You made your bed, now lie in it: the best sleeping positions


By: Patrick Smith 2016 Orthopaedic Resident at Quarles Court Center

American adults sleep an average of 6.8 hours per night, according to a 2013 Gallup poll. But are they getting a good night’s rest?

best sleep positionsPhysical therapists often are asked what the best sleeping position is. This is a great question, as musculoskeletal conditions involving the cervical (neck), thoracic (midback) and lumbar (low back); hips; shoulders; and knees can be exacerbated by abnormal stresses to the body while you’re snoozing.

Sleeping positions often are habitual and chosen based on comfort. Although there are variations, these are the most common positions and how they can be modified to the benefit of your body.

On your side

The best sleeping position is side-lying in order to maintain the natural curve of the spine and hips. A moderate-sized pillow under the base of the neck will support the head, and one between the knees will maintain proper hip position. A pillow or towel roll may be placed under the waist for additional comfort, and the knees may be slightly bent under for balance.

For pregnant women, sleeping on the left side is widely viewed as favorable as it improves circulation to the heart. A pillow may be placed under the belly bump for support. A pillow may be placed under the belly bump for support, and a moderate-sized pillow can be positioned between the knees to maintain hip neutrality.

On your stomach

If you are prone to sleeping on your stomach, do not use a pillow under your neck but rather a small pillow under your chest to reduce hyperextension of the cervical spine. A pillow placed under the hips can reduce excessive lumbar lordosis (inward curve of lower back). This position is not recommended because of the prolonged strain it places on the cervical and upper thoracic spines.

On your back

If you sleep on your back, a pillow or rolled up towel should be placed under the knees to decrease stress on the low back. A towel roll may also be placed under the low back to maintain lumbar lordosis. This position is not ideal because of its contribution to sleep apnea and potential difficulty breathing even though neutrality of the spine and hips is typically preserved during the night.

If you have any questions, your physical therapist will be happy to assess your preferred position and suggest potential changes.


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