A common question I receive from patients is: “What’s the best position to sleep in?” Although it’s possible there may be an absolute answer to that question; I work with each individual patient to modify the position in which they fall asleep. I may also modify a patient’s sleep position based on a particular musculoskeletal complaint they have. But regardless of pain and symptoms, there are certain modifications we can all make. So whether or not “you” are asking this question to help a certain condition heal better, or even prevent a condition from arising in the first place, it might be wise to heed these guidelines.
The basic concept is to take the strain off major muscles of our pelvis and spine. The goal of this is to get our spine and pelvis in the best alignment possible. Now I’ll discuss how to evaluate and if necessary, “correct”, different sleeping positions.
Let’s first deal with the “side-sleeper”. When sleeping on your side, the main areas to take into consideration are the pelvis/hips, neck, and low back. Most people realize that having a pillow between their legs is best, and that is true. However, to take it a step further, it would be wise to check the muscle tension and tenderness when you’re in that position (with or without a pillow). The main muscle to check would be the gluteus medius. This muscle lies on the side of the pelvis and connects into the femur at the greater trochanter, which is the large piece of bone that protrudes out of of the thigh bone at the very top on the outside. Simply apply pressure to the muscle in order to locate a tender area. Next, put a pillow between your legs and reapply pressure to see if it’s diminished or significantly less tender. If it’s not, you’ll need to adjust the height of the pillow between your knees until you find a level that allows the gluteus medius to relax and remain in a position that doesn’t cause strain and reduces tenderness the most. Usually, this position will be the normal alignment of your pelvis and hips when you are standing.
Next, check for tenderness in the muscles on the side of your neck that is facing up. These are the scalene muscles. If you find tenderness, adjust the height of the pillow until these muscles are relaxed. Again, this will usually be the position of the neck as if you are standing upright. That is, the head won’t be leaning more to one side than the other.
Lastly, feel for tenderness (or have someone else do it) in the muscles on both sides of your spine in your low back. If these muscles are tender, either flex or extend your hip joints by bringing your knees closer to or farther away from your chest. When you find the position that allows for the least contraction and tenderness of those muscles, stick with that.
Now let’s consider “back-sleepers”. Most people assume this is the best position to fall asleep in. That may or may not be true, and again, I don’t take a very ardent viewpoint on any sleeping position. These days, I’m happy if patient’s of mine get a minimum of seven hours of sleep.
When it comes to sleeping on your back, we again need to evaluate the tension of the low back and neck muscles. Check for tenderness in the muscles on both sides of the spine in the low back. If they are tender, put a pillow underneath your knees and recheck for tenderness in those muscles. Adjust the height of the pillow accordingly.
Also, the position of your head needs to be taken in consideration while sleeping on your back. Again, check for tenderness in the scalenes, especially those closer to the front of your neck. If you find tenderness, chances are that you need to lower your head so that it’s more in line with the rest of your spine – i.e.: not overly flexed with your chin too close to your chest. You may need to raise your head as well, but that’s why we check via palpating for muscle tenderness and adjusting the pillow accordingly.
Lastly, we come to the “stomach sleeper”. Even though I said I don’t take an ardent stance on one position or another, I would recommend against this. But if it’s the only position you can fall asleep in, so be it. The main areas to be concerned with here are the neck and low back.
First, check for tenderness in the scalenes, then use a pillow under your chest and see if you can find a pillow height that takes the strain off of those muscles. Additionally, check for tenderness in the muscles on either side of the spine in your low back. If these are tender, try putting a pillow under your abdomen and see if that helps. Again, it’s very likely that a pillow will help, but you’ll need to find the best thickness or height of the pillow in order for it to be most effective.
Sometimes it’s necessary or best to have someone else check for tenderness in these muscles. But regardless, you now have the tools to figure out the optimal way to adjust your sleeping position to prevent undue strain on your muscles and joints thoughout the night. This is of prime importance for people who wake up in pain, and/or have musculoskeletal issues with their neck or low back. But it’s also a way to help prevent problems in the future.
If you wake up in another position, simply go back to your optimal position and try to make it a habit. And by the way, if you’re a person who flip flops like a fish out of water all night, you may be hypoxic, or lacking an optimal amount of oxygen in your blood. This can be the result of many different things, like a diaphragm problem or a lack of proper rib motion.
I hope this information helps. There’s nothing I know of that can replace the benefits of an adequate amount of sleep. And why not do it in the optimal position for musculoskeletal health.
Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology
Great post, lots of great information and easy to understand with me.
Children spend most of the time every day in sleep. Children’s sleep may seem simple, but many problems are hidden, for example, many parents have made mistakes in coaxing children to sleep and correct child’s sleeping position.
Hi Dr. D’Aquila… this is a really informative article. I sleep on my side and often feel sore in my neck. It could very well be the height of my pillow. And I also suffer from hip pain in the mornings. I will try these adjustments to see if they help! Thanks.
Also, I was wondering if you could address the issue, in your blog, of starting an exercise regime. I have been living a rather sedentary lifestyle because I work in an office and on the weekends rarely have the time to get to the gym. I would like to start working out again, but worry about hurting myself if I jump straight into my old workout plan. Can you suggest some basic exercises to do to strengthen main muscle groups like ankles, etc before I start running on the treadmill again or start taking rigorous dance classes.
Thank You, Dr. D’Aquila! I’ve been needing information to help relieve nighttime jaw clenching. Although I wear a night guard, it had gotten to the point of a mild morning headache from the tension. I’m a back sleeper and have followed your suggestions. I’m happy to say that I’ve noticed some relief. I appreciate your taking the time to share your knowledge:)
I usually sleep on my side but every few months my hips and behind my knees are so sore sometimes that it is impossible to sleep!!! What am I doing wrong?
Dr. Rob D'Aquila
It’s very possible, and sounds like, this may have nothing to do with your sleep position. I’d seek out a qualified, licensed healthcare practitioner who knows about musculoskeletal health to help you out.
Dr. Rob D’Aquila
I typed in “gluteal muscle hypoxia during sleep” in my search engine and your blog on Sleeping Positions came up. However, I didn’t find information on muscle hypoxia during sleep. Do you have experience with this complaint or do you know of any research on this topic?
My gluteals and lower back are so tight in the morning I can’t stand up without intense pain. (I’m a side sleeper with pillow). The pain usually subsides in fifteen minutes after moving around. If I use a massager or heating pad before I get out of bed, the problem is greatly reduced. While this solution sound simple, it competes with the urgency I have in the morning to urinate. You can guess which one wins this competition.
Thanks, in advance for any references you can give me.
Dr. Rob D'Aquila
Thank you for your comment. It may actually be hypoxia that you’re experiencing. However, I find it hard to think that you’d get hypoxia in only one muscle. I generally find that those with systemic hypoxia “flip flop” around the entire night in bed, like a fish out of water. It sounds like this is specific, unless of course you do toss and turn “excessively”.
I’d look to see if there was a structural issue and look to correct that. Personally, I’d look to find a competent applied kinesiologist.
Additionally, I’d look into the urinary urgency issue. It could be a lack of thiamine (often from sugar metabolism issues), fibroids, or maybe even a UTI – I’d rule those out.
Dr. Rob D’Aquila