Do you find yourself waking up multiple times through the night? Neck pain or back pain breaking your sleep? Or maybe some nights you snore loudly and struggle to breathe while you sleep and find yourself poorly rested in the morning?

Everyone loves a great night’s sleep, and we spend a third of our lives lying down! Most of you will have a favourite position to sleep in, whether that’s on your side, your back, or face down on your tummy, most people will have a preferred sleeping position. But when something gets in the way, it’s important to know the pros and cons of each position so you can still rest up despite things like back/neck pain, sleep apnoea, snoring, or reflux!

Just The Tips:

1. Face Up
   • Pros: unloads spine, good for back pain; helps digestion and reflux
   • Cons: higher chance of snoring and sleep apnoea
2. Side Lying
   • Pros: Better for sleep apnoea, which can also improve reflux. Comfortable for most people/preferred sleeping position. Better for circulation in pregnant women.
   • Cons: Not as good for spinal alignment and helping with back pain
3. Face Down
   • Pros: Good for sleep apnoea
   • Cons: higher risk of SIDS for infants, not as good for spinal alignment

1. Face Up

This one is not too common, a 2007 study (Gordon, Grimmer & Trott) reported approximately 10-15% of people choose to sleep on their backs, but there are plenty of good things about this position!

An important process with sleeping, especially for those with aches and pains, is the unloading of our muscles, joints and connective tissues, and their refuelling and recovery over the night. These loads and pressures drop to 25% of what they are while standing, if we lie on our backs (Haex, 2004). This position is especially effective in unloading the spine as it allows for neutral alignment, where pressure is distributed more evenly.

Furthermore, for those with reflux, assuming they’re using a pillow so their head is elevated, lying on their back is also helpful in reducing these symptoms while they sleep (Hamliton, Boisen, Yamamoto, Wagner, Reichelderfer, 1988)

Now, we should also note that sleeping on your back may not be as good for people who have sleep apnoea (trouble breathing while sleeping), which is often those who tend to snore. This is because of the position of the tongue, which may block your airways, making it harder to breathe (Lee, Kim, Kim, Rhee & Won, 2015).

 

2. Side lying

Moving on to the most popular sleeping position: lying on your side is commonly reported as being the preferred position of 40-50% of people but has been reported as high as 70% (Gordon, Grimmer & Trott, 2007). This can be from a foetal position – curled up into a ball – to a ‘log’ position, arms and legs straight, or anywhere in between.

One huge benefit for side sleeping would be that it considerably reduces the risk of sleep apnoea (Lee et al., 2015). This is especially useful in comparison with sleeping on your back and can be paired with the advantage that improving symptoms of sleep apnoea can actually alleviate those of reflux (Shepherd et al., 2011). So, if you’re having trouble with breathing/snoring while sleeping on your back, and having some issues with digestion and reflux, sleeping on your side is a great alternative to try that could help both!

Side sleeping is also important for pregnant women, with evidence showing issues with circulation for expecting mums sleeping on their backs. This can lead to a reduction in oxygen delivered to the foetus and has resulted in recommendations from the American Heart Association for pregnant women to try sleep on their left side if they have any heart or blood vessel issues. However, it is also acknowledged that people do move around while they sleep and its normal to lie on your back at times through the night (O’Brien & Warland, 2014).

Finally, side sleeping also unloads the spine, but not to the degree of lying on your back. If you spend a lot of time with your spine in a curled/flexed position, for example sitting at a desk, sleeping in a foetal position can contribute to added volume in this position, which could cause your back to stiffen up. It would be worthwhile considering sleeping in a way that offsets this. So, if you prefer sleeping on your side, try straightening your legs out, rather than sleeping curled up (Haex, 2004).

 

3. Lye Face Down

Prone sleeping, or lying face down, is the least commonly chosen position for sleep, and it reduces with age, dropping to essentially 0 by 65 years of age, likely due to decreasing mobility with age and possibly the extra effort required to expand the rib cage for breathing (De Koninck, Lorrain & Gagnon, 1992)

Much like sidelying, sleeping in prone has been shown to reduce sleep apnoea and snoring compared with sleeping on your back (Bidarian-Moniri, Nilsson, Rasmusson, Attia & Ejnell, 2015). Other than this, there isn’t much research showing any benefits to lying face down, but it has been shown that a prone sleeping position is a significant risk factor related to SIDS (sudden infant death syndrome) and it is recommended that infants should NOT be put to sleep in a face down position (Task force on Sudden Infant Death Syndrome, 2011).

 

Final Thought:

Overall, barring medical conditions, sleeping position generally comes down to what’s comfortable for you. If you do have any of the above issues, or any other trouble sleeping, please be sure to consult your GP or a qualified health professional about these issues as well as what sleeping position may be ideal for you, your sleep is important!

 

About the writer

Pei Gan is the Managing Director and Owner PB Physio. Gan is a Physiotherapist (BAppSci) who specialises in musculoskeletal physiotherapy, specifically sports and performance for strength athletes (powerlifting, weightlifting, bodybuilding and gym goers).

 

 

 

 

 

 

 

References

1. Bidarian-Moniri, A., Nilsson, M., Rasmusson, L., Attia, J., & Ejnell, H. (2015). The effect of the prone sleeping position on obstructive sleep apnoea. Acta oto-laryngologica, 135(1), 79-84.
2. De Koninck, J., Lorrain, D., & Gagnon, P. (1992). Sleep positions and position shifts in five age groups: an ontogenetic picture. Sleep, 15(2), 143-149.
3. Gordon, S. J., Grimmer, K. A., & Trott, P. (2007). Sleep position, age, gender, sleep quality and waking cervico-thoracic symptoms. Internet Journal of Allied Health Sciences and Practice, 5(1), 6.
4. Haex, B. (2004). Back and bed: ergonomic aspects of sleeping. CRC press.
5. Hamilton, J. W., Boisen, R. J., Yamamoto, D. T., Wagner, J. L., & Reichelderfer, M. (1988). Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid. Digestive diseases and sciences, 33(5), 518-522.
6. Lee, C. H., Kim, D. K., Kim, S. Y., Rhee, C. S., & Won, T. B. (2015). Changes in site of obstruction in obstructive sleep apnea patients according to sleep position: a DISE study. The Laryngoscope, 125(1), 248-254.
7. O'Brien, L. M., & Warland, J. (2014). Typical sleep positions in pregnant women. Early human development, 90(6), 315-317.
8. Shepherd, K. L., James, A. L., Musk, A. W., Hunter, M. L., Hillman, D. R., & Eastwood, P. R. (2011). Gastro‐oesophageal reflux symptoms are related to the presence and severity of obstructive sleep apnoea. Journal of sleep research, 20(1pt2), 241-249.
9. Task Force on Sudden Infant Death Syndrome. (2011). SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment.