Sleep position can dramatically change your posture and your health.
“What position should I sleep in?” It is one of the most common questions I receive in the office. It is a natural question, after all. Many back problems cause people to stay up late, wake up too early, or wake up stiff and sore. Since the pain is interfering with our sleep, it is a natural assumption that we can somehow twist and contort, untwisting and re-aligning ourselves like a Rubik’s cube to somehow reach a position that gives us sleep-nirvana. It is then our assumption that when we reach this magical pose, we shall remain there all night, and awake refreshed and new.
Is it the mattress?
When we wake in pain it is a natural assumption that your mattress is a problem. It could be. If it is very old, you have a problem falling asleep because it is uncomfortable, or if it is sagging, then you may definitely need a new mattress.
If your mattress is reasonably comfortable and not sagging, but you are waking up in pain, the issue is not the mattress, you have a back problem. In other words, you should be able to sleep on any reasonably comfortable surface
What Pillow Should I Use?
Now that we have cleared that up, we can move on to the pillow. My second favourite pillow is a Therapeutica pillow. The Therapeutica has a central section that supports the neck while sleeping on your back. What makes it different is a wedge that comes down between your shoulder blades. This allows your shoulders to come back, reversing the forward rolling that occurs when we slouch during the day.
But, that’s only my second-favourite pillow. My favourite pillow is no pillow at all. When you lie on your back with no pillow, it allows your head to come back into a straight-up posture.
But Gary, I sleep on 2 pillows!
If you sleep on your back and use two pillows, I have some bad news. If you have trouble lying flat on your back and need pillows under your head, you are likely developing postural deformation in your neck. This deformity where the head is too far forward, is called anterior head carriage. Lying on your back with multiple pillows is like being in bad posture all night long.
When you sleep with multiple pillows and on your back, it is common to wake up with arms that are numb, headaches and a sore neck.
Should I sleep on my stomach?
We professionals spent decades telling patients to sleep on their back or side. If you sleep flat on your stomach, your head will be turned so you can breathe. This would theoretically put too much stress on the neck, it would wrinkle your face, and you would drool everywhere.
The truth is that when people sleep on their stomach, they don’t just lie face down, they tend to bend one leg and place a hand under their shoulder. This means that the neck rotation is only about 40 degrees. Not only is this good to maintain rotation, but it is good because by sleeping on your stomach, it brings the head out of that anterior head carriage, and it improves your posture.
Should I throw out my pillow?
You can take your pillow and place it under one of your shoulders. This brings the shoulder a couple of inches back so your head does not need to rotate so far. This also creates a space for your chest so your shoulders will come a little farther back and improve your posture.
What about my lower back?
The most common problem with the lower back is a loss of the lumbar curve. Our overly-sitting culture tends to create a rounding of the lower back. If you sleep on your side, the lower back will tend to stay rounded. The hip flexors will remain shortened all night long.
If you sleep on your stomach, one leg will usually remain straight. This allows that hip flexor to lengthen. Having one leg bent allows the lower back to extend, bending backward, and allows the muscles of the lower back called the paraspinals, to relax.
This is all a surprise to most people. For decades, experts have said to sleep on your back or side or suffer extreme consequences. This may be true if your head is on a pillow. By ditching the pillow and practicing 3 sleeping positions you can have better posture and reduced pain in the morning. The niche thing about being a scientist is that things keep changing and improving. They used to tell us not to put water on burns.
1: On your back. Use no pillow. If your low back is sore you can put a pillow under your knees, and put another one under your lower back, just not under your head.
2: On your stomach turned to the left. Put a pillow under your left shoulder and wrap your left arm around the pillow. Put your right arm down by your right side, (not above the head). If you put your right arm above the head, it will rotate the rotator cuff all the way, and that could become a problem by morning.
3. On your stomach turned to the right. Put a pillow under the right shoulder, wrap your right arm around the pillow, and left arm down by your side.