If you ask your friends what they think is the best sleeping position, most will probably answer that it's on one side, and, in fact, that's the trend for most adults. But is it the healthiest?
While sufficient and restful sleep is crucial to our health, quality of life and longevity, not enough research has been done to accurately support all the ingredients involved in this physiological need we have as a species.
To begin with, you may not even know what position you sleep in, perhaps you are aware of the position in which you usually fall asleep and wake up in, but not throughout the night. Studies in Denmark and Norway using different technologies found that, in general, adults spent slightly more than half the time on their sides, about 38% of the time on their backs and 7% on their stomachs. And the older people were, the more time they spent on their sides.
The tendency to sleep on the side seems to develop only in adulthood, with children over the age of three spending on average the same amount of time sleeping on their sides, backs, and stomachs.
Babies, on the other hand, sleep mostly on their backs, because they are placed in the cot this way for safety reasons.
What is the best sleeping posture?
According to the Sleep Foundation, the best sleeping posture is one that promotes natural spinal curvature, i.e. keeping the spine aligned from the hips to the head. For you personally, it depends on your state of health and where you feel comfortable.
However, there are some positions that are considered "healthier" than others. Sleeping on your back or side is considered more favourable than sleeping on your stomach. It seems that either of these two positions facilitates spinal alignment, balance, and support. This relieves any pressure on the spine and allows the muscles to relax and you get a restful sleep.
To dig deeper, it turns out that certain sleeping postures have specific benefits that you may find helpful if you suffer from back pain or another condition. Perhaps trying a new posture will provide relief and better sleep quality as indicated by a study where a group of adults with back pain were taught to sleep on their backs or sides, resulting in significant pain relief in just four weeks.
The 8 Most Common Sleeping Positions and How They Affect your Health
- On your back with your arms at your sides. Considered the best posture for head, spine, and neck, as long as you don't use too many pillows. However, people who tend to sleep on their backs are more likely to snore and suffer from sleep apnoea compared to those who sleep in other positions.
- On your back with your arms up. Known as the "starfish" posture, it is considered good for the back and additionally prevents facial wrinkles and skin rashes. However, like the face-up position, but with arms at the sides, it can cause snoring and reflux (heartburn) problems for people with these propensities. In addition, having the arms up can induce unnecessary pressure on the nerves in the shoulders that can eventually lead to pain and discomfort.
- On your stomach. Sleeping on your stomach may help improve digestion, however, it is mandatory to turn and perhaps put too much pressure on the neck by turning your face to release the airway. With this position the curvature of the spine loses support and neck, and back pain can occur.
- Foetal position. Sleeping in the foetal position, in a curled-up position, with the knees to the chest and the chin down, may be comfortable at times, but it puts too much strain on the neck and back.
- Side-lying position with arms at the sides. Undeniably, the spine maintains better alignment and its natural curvature when sleeping in this position. Among the advantages of sleeping on your side are that it reduces back and neck pain, as well as the propensity to sleep apnoea. However, the downside is for those who want to avoid premature facial wrinkles and sagging breasts, due to the force of gravity imposed by the posture and the pressure of one side of the face against the pillow.
- Side-lying position with arms extended. This position shares many of the advantages of sleeping with arms extended downwards. However, sleeping on the side can cause discomfort in the shoulders and arms due to restricted blood flow and pressure on the nerves, which can be aggravated by having the arms extended forward.
- Sleeping on the right side. Yes, the side you sleep on makes a difference too. If you suffer from reflux or heartburn, this posture can worsen the condition, whereas sleeping on the left side can relieve pressure on some internal organs such as the liver, lungs, and stomach, thus tending to reduce the symptoms of heartburn. Sleeping on the left side is generally recommended for pregnant women as it improves the baby's blood circulation.
- Sleep with a pillow for support. Some of these positions can improve spinal support by adding a pillow. Chances are you will rest better and wake up pain-free. For back sleepers, a small pillow can be placed under the arch of the spine. Side sleepers can benefit from placing a pillow between the knees, while stomach sleepers can place a pillow under the hips to support the joints.
Possible Disadvantages of Sleeping in Certain Positions
On the back:
Sleeping on the back is not recommended for pregnant women; people who snore or have sleep apnoea; people with some types of back pain; people with acid reflux; heavy adults; and older adults.
The Sleep Foundation emphasises that "more than half of all people have position-dependent sleep apnoea, meaning that the severity of their symptoms increases when they are lying on their backs. Especially as we get older or gain weight, it becomes more difficult to breathe while lying on our backs, due to the pressure of gravity on the body." (article)
Also, while some people feel relief from sleeping on their backs, others feel increased pain in their backs. If this is the case, it can be solved by placing a thin pillow under the lumbar area of your back or under your knees as well. Either way, the effect will be to remove pressure while supporting the natural curvature of the back.
On the stomach:
Not recommended for pregnant women, people with neck or back pain and people concerned about wrinkles.
Of all sleeping positions, the face-down position is the least supportive for the back and increases pressure on the spine, sometimes causing pain on waking. If your mattress is not firm enough, the stomach and hips sag, misaligning the spine and eventually causing back pain. Also, sleeping on your stomach will contribute to facial wrinkles as your face is pressed against the pillow or the surface of the mattress.
Sleeping on one side or the other:
According to the Sleep Foundation, side sleeping is not recommended for people with shoulder pain or concerned about wrinkles.
Sleeping on your side can cause pain or tension in your shoulders, or at the very least, change your position from time to time and make sure you use the right pillow and mattress.
Sleeping on your side can also contribute to facial wrinkles. According to studies by the National Centre for Biotechnology Information, facial wrinkles occur either when sleeping on the stomach or on the side, as the face is pressed against the pillow, stretching, and compressing the skin.
In an article published in the Aesthetic Surgery Journal, a group of plastic surgeons suggest that the face should be forced as little as possible while sleeping, which excludes the possibility of sleeping on the stomach. And if preserving your skin is more important to you than sleeping better or dealing with pain or reflux, sleeping on your side is not ideal either.
So, what is the ideal sleeping position?
In principle, sleeping on your side seems to have several advantages, but the position you adopt can influence neck and back pain, and the side you sleep on can increase or reduce acid reflux. Snoring increases if you sleep on your back, but we all vary, so the latter may still be the way you sleep best.
However, if you have never had a problem with waking up with pain in any part of your body and you feel you are getting a good night's sleep every night, you may be sleeping in the position that best suits your health and should not bother to change it.
Can Your Mattress and Pillow Make a Difference When it Comes to Sleep Quality?
Here, too, it depends on your habits and preferences. The Sleep Foundation suggests that your mattress should be flexible enough to "give", allowing your shoulders and hips to sink deeper than the middle of your spine and thus not compromise the natural curvature of the spine.
I, for one, prefer the firmest mattress I can get as it gives the perfect support to my torso, which allows me to sleep very well (I consider myself a combined, but mainly, back sleeper). However, once again, it is a matter of taste, habits, and possible physical conditions that each person may suffer from.
Just like the mattress, the pillow you choose influences the comfort and quality of your sleep.
Just as some mattresses are better for back sleepers, so are some pillows. Not all back sleepers prefer pillows that suit side, stomach, and combination sleepers.
As for the pillow, if you have already made the decision to try sleeping on your back, you need one of those pillows that provides adequate neck support.
Generally, back sleepers would need a pillow with a higher loft than pillows for stomach sleepers and a lower loft than pillows for side sleepers. The ideal pillow for back sleepers should encourage spinal alignment rather than arching the neck too far upwards or allowing the head to sink too low.
In this position, choose pillows of medium height and not too soft, otherwise the nape of the neck will turn backwards, and you risk neck pain.
Which pillow with natural filling is best for sleeping on your back? Choose a pillow that is not too bulky: a large pillow is not for you. A pillow for sleeping on your back should be no more than 9 cm thick.
If you prefer to sleep on your side, the pillow should support your head and neck so that your cervical vertebrae are aligned with your spine. In addition, the pillow should be high enough for your shoulders to rest comfortably.
The loft, or thickness, is arguably the most important factor about side sleeping. Most side sleepers need pillows of medium to high thickness (10cm - 15cm) that cushion the head and neck without sinking in too much. If your thickness preferences vary from night to night, you may be a good candidate for a pillow with adjustable loft levels.
People who sleep on their stomachs often complain of back pain and neck tension, as they are forced to turn their heads and necks to breathe freely. Especially since the spine is hardly supported in this position.
A firm mattress and a low pillow can help to keep the spine aligned. A pillow under the hips can also help. In addition, stomach sleepers should avoid turning their head to one side. According to the Sleep Foundation, a pillow with a height of 7.5 cm - 12 cm is recommended to provide support for stomach sleepers, but this will depend on other factors such as head size and personal preference. The pillow loft should support the head and neck, keeping them at a comfortable angle.
Ultimately, the best sleeping position is the one that allows you to enjoy a restful, undisturbed night's sleep and wake up in the morning feeling refreshed, energised, and free from aches and pains. If that is your current position, don't feel obliged to change it. However, if you think a new posture might make you sleep more comfortably, go ahead and try another posture. In any case, remember to be patient, use the above-mentioned strategies to adapt to the new posture and use the above-mentioned supports to maintain it for as long as possible during the hours of sleep.
Happy dreams!