What Is The Best Sleeping Position?


Follow me on the story of a patient and her search for the best sleeping position. Cheryl is a stay-at-home mom. Most days she’s busy driving the kids to and from school, sports, and after school activities. Recently Cheryl and her husband had sold their house. She had been busy packing up the house and carrying heavy boxes to the front living room. All the extra lifting of heavy boxes on top of her already busy schedule caused her a bout of back pain. 

At first, the back pain was mild. Feeling stiff when she first woke up, she would start her daily routine and by the time she had all the kids dropped off at school she would have loosened up. During the day her pain wasn’t bad, but the pain started to bother her more and more while she was sleeping. Feeling good through most of the day, she kept thinking it would resolve itself and simply go away. Unfortunately, nights continued to get worst.

Lack of sleep

At her moms’ group, she had a friend tell her she was probably sleeping in the wrong position and that was causing her pain. Having been told it was the best position to sleep in, Cheryl’s friend suggested that’s how she should be sleeping to rid her pain. Taking her friend’s advice she slept on her back. Cheryl slept even less after that and the pain worsened. 

Hitting her wit’s end Cheryl finally had a neighbor refer her to us. Poor Cheryl walked into our office very stiff. She had become so tired it was visible. She seemed defeated after reluctantly asking a neighbor to help with drop off and pickups. 

Cheryl gave her history saying her pain was manageable at first, but not sleeping started wearing her down. She explained that after hearing the best sleeping position was on your back, she started sleeping that way in an attempt to help her pain. Cheryl then looked at me and asked if that truly was the best sleeping position and if it wasn’t, what was? 

We get this question numerous times a week. People have been conditioned to think there is a “best” position to sleep. Or to that point a “worst” position. “Don’t sleep on your side because it twists your spine.” “Only sleep on your right side so you don’t compress your heart.” “Sleeping on your back deoxygenates your blood from the weight of your chest on your lungs.” We’ve all heard some version of these and there are many more. 

Unfortunately, as we noted in previous articles, there isn’t a “best” or “one-size-fits-all” to just about anything. There isn’t a “best” low back exercise. Nor a “best” sitting position. Not even a “best” restaurant; well, there is, Chipotle, but that’s beside the point. We’re all different and we all need different things and different times.  

Cant sleep

My response to Cheryl’s and other patients’ always catches people off guard when they ask that question. I tell them I don’t care what position they sleep in as long as they sleep. Getting a good night’s rest is far more important than sleeping in one specific position. Sure there might be modifications to avoid your pain while you sleep, but it is very hard to sleep in a position that you are familiar with or you can’t get comfortable with.

If I tell someone to sleep exclusively on their back because it is the best alignment of the spine, but they have never been able to sleep on their back, they won’t be able to sleep at all. At that point, their pain will likely worsen like Cheryl’s. Cheryl tried sleeping in a position she wasn’t used to and she lost even more sleep as a result. The increased restlessness and lack of sleep increased the inflammation she was experiencing and therefore worsened her condition. Sleep is the time for the body to repair itself and rest. I don’t care if you sleep standing on your head as long as you sleep through the night. We’ll take care of things during the day. 

Once we started treating Cheryl things improved quickly and she got some much-needed rest. She has her new house unpacked and is back to carting the kids all over town and the rest of her busy schedule. 

As Cheryl and I were wrapping things up, she rephrased the question. She asked, “now that I’m out of pain if I can adjust to it, what’s the best position to sleep in to make sure this doesn’t happen again?” I shared with her that there have been recent studies to see what position people sleep in the most. It turns out it’s all of them. We change the sleeping position about every 1.5 hrs. We spend a little over half our time on our sides. Then less on our backs and even less on our stomachs. The positions we sleep in changes as we get older, but we still change positions multiple times throughout the night. 

So a general rule is if you are having pain for more than a couple of days or your pain is keeping you up at night, schedule an appointment with us. This way we can minimize your sleep loss before the sleep loss makes the pain worse. The second rule is don’t worry about the position you’ve had to come up with to fall asleep or stay asleep. Remember, most of the time sleeping through the night is far more important than what position you sleep. 

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Tom Cotter, DC, DACRB