Which Sleep Position Is Best?

A very common question I ask my patients when determining the root of their neck or back pain is: WHAT POSITION DO YOU SLEEP IN?” This is a very important question as we spend approximately 8 hours of our day in this position… now multiply that by every single day you’ve been alive, and that’s a lot of hours! This is why your sleep position can both CAUSE neck and back issues, as well as contribute to the quickness (or lack thereof) of your recovery.

Most people will say “but I can’t control what position I’m in while I sleep”, which is in large part very true, however upon falling asleep and each time you wake during the night, my recommendation is: ensure you START in the desired/recommended sleep position and upon waking throughout the night, reposition back to the ideal position again. This will help you spend less time aggravating your problem and more time making it feel better.

So what’s the best sleep position?
If this was a multiple choice question, the short answer would 100% be ON YOUR BACK. Keep in mind, there are some reasons you may find other positions comfortable as well.

BACK

BACK IS BEST(especially with a pillow or rolled towel under your knee) as this keeps your body in the utmost neutral position, therefore not adding any additional stresses to your discs or joints, and not putting your muscles in constant stretch or compressed positions. But it doesn’t end there, your pillow height is very key. Your pillow should be placed right above your shoulders to keep your neck in NEUTRAL. Your specific pillow height and firmness depends on how big your frame and shoulders are. If you have large shoulders and are heavier set, you will need a larger and firmer pillow; alternatively if you have a tiny frame, you’ll require a thinner pillow. Pillows should be firm enough to hold you in the desired position throughout the night, not allowing your head to sink or move into other positions. Putting a pillow or rolled up towel under the knees is also ideal to keep neutral. The size of your “backside”/buttocks also will play a role, and patients with a larger backside will find that a larger-sized pillow under the knee better for encouraging better neutral posture. 

STOMACH

Sleeping on your stomach is the worst positionto sleep in, mostly for the sake of your neck. When sleeping on your stomach you must choose a side to crank your neck to… and then you keep it there all night. It horrifies me to think about. Imagine walking around all day with someone pressing on your head and jamming it as far to one side as you could possibly turn for 8 hours straight…. and then repeat that every single day! People often don’t realize what a crazy idea this is, but when you put it like this it sounds pretty silly, doesn’t it? Stomach sleepers are also compromising the neutral spine in their back, and it is especially stressful on the joints of the back.

SIDE

Sleeping on your side, when the pillow is in perfect position with extra thickness and firmness (again based on body frame) is “okay” but not the best. It is mostly worse for your shoulders, even if your neck position is perfect (which I can guarantee it will not be). It is also bad for our large, stabilizing sacroiliac joints which are located at the base of your back. The joint that is on the upside will have additional stress as it will be angled for the duration of your sleep. If you DO happen to sleep on your side, be sure to put a firm pillow in between your knees so that your legs stay shoulder width apart. Changing which side you sleep on every night can help make this position a little more doable if side-sleeping is your go-to.

A NEUTRAL SPINE IS ALWAYS BEST!

Here are some (temporary) exceptions I often recommend while dealing with a flare-up:

  1. Patients with joint problems in their back (ie. Pain with arching backwards, or osteoarthritis in their lumbar spine) will find side-sleeping (“fetal position”) comfortable and this is encouraged while healing; as well as lying on your back with a pillow under the knees. DO NOT SLEEP ON YOUR STOMACH.
  2. Patients with disc problems in the back (ie. pain with bending forward) are encouraged to basically sleep however they feel comfortable. Neutral spine can be achieved by lying on your back with a thin pillow under the knees. These patients will find lying on their stomach helpful temporarily and also recommended intermittently. This should be done in increments throughout the day as usually these patients find it hard to get up from a lying position. Sleeping the whole night on the stomach is still usually not a good idea, even in these cases.
  3. Patients with joint problems in the neck (ie. Those having trouble checking their blind spot or bending their neck to the side) will find having a thick pillow helpful until the problem resolves. They may also find it helpful to sleep on the opposite side of their neck issue.
  4. Patients with disc problems in the neck will find sleeping with their head very straight (thin pillow) or perhaps even without a pillow is ideal of them (until resolved).

Remember, every patient is different, and every issue is different, so these recommendations are meant to be kept relatively generic. It is always best to consult with your chiropractor for advice specific to your pain.

About Dr. Daniela DiPaola

Dr. Daniela DiPaola graduated from the Canadian Memorial Chiropractic College, prior to which she received an Honours Bachelor of Kinesiology Degree from McMaster University. She has completed her certification in Contemporary Medical Acupuncture, with continued education in Functional Integrated Needling courses. Dr. DiPaola is a full-body Certified Active Release Technique® (ART) Provider. She also has her Personal Training Certification. Dr. DiPaola utilizes a number of techniques including: Acupuncture, chiropractic joint manipulation, ART®, Class IV Laser Therapy, Shockwave Therapy and Kinesio-Taping techniques. Her treatment goal is to improve biomechanical and musculoskeletal dysfunction in order for her patients to return to activity and optimal function as quickly as possible.

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