Written by: Nicole Likarish
Updated November 20, 2020
The best sleeping position is generally the one that promotes the best slumber. This varies from person-to-person based on personal preference and physical and medical factors. While some studies suggest that sleeping on one’s side is preferred, as we’ll see below, there is not a one-size-fits-all solution. Read on to learn more about the benefits and risks associated with various sleeping positions.
Is Sleeping on Your Side the Most Common Position?
Most people prefer to sleep on their side. This is supported by a study showing that children sleep on the side, back, and front equally, with a growing preference for the side position when approaching adulthood. Side-sleeping with an arm overhead is the most common sleep position, representing 55 percent of the time asleep in bed. Research suggests that the preferred side position increases with age due to a loss of flexibility of the spine.
Patients with heart failure, however, instinctively avoid the left side position during sleep, possibly to avoid discomfort and shortness of breath. Instead, this population prefers to sleep in the right side position.
Sleeping in the Fetal Position
Side sleepers who curl inward with bent legs are sleeping in the fetal position. Sleeping in the fetal position has many of the same benefits as sleeping on the side. Research also has found that sleeping in the side position significantly reduces the frequency of sleep apnea breathing irregularities.
Unfortunately, sleeping in the fetal position may cause joint pain or stiffness for some people. To reduce the risk of discomfort, curl in a relatively loose position or with a pillow between your knees.
Lying Flat on Your Back: A Double-Edged Sword
Back-sleeping can promote better spinal alignment and reduce pressure on injured limbs. However, sleeping on the back is not recommended for everyone.
Studies indicate that sleeping on your back could worsen certain conditions such as snoring and sleep apnea. Back-sleeping is also not optimal for people with heartburn or GERD. Although most women report occasionally sleeping flat on their back during pregnancy, this position is not recommended for pregnant women as it has been possibly associated with late stillbirths in the the third trimester.
Sleeping on Your Stomach
Only a small percentage of people prefer to sleep on their stomachs, also known as the front or prone position. The respiratory movements of the rib cage require more energy because of the need to elevate the body against gravity in the front position, which may explain why many people avoid stomach sleeping.
This is supported by studies on infants showing that the prone position causes a higher heart rate than the back position, and may increase their vulnerability to sudden infant death syndrome and hyperthermia. In fact, the American Academy of Pediatrics recommends all infants sleep on their backs to avoid these risks.
Elderly adults rarely sleep in prone positions, also likely because of the extra effort required for breathing from the respiratory cage and lack of flexibility in the spinal cord.
In the front-sleeping position, sleeping with a flat pillow under the pelvis and stomach can help keep the spine in alignment. Sleeping with a flat pillow or without a pillow under the head may also promote better alignment of the spine.
Additionally, prone sleep positions have been found to help treat individuals with respiratory symptoms as a result of Covid-19.
Considerations for Choosing the Right Sleeping Position for You
Choosing the right sleep position depends on a number of factors. These include personal preference, as well as physical and medical factors such as:
- Back and shoulder pain
- Sleep apnea
It is often challenging to change personal sleeping positions. Once we're asleep, we may find we revert to what is familiar. The use of pillows and back supports may help keep you in your new position during the night.
Sleep Positions to Relieve Back and Shoulder Pain
Research indicates that it's possible to reduce back and shoulder pain and discomfort and increase sleep quality by modifying sleep posture. The best sleeping position for both lower and upper back pain is on the back. This position distributes weight across the entire spine. To help maintain the natural curve of the spine, place a pillow under your knees. The best sleeping positions for neck pain are on the back or the side.
Sleeping on the side with an arm overhead may aggravate and delay healing of an acute elbow injury and result in chronic pain. Therefore, people with tennis elbow who prefer sleeping on their side should keep the arm down.
Sleep Positions for Sleep Apnea and Snoring
People with sleep apnea experience more light sleep and less deep sleep compared with people without apnea. A strong relationship also exists between a history of snoring and complaints of daytime sleepiness. Furthermore, many adults sleep with a partner, and snoring and symptoms associated with sleep apnea can negatively impact a partners' sleep and daytime functioning. Poor sleep has also been linked to glucose intolerance, insulin resistance, and type 2 diabetes, among other negative health outcomes.
Body position during sleep may reduce snoring and improve sleep apnea. One study found that 50% of patients with mild obstructive sleep apnea and 19% with moderate obstructive sleep apnea both saw a 50% reduction in sleep apnea events by sleeping in a non-supine position. Research also has found that sleeping in the side position decreases the frequency and severity of these events in patients with obstructive sleep apnea and with central sleep apnea. Therefore, sleeping in the side position is recommended for people with both obstructive and central sleep apnea.
In addition to positional therapy, other treatment options for sleep apnea include:
- Avoiding alcohol and certain medications such as sleeping pills
- Using continuous positive airway pressure (CPAP)
- Losing excess weight
- Using oral appliances
- Quitting smoking
- Treating associated medical problems
Sleep Positions for GERD Symptoms
Research indicates a significant association between disturbed sleep and GERD. Sleep disorders may induce gastrointestinal disturbances, and gastrointestinal symptoms may trigger or worsen sleep disturbances. Cessation of swallowing during sleep reduces the clearance of the esophagus and impairs acid neutralization, resulting in prolonged acid contact with mucous membranes.
GERD is linked to a lack of quality sleep and to experiencing less sleep, either from difficulty falling to sleep, waking too early in the morning, or frequently waking during the night. The relationship between sleep disturbances and GERD can decrease the quality of life. Heartburn during sleep and sleep disturbances are common symptoms of nocturnal GERD.
Studies indicate that lying on the left side is the preferred sleeping position in people with heartburn and GERD, although the reason isn't entirely clear. Hypotheses hold that right-side sleeping may relax the lower esophageal sphincter or left-side sleeping may keep the intersection between the stomach and esophagus above the level of gastric acid.
Other treatment options for GERD include:
- Antacids to neutralize stomach acid
- Medications that reduce acid production
- Medications to block acid production and heal the esophagus
- Surgery and other procedures
Best Sleeping Position During Pregnancy
Sleeping on the side is recommended as the best sleeping position during pregnancy. Research indicates that from as early as 20 weeks, the left side position can positively affect blood flow to the fetus. Most women report spending some time sleeping flat on the back during pregnancy, but this position is not recommended as it may be a risk factor for stillbirth after 28 weeks' gestation.
Most studies suggest an increased need for sleep during pregnancy. The high levels of hormones required to maintain pregnancy also induce drowsiness. At the same time, it is very common for pregnant women to experience back pain, heartburn, nausea, and excessive urination at night, all of which may interfere with sleep. Moreover, pregnancy increases the risk of sleep disorders such as obstructive sleep apnea, snoring, and restless leg syndrome.
An increasing amount of data shows that sleep disturbances have a negative impact on pregnancy outcomes. Conditions that are linked to fetal death, such as maternal hypertension, gestational diabetes, and fetal growth restriction, have all been associated with maternal sleep disruption.
Some tips to promote better sleep during pregnancy include:
- Avoiding caffeine before bedtime
- Avoid acidic, fried, and spicy foods to prevent heartburn
- Lower the lights and keep noise to a minimum
- Disconnect from electronic devices
- Find an agreeable temperature
- Use body pillows and wedge pillows
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