Q&A: Sleeping Positions

Q: Am I the only one who continuously wakes up with a stiff neck or tight back muscles? Do I just sleep in the worst possible positions? Help! (This person sleeps on both right and left sides with her knees bent, and avoids sleeping on her back and stomach due to back pain.)

A: There is nothing inherently wrong with sleeping on your side, or in any other position, as long as you have the support you need to keep your whole spine and hips in a neutral position.

(Please, please ignore any claims you find in the dark corners of the internet that sleeping on your side will make your skin and breasts sag. Gravity does not pull on you any harder on your side than at any other time. That's pure pseudoscience.)

Side Sleeping
Side sleeping is one of the most popular positions out there. It's easier for most people than sleeping on your back or stomach, but still keeps your spine in a fairly neutral position. Here are a few problems people run into and things to try for side sleeping:

  • I wake up with a stiff or sore neck.
    This usually comes from the wrong pillow. Too small or squishy, and your head tilts down toward your bed all night; too big or hard, and your head tilts up toward the ceiling all night. In either situation, one side of your neck is being compressed all night. Test out some different pillows and find the one that keeps your neck in line with the rest of your spine. 
  • The middle of my back is so sore when I try to stand up in the morning!
    This might sound familiar if you sleep curled up with your back rounded. A body pillow can work wonders for healthier side sleeping, keeping you feeling cozy with something to curl around without hurting your back.
  • My lower back or hips hurt when I'm lying on my side. 
    This happens for two reasons. 1 ) Your knees are not bent enough, putting your hips and back at a strange angle. Many will find that a 90° (or so) angle between legs and torso, like in sitting, is most comfortable. When you lie like this, look at the line from your hip to your knee of the leg on top. If that line slopes down toward your knee, you'll likely be more comfortable with a small amount of padding between your knees. 2 ) You are falling forward in your sleep, probably from either your torso or legs but not both. That twist puts torque in your lower back and pulls all night. Again, body pillow or padding between your knees.
  • I can only sleep on one side comfortably. Why is that? 
    Reasons for this are really specific to each person, so it's not very helpful to answer generally. Please contact me if you'd like to know more.

Back Sleeping
Sleeping on your back (or even just lying flat on your back every so often) is really good for you. All of your anti-gravity muscles get to take a break, it's the most calming position for your nervous system, and that support from behind makes your spine really happy, especially if you've got a fairly firm mattress. (If you have acid reflux, however, sleeping flat on your back is not a good idea.)

  • I don't know why I'm not comfortable on my back, I just can't seem to relax there. 
    Instead of "trying to relax" (a very difficult thing to do), find the places where you already have contact with your bed and allow those places to be heavy and soft. You can find this sensation by, for example, pulling your shoulders away from the bed and letting them drop all the way, so all that work to hold them up lets go.
  • My neck starts hurting when I lie on my back.
    Same as with side sleeping, a pillow that's too big can cause a lot of trouble. Here, if your pillow either pushes your head higher than the line of your spine, or your chin points toward your chest, your pillow is too big. If you need a pillow to lie comfortably on your back, it shouldn't be more than a couple of inches thick. Some may not need a pillow at all. If you do need neck support specifically, most neck pillows are either too wide or too tall, and rolling up a towel under your neck (not under your head) will probably do the trick.
  • Lower back or hip pain keep me from ever lying on my back.
    For those with a strong lower back arch, lying on your back may feel like a lot of work, because while the rest of you tries to lie flat, that spot in your back is still hovering really far from the bed. If that's the case, instead of forcing yourself to lie all the way flat, put something under your knees so the weight of your legs isn't pulling on your hips and back. Try experimenting with different amounts of support, a rolled up towel vs. a rolled up blanket for example, and see what works for you.

Stomach Sleeping
A lot of people struggle with sleeping on their stomach, but like any other position, it can become comfortable for almost anyone. Once you get to that comfortable place, it can bring a wonderful sense of peace as you tune the rest of the world out.

  • I can't relax on my stomach either!
    Same as on your back, finding your contact points and making them softer and heavier can be very useful here. There's also a breathing trick here - most people breathe into their chest or stomach, so when lying on your stomach, it can feel like your breathing is being constricted. Lungs are way bigger and ribs are much more flexible than most of us think though, and it's entirely possible to breathe into your back. To feel this, put your hands on different parts of your back and try breathing into that pressure. If you can breathe into your back, sleeping on your stomach will become much easier.
  • I can't find a place I like for my head when I'm on my stomach. 
    Likely another pillow issue! Notice a theme? If your pillow is too big, it will compress the back of your neck. Try a small pillow, and different combinations of which direction your head is turned and where your arms are resting.
  • I hate lying on my stomach! It makes my back hurt immediately. 
    If you have a strong lower back arch, lying on your stomach can feel like your lower back is getting crunched. A little support can work wonders here. Find the bony part of the front of your pelvis (a couple of inches below and to the sides of your belly button), roll up a small towel to a couple of inches thick, and put the roll under that part of your pelvis while lying on your stomach. This will change the tilt in your pelvis and uncrunch your lower back.
  • My feet, ankles, or calves get crampy when I lie on my stomach.
    Another little towel roll under your ankles will take care of this.

These suggestions will work for many, but not all of you. If you would like to do a consultation in person or over Skype on how you sleep, please contact me.