What Sleep Positions are Best?

Getting a good nights rest is one of the best things you can do for your health. Aside from just feeling refreshed in the morning, a good night sleep helps lower your blood pressure, relax muscles, repair tissue damage, release hormones like growth hormone which is essential for muscle growth, boost your immune system, boost energy levels, can help you lose weight, help you look younger, and can even help you prevent Alzheimer’s disease by clearing out amyloid proteins from your brain while you sleep. The benefits just go on and on. But what happens if you aren’t getting a full 8 hours due to pain while you sleep? Maybe it’s time to take a look at your sleeping position which may be contributing to your lack of sleep.

Back Sleeping Position:

Anyone with a newborn has been told that “Back is Best” when it comes to sleeping position and this doesn’t really change much once we grow out of the newborn stage. Sleeping on your back has lots of benefits including keeping your head, neck, and spine all aligned in a neutral position, dispersing your weight so no one body part has excessive weight on it and can even help with acid reflux. However, based on my experience, I would say that at most 10% of people sleep on their back.

Cons: SNORING! Maybe it’s not so much a problem for you (although it can also contribute to sleep apnea), but your spouse hasn’t slept well for years now and you are about to get another elbow in the side and a gentle nudge to roll over on your side. CPAPs, mouth taping and surgery can help with this issue, but it none of those are an option for you, let’s move on to side sleeping.

Side Sleeping Position:

Benefits of side sleeping are similar to that of sleeping on your back. It is possible to keep your spine neutral, it is good for acid reflux (especially if you sleep on your left side) and it tends to lessen snoring. If you are pregnant, this is the ONLY option for you. But it also comes with some pitfalls.

Back in the 60’s, Avis car rental company came up with what some people think is one of the best marketing campaigns of all time:  “When you’re only No. 2, you try harder, or else.” Side sleepers can relate to that. If you can’t sleep on your back, sleeping on your side is second best… but you are going to have to try harder. Side sleepers CAN, and I emphasize the word can, still sleep with a mostly neutral spine but it is a lot more difficult to accomplish. Your pillow has to be just the right height so you head doesn’t dip down or get pushed up. If you aren’t supporting your top leg, it tends to either lay right on top of your bottom leg,  or, you position it out in front of the bottom leg a little which makes it rest on the mattress. This pulls the pelvis up and forward due to the weight of the top leg. With a rotated and uneven pelvis, this affects the rest of your spine also putting it into rotation and pulled forward and down. Now a little rotation in your spine isn’t bad… after all it is designed to move in multiple directions, but the length of time it is out of neutral is the issue. Try this, just sit in a chair and rotate you body to one side or the other while keeping your hips pointed forward. How long does it take to start feeling uncomfortable? After about a minute I’m ready to come back to neutral and give my back a rest. Now imagine staying in that position for 8 hours! No thanks.

Notice the pushed up head, curved spine and uneven hips when laying in side position without supporting the upper leg.

So if you are a side sleeper, you HAVE to support your upper leg, usually by placing a pillow in between your knees. This can keep your leg from pulling your pelvis and spine forward into rotation and help you maintain that neutral spine position. One other tip would be to try to keep your legs straight. Most people sleep in the fetal position with their knees and hips bent. Sleeping with straight legs is even more important if you have a desk job. We spend a TON of time in a seated position all day long sitting at our desks. Now, imagine you are sitting on a chair and the chair tips over to the side so you are now laying on your side. The position of sitting and sleeping in a fetal position are almost identical. This leads to chronically weak and tight hip flexor muscles which can contribute to back and hip pains. Straitening out you legs while you sleep helps elongate that hip flexors and counter acts the seated posture of the day.

Another downfall of side sleeping is increased pressure. When you sleep on your side you are lessening the contact area of your body on the mattress there by concentration the weight of your body on a smaller area. This causes ischemic pressure and impedes blood flow in that area which, in turn, leads to decreased healing in that area. If you are dealing with rotator cuff injuries, laying on the affected side will probably make your injury worse and increases the time it takes to heal due to the increased ischemic pressure. Many people who sleep on their side also sleep with the bottom arm up overhead (head resting on the arm). This places the shoulder in an even worse position. When doing a shoulder exam on patients, doctors will often do what is called Neer’s Test. It is an orthopedic exam designed to rule in/out shoulder impingement. In order for the test to work, the doctor raises the patient’s arm up overhead into full flexion. This test is designed to put the shoulder in a compromised position to test for impingement of tissues in the front of the shoulder. If the patient states that there is shoulder pain while performing the test, there is a good chance that there is impingement of tissues which causes pain when the arm raises up far enough to pinch the tissue between the arm bone and the clavicle. This repetitive injury of the tissue over time leads to fraying of tendons of the rotator cuff and can eventually lead to a total or partial tear of rotator cuff muscles.

Now looking at the picture below, doesn’t sleeping with your arm under your head look an awful lot like performing Neer’s Test? You are putting your shoulder in a compromised position (Neer’s Test) by flexing the shoulder, then making it worse by jamming the shoulder into the socket by placing more of your weight on it (by sleeping on your side), which also causes ischemic compression, decreased blood flow and decreased healing. It’s a lose, lose, lose situation for people with shoulder issues.

Side sleeping can also contribute to low back and hip pain by for people with gluteal tendinopathy. Gluteal tendon pain increases with positions, activities, and exercises that involve sustained or repetitive compressive loading—including sleeping. Side sleeping directly compresses the hip resulting in, you guessed it, ischemic pressure and reduced ability to heal.  Sleeping on the opposite side to avoid the ischemic pressure without a pillow under the knee will traction the IT band against the greater trochanter resulting in static compression which will also worsen your condition.

Stomach Sleeping:

Just… Don’t… Do… It!

Look at the picture below. You have all the same problems of side sleeping but amplified do to increased rotational stress on the body and now you are adding in rotation at the head/neck. This IS going to cause you all sorts of problems. Just don’t do it.

So to recap, Back is Best, Side Sleeping is second place but you have to work harder or else it will cause you issues. Stomach sleeping is a hard pass, a solid no, a just don’t do it activity.


Getting used to a new sleeping position can be difficult. Like any habit it is going to take some work to change your previous pattern of behavior. You may also find that you’ll fall asleep in one position and wake up in a totally different position. This isn’t that bad. I often tell patients that have desk jobs and also have standing desks that it is the variety of positions that is best. Standing all day is tiring and probably just as bad as sitting all day. Sleeping isn’t all that different. If you’re a side or stomach sleeper, focus on starting on your back. If you don’t stay there, that is ok, just keep at it and it will get easier as time goes on. Putting a small pillow under your knees while on your back can reduce low back pressure even more and help you stay in one position a little longer.

You can also try this method of falling asleep that is (supposedly) taught by the military to help soldiers fall asleep quickly in any condition. I tried it and have to say it works pretty good. Give it a shot: Military Trick to Fall Asleep Anywhere


Sleep Positions for 6 Common Conditions

Can Quality Sleep Help Prevent Alzheimer’s?

Pro’s And Con’s of Sleep Positions

What Happens When You Sleep?

Beauty Sleep

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Joshua Fritz, DC

Joshua Fritz, DC

Dr. Fritz is a licensed chiropractor in Milwaukee Wisconsin. He is certified in nutrition counseling, Graston Technique and Kinesiology Taping. He has been practicing since 2010.

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