What’s the best position to sleep in? (and other sleep questions)

Dr. Robin Armstrong & Dr. Jody Freedman [Chiropractors]

Are you waking up stiff and sore? Feeling like your mattress and pillow might be contributing to your back or neck pain? Not a day goes by in our practice where we don’t get asked about sleep and back pain. The reality is we spend a lot of time sleeping, and our position and bed can make a big impact. This is a big topic but let’s try and tackle a few of our patients’ most asked sleep questions:

What kind of Mattress should I buy?

The best mattress for you is one you can test out and exchange or return before you commit. A few minutes in a store is not enough to determine how a mattress is going to feel night after night. To start, our general advice is to choose the firmest mattress that feels comfortable to you, with enough cushioning to avoid pressure points but still keeps your spine in a neutral position. That cushion level will be different for every person. If you and your partner have different firmness needs, consider a firmer mattress with a single foam topper for the side of the bed that needs more cushion.

Each type of mattress has it’s pros and cons but they all are worth considering. Innerspring mattresses can offer good support, are more breathable (and thus cooler) than its all-foam counterparts, and comes in a range of firmness levels. Consider a tight top version instead of a thicker pillow top if it is enough cushion for you, as the top layer is the first to break down and form divots.

Foam mattresses can be affordable but they are not all created equal. Cheaper ones tend to have poorer foam density and compress more easily. Better quality ones can be more supportive but lead to stiffness for some by molding to your body and keeping you in one position. They also can sleep hot.

If you like the feel of foam, consider a Hybrid Mattress which adds more layers of foam to a spring coil base or Adjustable Air Mattress which has pockets of air under a foam upper layer.

For a few more insights watch the consumer reports video at the bottom of this page.

What’s the best pillow for a back/side/stomach sleeper?

A pillow is another very personal choice depending on your body and sleep position. If you are a side sleeper, your pillow needs to be high enough to fill the space between your neck and shoulder, so your neck is not tilted to one side or the other. If you are a back sleeper, your pillow shouldn’t be so high that that it causes you to tuck your chin, but also not so low that your chin is jutting up towards the ceiling. If you can’t give up stomach sleeping (more on that later), no pillow at all is the best choice, or the lowest profile pillow so that your neck doesn’t end up in in extension. Pillows can also be used for support in other areas of your body depending on your sleep position (see below).

We tend to recommend the Mediflow water pillow for both side and back sleepers. It looks like a pretty standard poly-fill pillow but has an integrated water bladder that can be filled to the appropriate height for your sleep position. It also molds around your head and neck to give flexible support.

If your neck is sore after sleeping, remember that all pillows compress over time and it might be time to replace your once favorite pillow.

What’s the best position to sleep in?

Back sleeping: Great for people with neck pain, shoulder pain, or hip pain that is sensitive to pressure in a side lying position. Low back pain or tension can be relieved by placing a pillow under the knees OR rolling a towel under the curve of the low back so that the muscles can relax with support. If your neck feels like it needs more support, rolling a towel and placing it under the curve in your neck, or under each side of the pillow to keep your neck in a neutral posture can often be relieving.

Side sleeping: Great if you snore or have heart burn, lumbar spinal stenosis or if lying on your back causes low back pain. Your neck is best supported if your pillow fills the space between your head and shoulders. Placing a pillow in between your knees helps keep your pelvis and low back in neutral, avoiding twisting. Hugging a pillow is helpful if your upper back tends to stiffen, or if you get pain near the shoulder blades from rib irritation. Body pillows can serve both functions with one larger pillow you can hug and place between your legs.

Stomach Sleeping: This is the least ideal position to sleep as it causes the low back to go into extension and the neck to turn significantly to one side. This often results in low back and neck pain from jamming the joints together and tightening of the surrounding muscles. If sleeping on your stomach is a hard habit for you to break, try a very slim (or no) pillow under your head and a pillow under your stomach or pelvis so that your low back is less extended. For some types of low back pain (eg: disc herniations) you might find relief sleeping on your stomach. If that allows you to get restorative sleep and lets your body heal, then spending a few weeks in this position may be worth it.

Set yourself up for a restful sleep

If pain or discomfort is waking you at night or is there first thing in the morning, you likely will benefit from a short stretching or mobility routine before you head to bed. Just 5 or 10 minutes can lengthen the time you are able to sleep comfortably. You may also find a heating pad or a hot shower before bed can relax your muscles and give some relief.

If you are still waking up sore after trying a few of these tips you may need some more specialized advice and treatment. Dr. Jody or Dr. Robin can help you get to the bottom of things and get a better nights sleep.