Last updated on February 25th, 2017
I’ve been a practicing chiropractor for over ten years, four of them for a Major League Baseball team. On each history form, I’ve always included a question about whether the patient sleeps on his or her back, sides or stomach. This is so that I can ensure they’re using an appropriate pillow for their sleeping position.
When I initially posed the question, many years ago, my expectation was that most patients would simply acknowledge that they slept in only one of these three sleeping positions.
Sleep in motion
What I discovered, based upon thousands of patient responses over the years, was that at least 60% of my patients did not sleep exclusively on their sides, back or stomach. In fact, most shifted between their sides and back throughout the night.
That is, they would sleep either primarily on their back throughout the night and shift occasionally to their sides or, more commonly, they would sleep primarily on their sides and shift occasionally to their backs on occasion.
Although during REM, we are effectively in a state of paralysis, in other phases of sleep, tossing and turning is common. Over the years, I developed a theory to explain this shifting between back and sides. It has to do with the low back and the body’s innate wisdom.
Sleeping, sitting and standing
You see, when we are in the side sleeping position, we often curl our legs up a bit, and for the low back, this approximates a “sitting” position. However, when we shift to sleeping on our backs, our lower back is now more in a “standing” position.
Just as we intuitively know not to sit or stand for hours on end during the day because it is simply uncomfortable for our low backs, it seems we have the same cues that exist at night as well.
Sleep and your low back
The unfortunate fact is that 80% of Americans will suffer from low back issues at some point in their lives. Considering that we spend, on average, 1/3 of our lives in bed, it makes sense to ensure that we’re not sleeping in a way that contributes to our low back problems.
Patients for many years have asked me what is the best position for lower back pain while sleeping. My response has always been the same.
Best sleeping position for the lower back
First, if you’re a stomach sleeper, you need to do all you can to try and break the habit. Not only does this position put your low back in an awkward position of hyper-extension, but it also forces the neck into rotation throughout the night, which is extremely unhealthy for both regions of the spine.
There are some thoughts from the psychology community that stomach sleeping may have an emotional component. Stomach sleepers often find it difficult to fully relax enough to fall asleep whether on their back or sides.
Some believe this has to do with the “heart center” (located in the chest region) needing a certain level of compression in order for this type of sleeper to feel safe. So, I will always recommend that my patients who gravitate towards sleeping on their stomach try to sleep on their sides.
Choose the right pillow
For stomach sleepers I recommend using a pillow against the chest region to recreate the compression they enjoy while sleeping on their stomachs.
For the side sleeping position, ideally we want to have a pillow between our knees. I recommend the width of this pillow to be approximately the width of a fist. This will serve to keep the pelvis in a neutral position, minimizing compression or torque forces on the sacroiliac joints, which are a very common source of low back pain.
For the back sleeping position, ideally, we want to sleep with a pillow underneath our knees. The height of the pillow should be equivalent to about the width of two fists. By placing a pillow under one’s knees while back sleeping, the low back spinal joints are flexed just slightly, which prevents any jamming of these joints throughout the night.
So, in short, back and side sleeping are best especially when the correct head pillow, mattress and knee pillow are utilized to promote a neutral and ultimately healthy spine.