How Your Sleep Position Affects Your Back and Neck

Is There Really a “Best” Way to Sleep?

You go to bed feeling reasonably good.

Then you wake up and wonder what happened during the night.

Your neck is stiff.

Your lower back doesn’t want to straighten up.

Your shoulder aches.

Maybe your hand is numb because you’ve somehow spent part of the night sleeping on your arm.

So what happened?

Sometimes the answer may be surprisingly simple:

You spent several hours in a position your body didn’t particularly like.

Sleep position can influence neck, back, shoulder, and hip discomfort. But before we start declaring that everyone needs to sleep on their back with three strategically positioned pillows, there’s something important to understand:

There isn’t one perfect sleeping position for everybody.

The goal is finding a position that allows your body to rest comfortably without repeatedly aggravating something that’s already irritated.

You Don’t Actually Stay Still All Night

One misconception is that we fall asleep in one position and remain there for eight hours.

Most people don’t.

We naturally change positions throughout the night.

That’s a good thing.

But we can still spend substantial amounts of time lying in positions that place certain joints, muscles, or nerves under stress.

If your neck is already irritated, several hours with your head poorly supported may make it more noticeable.

If your shoulder hurts, sleeping directly on it may aggravate it.

If you have sciatica or lower-back pain, certain positions may increase or decrease your symptoms.

That’s why sleep position matters.

Not because your spine has to remain perfectly “aligned” all night.

Because comfort and support matter when you’re spending roughly a third of your life in bed.

What About Stomach Sleeping?

Stomach sleeping gets blamed for a lot of problems.

And there is a legitimate reason it can be troublesome for some people.

You have to breathe.

Unless you’ve discovered a remarkable new technique, that means your head needs to turn to one side.

Spending long periods with your neck rotated can be uncomfortable, particularly if you already have neck stiffness or limited mobility.

Stomach sleeping can also change the position of the lower back depending on your body, mattress, and how you position your legs.

Does that mean everyone who sleeps on their stomach is destroying their spine?

No.

Some people have slept comfortably that way their entire lives.

If you’re a stomach sleeper and you wake up feeling great, I’m not going to tell you that you have to change because somebody declared your sleeping position “wrong.”

But if you regularly wake with neck or back discomfort, your sleeping position is worth looking at.

A thinner pillow under your head may be more comfortable than a thick one because it reduces how far the neck is pushed backward while you’re lying on your stomach.

Side Sleeping

A lot of people prefer sleeping on their side.

The important question here is usually:

Is your head reasonably supported?

If the pillow is too thin, your head may drop toward the mattress.

If it’s too thick, your head may be pushed in the opposite direction.

Ideally, you want a pillow that comfortably supports the space between your head and the mattress.

And remember: a broad-shouldered person may need something completely different from a smaller person.

This is why I don’t think there’s one “best pillow.”

Your pillow needs to fit you.

What About a Pillow Between Your Knees?

Some people with lower-back or hip discomfort find a pillow between their knees more comfortable when sleeping on their side.

It can reduce rotation through the pelvis and may simply allow the hips and lower back to relax.

You don’t need a special $150 orthopedic pillow.

Try an ordinary pillow first.

If it helps, great.

If it doesn’t, you haven’t failed the sleep-position test.

Try something else.

Back Sleeping

Sleeping on your back can be very comfortable for some people because your weight is distributed across a relatively large surface.

But again, it isn’t automatically the best position for everyone.

Someone with certain types of back pain may love it.

Someone else may hate it.

If lying flat on your back bothers your lower back, try putting a pillow underneath your knees.

That slight bend at the hips and knees can sometimes make the lower back more comfortable.

Your head pillow matters here too.

A pillow that’s too thick may push your head too far forward.

One that’s too thin may not provide enough support.

Again:

Comfortable and supported beats theoretically perfect.

Your Shoulder and Hip Get a Vote Too

Sometimes we become so focused on the spine that we forget the rest of the body.

If you have shoulder pain and sleep directly on that shoulder every night, don’t be surprised if it complains.

The same goes for an irritated hip.

Sometimes changing sides, using a pillow for support, or temporarily avoiding direct pressure on the painful area can help.

And sometimes persistent shoulder or hip pain has very little to do with your sleeping position.

Your position may simply be aggravating a problem that’s already there.

That’s an important distinction.

What About Numb Hands at Night?

This is another common complaint.

You wake up and your hand is numb or tingling.

Sometimes you simply slept on your arm.

But repeated nighttime numbness can have several possible causes.

A nerve can be irritated at the wrist.

At the elbow.

In the neck.

Or somewhere else along its course.

If it happens occasionally because you’ve fallen asleep with your arm underneath you, that’s one thing.

If you’re repeatedly waking with numbness, tingling, weakness, or symptoms traveling into your arm or hand, it’s worth finding out why rather than simply buying another pillow.

Don’t Turn Sleep Into Another Thing to Worry About

This may be the most important advice in the article.

People already worry enough about sleep.

Now we’re tracking sleep stages.

Buying special mattresses.

Trying different pillows.

Monitoring watches.

Changing room temperatures.

Listening to sleep sounds.

And worrying that we’re sleeping incorrectly.

You don’t need to lie perfectly still in an anatomically ideal position all night.

Your body is allowed to move.

If you’re comfortable, sleeping well, and waking up feeling good, you probably don’t need to fix your sleeping position.

If You Wake Up Hurting, Experiment

Before you spend thousands of dollars replacing your mattress, try the simple things.

If you’re a side sleeper, experiment with the height of your pillow.

Try a pillow between your knees.

If you’re a back sleeper, try putting a pillow underneath your knees.

If you’re a stomach sleeper with neck pain, experiment with a thinner head pillow or gradually try another sleeping position.

And pay attention to what happens.

Do you feel better?

Worse?

No different?

Your body will give you useful information.

Sometimes the Problem Isn’t Your Bed

This is another thing I see.

Someone has back or neck pain.

They buy a new pillow.

Then another pillow.

Then a mattress topper.

Then a new mattress.

Six months later, they’re still hurting.

At some point, we have to consider the possibility that the bed isn’t the problem.

If a joint is irritated, a muscle is injured, a disc is involved, or a nerve is being aggravated, changing pillows may make you more comfortable without addressing the reason you’re hurting in the first place.

That’s where an examination becomes useful.

At O’Hara Family Chiropractic, I look at how the neck or back is moving, what positions reproduce the symptoms, whether nerves may be involved, and whether the problem appears appropriate for chiropractic care.

Sometimes changing the sleeping position is part of the answer.

Sometimes chiropractic treatment may be appropriate.

Sometimes exercise or another approach is needed.

And sometimes the problem needs to be evaluated somewhere else.

The pillow isn’t the diagnosis.

The Bottom Line

There is no single perfect way to sleep.

Side sleeping isn’t automatically good.

Stomach sleeping isn’t automatically bad.

Back sleeping isn’t automatically best.

The better question is:

How do you feel when you wake up?

If you’re comfortable and sleeping well, don’t make yourself crazy trying to achieve perfect sleep posture.

If you’re waking up stiff or sore, experiment with some simple changes.

Support your neck comfortably.

Use pillows to make your hips or lower back more comfortable.

Avoid spending long periods directly on a painful shoulder or hip.

And if you’re continually waking up hurting despite changing positions, find out what’s actually causing the problem.

At O’Hara Family Chiropractic, that’s where we always start:

Find it. Fix it. Leave it alone.

And hopefully get some sleep.