What’s The Best Sleeping Position? (And Why Sleep Position and Sleep Posture Matter)

Are you a back sleeper, or a stomach sleeper? Do you sleep on your side? Believe it or not, your sleep position is a very important part of getting a good night’s sleep. Your sleep position can have a significant effect on your sleep posture— and both can impact your overall sleep quality.

Good posture doesn’t just make a difference during the day. We spend a third of our lives in bed, but most of us never learned how to achieve the optimal posture for sleep. Improper sleep posture can create a lot of problems for your body, and you may not even realize that your sleep is the cause. Thankfully, you can improve your sleep posture by sleeping in the correct position.

Before I talk about what the best sleeping position is, let’s take a closer look at what sleep posture is, and why it’s so important to your sleep health.

What is Sleep Posture?

Let me begin by saying that sleep posture is not the same as sleep position. The right sleep position is an essential part of healthy sleep posture— but it isn’t the whole story.

Think of it this way— how you carry yourself while you are awake is a key factor for how you get through the day, and how you feel at the end of the day. If your daytime posture is good— back straight, shoulders back, sitting comfortably in a supportive chair, et cetera— then you will likely feel good throughout the day. However, if your posture is bad, you will likely feel stiff, sore, or even in pain as the day is ending.

Sleep posture requires the same components: the right sleep position, great sleep equipment, and mindful attention to your body’s natural alignment from head to toe. Poor sleep posture also exacerbates those waking aches and pains in the hips, back, shoulders and neck, and can create new problems with pain and stiffness throughout the body, particularly at the joints and at certain pressure points.

How Does Healthy Sleep Posture Look and Feel?

Good sleep posture has your body relaxed and in alignment, and alignment starts with the position of your spine. When lying down for sleep, your spine should follow its natural curves.

There are 3 different curves in the spine— at the neck, the middle back, and the lower back. For these curves to fall naturally during sleep, the whole body must be supported. A strong sleep posture allows these natural curves to be maintained throughout the night. That means no crunching at your neck, no sagging of your lower back, and no rotation of your middle back. In addition to your spine in its natural position, good sleep posture has your hips, shoulders, and head lining up.

Is Your Body in Alignment?

Think for a moment about good posture. Your head is held above your shoulders— not pushed back or craned forward— and your shoulders sit over your hips— not dipped forward or pushed behind. With the muscles of your core engaged, your spine follows its 3 natural curves.

The same basic posture applies to sleep. But there are some key differences:

• When we are awake, the muscles and ligaments of our body are working actively to hold our posture, whether we’re still or in motion. During sleep, the muscles and the ligaments relax. That relaxation is essential for the healing and rejuvenation of those tissues.
• Our posture is more static— or stationary— during sleep than during most waking activities. We maintain static posture during the waking day, too— sitting in a chair, standing at a kitchen counter, et cetera. But at no point during the 24-hour day does our posture remain static for longer than it does during sleep.

This is why support is so important for holding the body in relaxed alignment throughout the night. Let’s take a look at what this should look like.

First, put yourself in a healthy upright posture as a way to get in touch with the feeling of your body in alignment. Stand up straight with your feet shoulder-width apart, then follow these steps:

• Distribute your weight between the balls and heels of your feet. For most people, that means shifting some weight forward to the balls of the feet— a lot of people sit back on their heels. Relax your toes, and center your hips over your knees.
• Relax your shoulders. Let them drop away from your neck. Center the tops of your shoulders over your hips, and let your arms fall naturally to the sides.
• Level your head and look straight ahead— it can be helpful to think about a string pulling up from the back of your head at the base.

Feel relaxed, strong, and centered? No clenching, craning, compression or tightness? That’s a body in alignment. No matter the sleep position you choose, this basic alignment— and the feeling that comes with it— is what you’re shooting for in your sleep posture.

One of the best ways to maintain this relaxed alignment and help support a healthy sleep posture is to sleep on the right mattress.

Sleep Posture and Your Mattress

A supportive mattress is essential for healthy sleep posture. Different people need different types of support— and each of us may need different kinds of support throughout our lives. That’s why there are so many different options for mattresses.

For good sleep posture, you need a mattress to provide your body with sufficient support to bring your spine into alignment and allow your muscles to relax during sleep. The key is to find the right degree of support without sacrificing comfort. Let’s talk briefly about comfort and support, because they aren’t the same and people often get them confused.

The Right Support

A mattress provides support by pushing against the body, allowing the spine to relax and fall into alignment. Not every individual needs the same level of support to allow the spine and body to relax and align. And at different points in life, each of us may need a different degree of support from our mattress. This can be due to changes in our strength, muscles, and even the density of our bones!

You want a mattress that:

• Supports your body without sinking at the hips
• Allows relief and comfort at pressure points, including the knees, hips, shoulders, and head
• Lets your muscles relax throughout the body, especially at your back

If you experience stiffness or pain in the morning, even after a full night’s sleep, then your mattress is not delivering you the right support.

The Right Comfort

Each of us has our own experience of comfort— it’s a subjective feeling, not an objective measurement. But when you’re thinking about a mattress, remember that comfort is how the mattress feels to you combined with the product’s ability to keep you in alignment over time. You are the only one who knows whether a firm bed or a softer one is more comfortable for you.

One important thing to know is that as you age, your comfort preferences will likely change. As you get older and pain issues become more common, you often need a softer mattress. This is because as you age, your skin gets thinner and has less fat, which means less cushion on your body during the night.

Keep this in mind though— firmness does not equal support. From extra-soft to super-firm, support comes from a well-constructed mattress made with high-quality materials that keep your spine in alignment.

It can be overwhelming to sort through all the different kinds of mattresses on the market. That’s why I’ve done a ton of research and writing about mattresses of all types— for different budgets, body types, sleep positions, and types of pain. If you’re looking for a better mattress for your sleep needs, check out my articles on how to choose your perfect mattress.

Sleep Posture and Your Pillow

When it comes to your sleep posture, your pillow matters too. Select a pillow that supports the natural curve of your neck, and allows you to keep your head in alignment with your shoulders and hips. Avoid high pillows that elevate your head out of alignment— this leads to muscle strain not only in the neck but in your back and back and shoulders.

The right pillow can be especially effective in helping alleviate back pain too. Research from the Journal of Physical Therapy Science shows that for patients with low back and lumbar pain, supportive pillows can reduce pain significantly, beyond what physical therapy often can do.

I recommend an ergonomic pillow like Everpillow, which can be customized to suit different sleep styles right in the comfort of your home, and is especially helpful for lower back pain. It offers great head and neck support while also being remarkably comfy, no matter which position you sleep in. I recommend “The Curve” if you’re a side sleeper, and “The Original” if you sleep on your back or stomach. Both pillows offer the option of removing or adding filling to get the exact support you need for a great night of sleep.

If you’re not sure how to select the right pillow for your sleep needs, check out my article on how to pick a pillow.

Back, Stomach, or Side: What’s the Best Sleeping Position?

In short, it depends. The dirty little secret when it comes to picking the best sleep position is that there is no “one size fits all” approach. Instead, it varies from person to person based on your physical and medical attributes including pre-existing health conditions.

Or, as Dr. Rachel Salas from Johns Hopkins University put it, there are “caveats” to each sleep position. Let’s take a look at each common sleep position and see the pros and cons for everything from back pain to sleep apnea.

Sleeping on Your Back

If you’re a back sleeper, you’re in the minority— a mere eight to ten percent of people are back sleepers.

And while sleeping on your back can have some downsides, that doesn’t mean that sleeping on your back is a bad thing though. In fact, like all sleep positions, sleeping on your back can be good for your health and your sleep posture. For some, it may actually be the optimal sleep position.

Pros of Sleeping on Your Back

Sleeping on your back can have significant benefits for your health, including:

• Fewer aches and pains: You’re giving your muscles more support, and are less likely to strain your neck while you sleep. When you lay on your back, you’re also supporting your spine. People with arthritis often find it easier to sleep soundly and more comfortably on their backs.
• Youthful Skin: There is no magical solution that can smooth wrinkles overnight— but back sleepers enjoy fewer fine lines and wrinkles when compared with other sleep positions.
• Helps your body naturally align: Sleeping on your back distributes your weight evenly, with no excessive pressure on any part of your body. From a back-sleeping position— and with the right mattress and pillow— your body can naturally fall into alignment. Using a firm pillow— not too big or thick— under your knees can also help keep your natural spinal alignment, helping your back muscles relax and relieving pressure on your spine.
• Less movement during the night: Back sleepers don’t move around as much during the night as sleepers in other positions do, which aids in maintaining good sleep posture and contributes to more restful sleep.

Cons of Sleeping on Your Back

A major con of sleeping on your back is an increased risk of sleep apnea. Sleep apnea is a serious but common sleep disorder where your airways are partially or entirely obstructed, causing loud snoring and pauses in breathing while you sleep.

Many people who snore suffer from sleep apnea, and sleeping on your back can contribute to or worsen snoring and sleep apnea symptoms. This is because sleeping on your back can cause airways to collapse for those already suffering, or create obstructions in your airways that can cause interruptions in your breathing.

If you snore, consider seeing a sleep expert for a consultation and testing to see if you have sleep apnea, or are at risk of developing it.

If you have back pain, it can be uncomfortable— and counterproductive— to sleep on your back. Try side sleeping instead, after talking to your doctor. Some types of neck pain may also be aggravated by sleeping on your back. When it comes to sleeping well with pain, it’s a good idea to try different positions to determine what gives you the most comfort and relief from tension.

Sleeping on Your Stomach

If you thought back sleepers were rare, stomach sleepers are even rarer with under ten percent of people preferring that sleeping position. And like sleeping on your back, the stomach position is neither all good nor bad.

Pros of Stomach Sleeping

• Better for Sleep Apnea Sufferers: As opposed to back sleepers, stomach sleepers actually breathe easier, which makes it a better position for those with sleep apnea. Your airways are more likely to stay open.
• Heartburn Buster: I find this really interesting— both back and stomach sleeping positions are the best for those prone to indigestion, heartburn, and similar digestive issues. The best sleep position for digestive issues is what is called a “freefall” position, where you lay on your stomach with your hands above a supportive pillow.

Cons of Stomach Sleeping

While there are some benefits to sleeping on your stomach, when it comes to achieving a healthy sleep posture, you should avoid sleeping on your stomach. Here are a few reasons:

• More Restless Sleep: The biggest drawback to sleeping on your stomach is that it may cause more nighttime awakenings. That’s because this position tends to place more pressure on your joints, which can cause joint pain. You’re more likely to toss and turn also.
• Muscle and Neck Pain: If you suffer from achy joints or neck pain— like so many adults do— you shouldn’t sleep on your stomach. Again, you’re placing pressure on those areas, and you’re more likely to put your neck and spine out of alignment. Stomach sleepers also often have their heads set too high, creating stress at the neck— a very flat pillow or no pillow at all are best for stomach sleeping if you need to sleep in this position. Stomach sleeping also puts the most pressure on joints and typically causes the most moving around during sleep.
• More Wrinkles: We’ve all heard of beauty sleep. While it’s true that sleeping more can keep your skin looking younger longer, some sleep positions are better than others. Stomach sleepers are more likely to have wrinkles because the pressure against your face adds friction, which can make those fine lines add up over time.
• More difficulty aligning your spine: It’s nearly impossible to maintain spinal alignment if you sleep on your stomach. Your body is more likely to sink at the stomach and pelvis, putting stress on your lower back. If you sleep on your back, consider putting a pillow under your stomach and hips to provide some extra support for your lower back.

Sleeping on Your Side

Side sleepers, rejoice— if it matters to you, you’ve chosen the most popular sleep position. In fact, an astonishing 63 percent of people sleep on their side. Of course, keep in mind that side sleeping includes a variety of positions— but since we’re speaking generally here, it’s still undoubtedly the most popular way to catch some zzz’s.

Pros of Side Sleeping

There are a lot of potential health benefits you can get from sleeping on your side. Some of them include:

• It May Help Boost Cognitive Functioning: According to a 2015 Stony Brook University study, sleeping on your side has been associated with clearing brain waste, which is linked to a lower risk for cognitive disorders like Alzheimer’s Disease.
• It’s Good for Your Heart: Compared with other sleep positions, sleeping on your side is best for your heart, because it promotes blood flow and circulation. I especially recommend the side sleep position for anyone with high blood pressure or circulatory disorders.
• Reduces snoring and sleep apnea symptoms: Sleeping on your side can help keep your airways open and unobstructed, allowing you to breathe a little easier while you sleep.
• Less Back Pain: As long as you have a supportive mattress and pillow, you’re less likely to experience back and neck pain while sleeping on your side. This is because there is reduced pressure on your spine, allowing it to fall into its natural alignment.
• Reduces discomfort from underlying conditions: Studies show acid reflux is worse when you lie on your right side, but symptoms can improve if you sleep on your left side. Similarly, pregnant women are advised to sleep on their left side to help increase circulation and blood flow to the placenta. Left-side sleeping may also help digestion.

Cons of Side Sleeping

While there are many benefits to this sleep position, there are also some drawbacks to side sleeping.

• More wrinkles: You’re more likely to develop wrinkles than if you sleep on your back, because of the pressure put on the side of your face.
• Disrupted circulation: You’re also more likely to disrupt circulation in your arm because of the pressure of your body on one side. This can cause that annoying pins-and-needles tingling sensation, which can disturb your sleep at night.
• More likely to toss and turn: Side sleepers tend to turn in bed more than back sleepers, which can break alignment if you don’t know how to turn yourself properly. If you’re a side sleeper who turns in your sleep, you can help maintain alignment by rolling your body in a single motion and as a complete unit, rather than turning at your waist to move your upper body, and having your lower body follow. 

Side sleepers may find that a small pillow between the knees helps keep the spine in alignment, and hips in line with shoulder tops. Just make sure it’s small enough that you can turn easily, and keep your head, shoulders, and hips aligned as you roll.

Sleeping in the Fetal Position

The fetal position is a curled-up variation of side sleeping. When it comes to sleep posture, the fetal position can work, but you need to take care not to overdo it and avoid curling up too tightly.

Curling up too tightly breaks the important lining up of your head, shoulders, and hips, and can leave you feeling stiff the next morning. A too-tight fetal position for sleeping also restricts breathing, preventing your diaphragm from functioning properly.

If you sleep in the fetal position, you can improve your sleep posture by stretching out and transitioning to a side-sleeping position. You can do this by using a body pillow to keep your body in a loose curl.

And remember, like healthy sleep itself, a great sleep posture is the result of all you do throughout the day. Paying attention to your posture during all your waking activities, from sitting and standing to walking the dog and going for a run, will help keep your spine aligned, your muscles and ligaments relaxed, and free of the stiffness and discomfort that so many of us take to bed at the end of a long, busy day.

Your sleep position and your sleep posture aren’t the same thing, but they’re both crucial to getting better sleep each night. Not only do they help you sleep more comfortably, but they can help relieve chronic pain, digestive disorders, and help you breathe easier.

If you’ve given thought to your sleep position— or sleep positions if you shift during the night— but haven’t ever really considered sleep posture, you’re not alone! Thankfully, paying attention to your preferred sleeping position can improve your sleep posture and help you get the restful sleep you need to feel alert and refreshed every morning.

Sweet Dreams,

Michael J. Breus, PhD, DABSM

The Sleep Doctor

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