Q: I often wake up with aches in my neck and back. How can I avoid this, and which sleep position is best for my health?
A: Try this simple change to optimise your sleep position: Add one more pillow.
But I don’t mean under your head. Place a pillow under your lower body.
Here’s what to do:
Side sleepers: Flex your legs slightly and put a pillow between them to help with back alignment. This also reduces pressure on the hips and knees. Then, place the arm that’s on the bedside on the opposite shoulder to ‘hug’ that arm. This position more fully supports the neck and back. A 2021 study published in PLoS One found that side sleeping without these extra postural supports was associated with worse neck pain in the morning.
Back sleepers: Place a pillow below the knees. This helps relax your back muscles, supporting its natural curve while you sleep.
Stomach sleepers: Put one pillow under your pelvis. This can reduce lower back strain by providing support in the area where the spine dips. Belly sleepers should also opt for a slim pillow - or no pillow at all - at the head to minimise neck strain, as well as help keep the airway open.
Consider raising the head of the bed 30 to 60 degrees with an extra pillow or two if you have sleep apnea, heart failure or are dealing with sinus congestion. The elevation helps that nasal fluid flow backward instead of forward through the nostrils.
Doing something new when we sleep can take some time to get used to, so don’t give up if one night feels weird. I’ve known many patients who are belly sleepers and lived for years with lower back pain, but they found the pain improved once they changed their sleep position.
Here’s what else to know about different sleep positions and your health:
Sleeping on your back
Worst for:
Obstructive sleep apnea: Obstructive sleep apnea affects almost 1 billion people worldwide - but it commonly goes undiagnosed. For many patients with obstructive sleep apnea, their symptoms are dependent on their position: It’s thought that sleeping on the back can cause the airway to close off. A 2015 randomised controlled trial found that stopping patients from sleeping on their backs improved the severity of their sleep apnea.
Best for:
Beauty sleep: People who sleep on their sides or stomachs may develop sleep wrinkles from compressing their faces into their pillows, or they may find they are more prone to breakouts, which may be mitigated when sleeping on your back (and washing your pillow cover often).
Babies: The American Academy of Pediatrics recommends infants sleep on their backs to reduce the risk of sleep-related deaths.
Chronic back, hip or knee pain: Back sleeping is one of the best positions to align the spine and distribute pressure evenly on your joints.
Sleeping on your side
Worst for:
Shoulder or hip pain: Those with certain shoulder or hip conditions may find the extra pressure uncomfortable, regardless of whether they sleep on the right or left side.
Best for:
Nighttime heartburn: Researchers have found less acid makes its way from the stomach to the esophagus among people who sleep on their left side as opposed to right side down or on their backs - probably because when we sleep on our right sides, the stomach becomes positioned above the esophagus, allowing contents to flow backward more easily. Remember, reflux symptoms can be a burning sensation in the chest - a classic ‘heartburn’ - but also can be inexplicable coughing that wakes you up at night. When in doubt, chat with your physician.
Obstructive sleep apnea: For people with obstructive sleep apnea, side sleeping is often advised because it’s been shown to minimise apnea events (when people temporarily stop breathing during sleep). If you’re worried about your own or your partner’s snoring - a common symptom of obstructive sleep apnea - it’s important to chat with a physician to ensure you’re not missing a diagnosis.
Sleeping on your belly
Worst for:
Back or neck pain: Sleeping on your stomach has been linked to an increase in back pain symptoms.
Best for:
Honestly, probably no-one: Sleeping on your stomach means you’re twisting your neck 90 degrees and putting pressure on your spine. If you’re committed to sleeping on your stomach and are otherwise healthy, try the pillow modifications to avoid further strain on your neck and back. While sleeping on your belly may be better than sleeping on your back for obstructive sleep apnea, you’d still be better off sleeping on your side because once you turn your neck, you risk partially blocking your airway.
What I want my patients to know
We need a good night’s rest to live healthy lives: Animal studies have found that the brain uses nighttime sleep to flush out toxins that accumulate during the day. Poor sleep is linked to weight gain, high blood pressure and, not surprisingly, worsened mental health.
To get the best seven hours (at minimum) you can, try these quick tips:
- Turn on your phone’s “nighttime” settings during evening hours
- Minimise blue light exposure with blackout curtains and warm lightbulbs
- Simply wearing an eye mask to bed has been shown to improve daytime memory and reaction time.
Trisha Pasricha is a physician and journalist who writes the Ask a Doctor column. She is an instructor of medicine at Harvard Medical School
- Washington Post
