“I think I slept on it funny...” Sleep Positioning: What’s Best? Depends
There are the 16 or so hours we spend awake, relatively aware of our body and how it’s positioned in the field of gravity. We know when a posture becomes uncomfortable and we can make conscious choices to adjust. But sleep, well, that’s a different experience. Of course, it’s hard to make good decisions about our posture when we’re sleeping. But increasingly I’ve both reflected on my own habits and had conversations with clients about the initial sleep position they choose and find most comfortable, positions they roll into over the course of a night, and how that positioning affects our tissues. “I think I slept on it funny” is a statement worth investigating.
When I wake up and realize my neck and right shoulder are unhappy, I’ll occasionally run down the possible reasons. “Did I do something yesterday or the day prior to cause it? Don’t think so. Hmm, is my pillow supportive enough? Is sleeping on the same side night after night messing with my neck?” Then while giving a massage, I’ll notice that some clients have a particular side of their neck or shoulder where there are more prominent knots and lesser mobility. Some folks come right in and say “the left side of my neck is all out of sorts, I think I slept on it funny”. And so after the session we debrief. We go over daily activities such as repetitive movements, work demands, or past injuries, etc. And then I’ll ask, “You mentioned sleep, do you sleep on that side every night?” And so we have the sleep conversation. With some, the sleep positioning talk doesn’t quite add up and we move on, but with others it’s a realization that’s quite helpful. Which made me want to look further into sleeping posture, find out what’s best, and share so that you have the knowledge to make informed sleep choices. So, let’s talk about sleep.
Of course, there are only so many ways we can sleep. On either side, on our stomach, and on our back. Pretty straightforward. In a moment I’ll rank these positions from “best to worst”, but it’s important to say that certain health conditions compel us to sleep in certain positions, and so you do what you must. Moreover, I wish for you not to fret if this “ranking” stresses you out as a stomach sleeper, for example. We can do plenty of movements during the day to offset sleep postures which might tighten us up. Plus, if you’re getting a good night’s sleep and not waking up with aches and pains, there’s no need to switch up what you’re doing. Within these positions there are adjustments we can make to improve upon that posture, and I know that many of us change positions throughout the night, so maybe we’re only in a compromised position for a little while. Of course, every body’s sleep, and every night’s sleep, is different. So, excuse these rankings which might feel like blanket statements, and I’ll share the nuances + indications of the various positions. Okay, sorry stomach sleepers. Ranking time!
On our back
On either side
On our stomach
Stomach Sleeping
It seems like it’s going to be so comfy… but I find my mind tricks me. To sleep on our stomach requires our neck to turn essentially 90 degrees one direction from anatomical position. Which means one side is getting a serious stretch, and one side is getting a shortening. But if we hold this position night after night, with our neck turned the same way, we will most definitely cause an overstretch on one side as well as intense tightness and likely pinching on the other side due to the muscles being in a shortened position for so long. Imagine if you held this position for 8 hours a day as you went about your business; I bet your neck would be pretty unhappy. Importantly, this can be worsened by a pillow, because we’ve now added some extension to that overstretch (imagine the neck lifted by the pillow) on one side and an intensified pinching + pressure on the other. This leads to a “crook” in the neck, that achy tightness which most definitely will restrict neck mobility, cause pain (in my experience), and put undue pressure on the spine plus cause misalignment. And that spinal alignment we’re concerned with isn’t just in your cervical spine (neck), but the lumbar or low back region too. Why? Because lying on your stomach will likely cause your lumbar spine to subtly contract as your belly and hips sink into the mattress. This lumbar curvature and pressure will likely bother the back, and while this sleep posture is rarely a ‘cause’ of hyperlordosis, this position could play into it or exacerbate it. Regardless, that lumbar pressure does add up and a laundry list of issues can arise.
While I as a massage therapist wouldn’t recommend stomach sleeping, some folks do sleep best this way, and a good night’s sleep is vital to our health. So if you prefer to sleep on your belly, go no pillow and do your best to change which side of your neck you lay on. You might also consider a particularly firm mattress or place a thin pillow below the hips to better align your spine.
Side Sleeping
Side sleepers unite! I’m admittedly a side sleeper a good portion of the time. And I’ll also admit that my right shoulder and side of my neck aren’t always happy about it; the right side is my preferred side. Without proper support from a pillow, it’s highly likely that the neck and shoulder crunch in toward each other, which shortens and tightens a whole slew of lateral neck and shoulder muscles. Moreover, many folks will raise the arm they’re sleeping on and place it under the ear, possibly to gain further support. But with that raised arm position, over time we can experience pain with particular movements in the shoulder. This is often the result of impinging (pinching) the tendon of supraspinatus in particular, night after night, causing inflammation.
So what can we do to alleviate it? Two primary things stick out. One, a supportive pillow which maintains the L shape of the intersection of our neck and shoulder for proper cervical spine alignment, and two, avoiding the lifted arm under the ear. I’ll add that a pillow between the knees helps to keep the hips even instead of collapsing forward or backward, which would take the hips out of alignment. If you’re someone who rises with neck or shoulder pain and you sleep on your side, consider if your pillow is supportive enough, changing the side you sleep on, or moving onto your back.
I should mention though, there are a good deal of pros to side sleeping. First, it’s the best position for pregnant people. And snoring and sleep apnea symptoms are lessened since your airway is consistently open compared to back and stomach sleeping. Plus, side sleeping often alleviates back pain associated with stomach and back positions. Sleeping on the left side is considered the best side to sleep on for our organs and for reducing acid reflux, whereas lying on the right can increase pressure on our internal organs. So, analyze that pillow support, grab a thin one for your knees, and flip flop to balance it all out.
Back Sleeping
Often considered the “safest” sleep position, sleeping on our back comes with its benefits, so long as the conditions are right. Back sleeping prevents neck or shoulder pain caused by stomach and side sleeping since our cervical spinal alignment is usually in good position. That said, if you do have upper back pain, it may be due to a pillow which is too thick or possibly too thin, aka not providing the right neck support for you. So play around with pillow thickness and firmness if needed. Also, I find back sleeping most comfortable with a pillow beneath my knees, which takes pressure off the low back. I also enjoy a pillow or weighted sandbag on my chest or hips to reinforce the position and keep me from rolling onto my side too often. So, test an array of pillow arrangements for your head, knees and maybe even your core.
If you are waking up with back pain as a back sleeper, you may need a firmer mattress. Our low back can get upset if there’s a space between our low back and mattress, which is why a pillow below the knees is nice. Of course, back sleeping isn’t right for everyone. If you’re someone who snores or has sleep apnea, sleeping on the back can collapse the airway and increase those symptoms. We encourage you to do what's best for you!
Final Thoughts
Real quick, there’s another way to improve sleep. Give yourself 5-10 minutes of restorative movement before bed. Gentle stretches on the floor, spinal rotations, hip openers, shoulder rolls, whatever you like along with some deep breathing can really do the trick. Both of us at Homebody know that when we give ourselves some floor time before bed, we sleep better. Moreover, when we provide ourselves time in the morning to move around and shake off a night’s sleep, we move through our day more gracefully.
While the “best” sleep position depends on each of us as individuals, I hope this rundown of positions and the little tricks to improve each position provides you with insights and ideas to better your sleep. Our sleep is so important to our overall health and functioning, so if you sleep well and wake up refreshed without aches, then keep doing your thing. If that isn’t you though, test out these different positions and check in with your body both when rising and throughout the day. Our mission here is to support your wellbeing and deepen your attunement with your body.
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