Even with the fast paced lifestyle that we all lead, we spend a decent amount of time sleeping.  As a chiropractor, I frequently get asked what the best position for sleeping is.  The quick answer I usually give is, “Not on your stomach.”  The longer answer is a little more complicated than just a simple, side or back.  Much of the decision will lie with your specific anatomy or conditions you may be dealing with.  For example, someone with scoliosis may be best sleeping on a specific side or if you have sleep apnea and sleep with a mask, you may need to sleep on your back.  With these individualities in mind, here’s a little general guidance.

Back Sleeping

When sleeping on your back, you want to take care of your neck and low back.  Typically, I recommend a neck specific pillow (called a cervical pillow) that has a supportive curved surface to match the ideal curve in your neck (called a lordosis).  My favorite is from a company called “Therapeutica.”  They’re a little pricey, but worth it since they can properly support both back and side sleeping.  If budget is of concern, take a bath towel, roll it up tight to about a four-inch thick roll, throw some duct tape around it, and voilà, you have a great neck support.  As for your legs, I highly suggest that you elevate your knees.  This unloads the joints in your lower back (facets) and tends to reduce motion during sleep. Even if you are suffering with a disc injury, this is a good idea, because although you are decreasing the lumbar curve by elevating the knees, you also are non weight bearing at the injured disc, so the end result is typically a decreased pressure inside the disc, reducing symptoms.

Who should absolutely sleep on their backs?

• Shoulder Patients
• Treated Sleep Apnea Patients (C-PAP/Bi-PAP)
• Neck Patients (especially with forward head posture)

Side Sleeping

For many people, side sleeping is the most comfortable.  However, I see more incorrect side sleeping positions than back sleeping ones.  The biggest problems, again, deal with positioning of the head or the lower extremities.  There are a few more rules here.  First, in regard to the head, we want to try to align our nose and lips with our spine.  Again, your pillow is paramount.  Here, we are looking to bridge the distance between the bed and our head with the pillow.  This is a variable distance based primarily on your shoulder with, and secondarily on the firmness of your bed and your pillow.  Here is another reason why I am a fan of the “Therapeutica” pillow.  It comes in different sizes for different shoulder widths.  It is also moderately firm, although comfortable.  I find this to be ideal, as if a pillow, or a bed for that matter, is too soft, it will lose height with the weight of your head and body, and not provide enough support for the spine.  A final word on head position for side sleepers.  Be cautious to not have your neck overly flexed forward.  Many folks get cold at night and want to curl up into a fetal position.  Unless you want to end up like the old lady or man that you see slumped over their shopping cart in the grocery store, the overly flexed spine isn’t the way to sleep.  A good guideline is to keep your earlobe, your shoulder and your hip joint all in a straight line.  Even though gravity isn’t working in a compressive fashion on the spine, a flexed position during sleep will stress the joints and muscles nonetheless.

The obvious goal of aligning the head and spine is to keep the joints of the spine neutral.  The not so obvious goal is to protect your shoulder.  If the head is not aligned with the spine, your shoulder will invariably shrug (or worse, go under your head to provide that support) and compress the acromioclavicular joint to the front and cause inflammation and eventually impingement syndrome.  (See my past article about shoulders here.)  I explain to people that the arm should be slightly in front of your body, and I typically tell people to hug a pillow.  Head to Wal-Mart and buy a $10 body pillow and hug it with your arms, put the bottom part between your knees.  (We’ll get to the why on the “between the knees” in a second.)  This places not only your shoulder on the down side in a better spot, but also the top side.  If the top arm dangles across the body and lies on the bed, it also compresses the acromioclavicular joint.  Additionally, it tractions the nerves of the brachial plexus, stretches the posterior shoulder capsule (leading to forward shoulder posture) and potentially compresses blood vessels in the armpit, affecting distal circulation.  Watch those arms when you’re a side sleeper!

Getting to the lower half for side sleeping, let me explain why I recommend using a body pillow between your knees. To do this, let’s review the anatomy.  Your pelvis is basically made up of three bones.  The sacrum in the middle and the two major bones on each side, each called an ilium (plural ilia).  Your leg bones (femurs) then connect to the ilia at the hip joint. (P.S., The hip is a joint, not a bone!)  In pretty much every person, the space between the hip joints is greater than the distance between the knees if you lay flat on one side.  Say you lay on your left.  Your left femur will lay flat along the bed.  Your right hip joint will be forced to go out of a neutral position to lay the bottom part of the right femur next to the bottom part of the left femur.  In other words, your knees touch and it causes stress on the hip joint.  This is a leading cause of “trochanteric bursitis,” a common source of pain on the outer upper part of the thigh.  The pillow allows the hips, knees and ankles to be more neutral.  I know some folks will lay one leg in front of the other.  This is even worse, as it causes rotation and flexion of the lower spine and pelvis. Not a good thing.  If this is you, you would need a much bigger pillow under the front knee to keep your spine in alignment.

Who should absolutely sleep on their sides?

• Pregnant Patients
• Scoliosis Patients (on side of concave curve of spine)
• Untreated Sleep Apnea Patients

Stomach Sleeping

A quick word on stomach sleeping: Don’t do it.  Your neck and low back will be in a horrible position, and I promise, you will quickly be reaching for Phoenix KinetiCream (shameless plug) or calling your local chiropractor.  It also increases wrinkles and if you’re a woman, squishes your chest decreasing firmness and increasing sagging.

I hope this gives you all some better quality sleep!  Please share this article via Facebook or Twitter and help out your friends and family as well.  They’ll be in a much  better mood!

-Dr. Craig