natural curve of your lumbar, or lower, spine. This sleep posture may also negatively affect your neck, place unnecessary stress on certain joints and muscles, and contribute to numbness, tingling, and pain in your extremities. Significantly reduced snoring is one of the few health advantages associated with sleeping on your stomach.

Bed Choice

Your bed is an important consideration for achieving optimal sleep quality and reducing your likelihood of sleep-related musculoskeletal problems. In most cases, mattresses that are supportive, yet comfortable may be most helpful in treating or preventing various back conditions, although personal preference is one of the most important considerations when selecting a mattress. Most people may benefit from a mattress that is firm enough to optimally distribute their weight and that supports the normal curves of their back. Consider devoting at least 15 to 20 minutes to each mattress you are interested in when mattress shopping.

Pillow Choice

The type of pillow you use can have profound effects on your sleep comfort and quality. Pillows that allow you to maintain a neutral neck position—and that provide you with enough cervical support to keep your face parallel to the ceiling—are optimal. If you prefer side sleeping, consider using a pillow that is thick enough to fill the entire gap between your neck and your mattress, as this will keep your head and neck in a neutral position and reduce the strain on your neck ligaments, muscles, and other connective tissues. Some pillows may be useful for both back and side sleepers, as they have a built-in depression, or notch, in the middle of the pillow for back sleepers and elevated side panels for side sleepers.

Sleep Hygiene

Poor sleep hygiene, or sleep habits, are common among Americans and can significantly affect your sleep quality. Helpful ways to improve your sleep hygiene, reports the University of Maryland Medical Center, include avoiding daytime naps, setting a regular bedtime and wake-up time, avoiding consumption of alcohol and caffeine 4 to 6 hours before you go to bed, establishing a pre-bedtime ritual, blocking out all loud noises from your bedroom, and setting a comfortable bedroom temperature.