Position Yourself for Sound Sleep With Back Pain

Raymond Jonathan Hah, MD, and Christopher C. Ornelas, MD, orthopedic surgeons at Keck Medicine of USC, reveal the best sleep posture to relieve back, neck or pregnancy pain and help you feel better each morning.

Good posture is key to a healthy spine, but posture isn’t just about sitting or standing straight. Your sleep posture also has a major impact on your back and neck. While some positions help you feel refreshed come morning, others can leave you stiff, sore and in pain.

When it comes to finding the best sleeping pose for your back and neck, think neutral. Positions that put your spine in a neutral, or straight, alignment put the least amount of stress on your back and neck. Learn which positions put your spine in a neutral state and those that should be avoided.

The best sleep position for your spine: on your back

Sleeping on your back is the best for putting your spine in a neutral alignment, but only 8% of people sleep in this pose.

A few strategically placed pillows can boost the benefits of back sleeping. A small pillow underneath your head and neck (but not your shoulders) will help keep your spine straight. Adding a pillow under your knees will provide even more support and comfort, as it encourages your spine to maintain its natural curve.

Though back sleeping is the best for your spine, it has a few drawbacks:

1. It’s not advised for those with sleep apnea. Back sleeping may cause the tongue to block the breathing tube, so those with sleep apnea should not sleep on their backs. Instead, they should sleep on their side with legs straight.

2. It’s not advised for snorers. Back sleeping can worsen snoring. Those who snore should sleep on their side with legs straight.

3. It’s not advised for pregnant women. Pregnant women who sleep on their backs risk developing a myriad of health problems, from back pain to low blood pressure. Plus, the on-the-back position decreases blood circulation to the heart and the fetus. The best sleep position during pregnancy is sleeping on the side with legs bent.

The next best option: on your side with legs straight

For those who snore or have sleep apnea — or if you simply find sleeping on your back uncomfortable — sleeping on your side with your torso and legs straight is a great alternative. This is the ideal sleeping pose for snorers and people with sleep apnea because it keeps your airways open. Adding a small pillow between your legs will also help keep your spine neutral.

In third place: on your side with legs bent upwards

Sleeping on your side with your legs bent upwards, also known as the fetal position, is the most common sleep pose — 41% of adults sleep this way. Though it’s a popular option, this posture prevents your neck and upper back from reaching a neutral position. The fetal position also promotes an uneven distribution of weight, which can cause sore joints and back pain. You can help reduce your odds of waking up in pain by keeping your bending angle relaxed as opposed to tucking your chin to your chest and pulling your knees up as high as they can go.

While this is the third-best sleep posture for most, sleeping on your side with bent legs is the best sleeping position for pregnant women. It provides the most comfort and safety for a growing abdomen, and sleeping on the left side adds the extra benefits of boosting blood and nutrients to the fetus. For added support, pregnant women may add a pillow between their bent legs and knees.

The one sleep position everyone should avoid

Regardless of the type of pain you have, whether it’s low back, neck, joint or related to pregnancy, sleeping on your stomach is not a good idea. This position puts the most pressure on your spine’s muscles and joints because it flattens the natural curve of your spine. Sleeping on your stomach also forces you to turn your neck, which can cause neck and upper back pain.

While stomach sleeping is best avoided, getting the sleep you need is even more important. If sleeping on your stomach is the only way you can rest soundly, you can ease some stress off your back by putting a pillow under your pelvis and lower abdomen, and another pillow under your head. If the pillow under your head causes pain, remove that pillow.

Still feeling sleepy?

If you have a healthy sleep posture, but you’re still struggling to get a good night’s rest, factors outside of your sleep position may be the culprit. For example, environmental disruptions such as bright lights in your bedroom, or dietary habits like eating a large meal before bed could be interfering with your slumber. Learn about some common habits that disrupt sleep in: Sound Sleep Advice for a Healthy Spine.

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