When I was a kid mom always told me, stand up straight, put your shoulders back. I might have rolled my eyes a little, but I did it—and you know what? I felt better, every time.

Years later, when I made sleep my life’s work, I realized that good posture doesn’t just make a difference during the day. We spend a third of our lives in bed. But most of us never learned how to achieve the optimal posture for sleep.

Sleep posture is different than sleep position. The right sleep position is an essential part of healthy sleep posture—but it isn’t the whole story. Think of it this way. You have a preferred position for the work you do every day. If you work at a desk, you might be sitting or standing, or a combination of both. That’s your position for work. Your work posture involves so much more than position. It includes the equipment you’re using—Does your chair support your lower back? Is it at the right height? Is your computer positioned to avoid stress on your wrists, and to keep you from craning your neck? It also includes attention to the way you hold and carry your body while you work. You can have all the right equipment in place, but if you’re slouching in your chair, or casting all your weight onto one leg at your standing desk, you’re going to feel stiff, uncomfortable, even in pain at the end of a long day. Stiffness and pain in the neck and shoulders, back pain, sciatica, and hip pain are common conditions that arise from chronically poor waking posture.

Sleep posture requires the same components: the right sleep position, great sleep equipment, and mindful attention to your body’s natural alignment, from head to toe. Poor sleep posture also exacerbates those waking aches and pains in the hips, back, shoulders and neck, and can create new problems with pain and stiffness throughout the body, particularly at the joints and at certain pressure points.

If you’ve given thought to your sleep position but haven’t ever really considered sleep posture, you’re not alone! Working with my patients to bring their awareness and attention to what sleep posture is, and how to sleep with great posture, has helped them get more comfortable, restorative rest. Today I’m doing my sleep posture consultation for you.

How does healthy sleep posture look and feel?

Good sleep posture has your body in relaxed and in alignment.

Alignment starts with the position of your spine. When lying down for sleep, your spine should follow its natural curves. There are 3 different curves in the spine—at the neck, the middle back, and the lower back. For these curves to fall naturally during sleep, the whole body must be supported. A strong sleep posture allows these natural curves to be maintained throughout the night, no crunching at your neck, no sagging of your lower back, no torqueing of your middle back.

In addition to a spine in its natural position, good sleep posture has the hips, shoulders and head lining up. (You can use your ears as a guide for your head.)

Think for a moment about good waking posture. Your head is held above your shoulders (not pushed back or craned forward) and your shoulders sit over your hips (not dipped forward or pushed behind). With the muscles of your core engaged, your spine follows its 3 natural curves.

The same basic posture applies to sleep. But there are a couple of key differences.

  1. When we are awake, the muscles and ligaments of our body are working actively to hold our posture, whether we’re still or in motion. During sleep, the muscles and the ligaments relax. That relaxation is essential for healing and rejuvenation of those tissues.
  2. Our posture is more static—or stationary—during sleep than during most waking activity. We maintain static posture during the waking day, too—sitting in a chair, standing at a kitchen counter. But at no point during the 24-hour day does our posture remain static for longer that in does during sleep.

This is why support is so important for holding the body in relaxed alignment throughout the night. I’ll talk more in a moment about the support that comes from a great mattress and the right sleep position.

Right now I want to focus on what this sleep posture feels like. To help, I’m going back to my mom’s advice, and I’m going to ask you to put yourself in a healthy upright posture, as a way to get in touch with the feeling of your body in alignment.

  • Stand up straight with your feet shoulder-width apart.
  • Distribute your weight between the balls and heels of your feet. For most people, that means shifting some weight forward to the balls of the feet. (A lot of us sit back on our heels.) Relax your toes.
  • Center your hips over your knees.
  • Relax your shoulders. Let them drop away from your neck. Center the tops of your shoulders over your hips.
  • Let your arms fall naturally to the sides.
  • Level your head and look straight ahead. It can be helpful to think about a string pulling up from the back of your head at the base.

Feel relaxed, strong and centered? No clenching, craning, compression or tightness? That’s a body in alignment. No matter the sleep position you choose, this basic alignment—and the feeling that comes with it—is what you’re shooting for in your sleep posture.

The foundation of great sleep posture? Your mattress.

A supportive mattress is essential for healthy sleep posture. Different people need different types of support—and each of us may need different kinds of support throughout our lives. That’s why there are so many different options for mattresses. It can be overwhelming to sort through these options. I’ve done a ton of research and writing about mattresses of all types, for different budgets, body types, sleep positions and pain conditions. Here’s where you can read up on all the details about the mattress options available to you, and why it matters to select one that fits your individual needs. And if you want to read what bed I sleep on we have that as well.

What do you want from your mattress? For sleep posture, you need a mattress to provide your body with sufficient support to bring the spine into alignment and allow your muscles to relax during sleep. The key is to find the right degree of support without sacrificing comfort. Let’s talk briefly about comfort and support, because they aren’t one and the same and people often get them confused.

A mattress provides support by pushing against the body, allowing the spine to relax and fall into alignment. Not every individual needs the same level of support to allow the spine and body to relax and align. And at different points throughout life, each of us may need a different degree of support from our mattress. This can be due to changes in our strength, muscles, and even the density of our bones! They key points about support to remember are these. You want a mattress that:

  • supports your body without sinking at the hips
  • allows relief and comfort at pressure points, including the knees, hips, shoulders and head
  • lets your muscles relax throughout the body, especially at your back

Each of us has our own experience of comfort—it’s a subjective feeling, not an objective measurement. But when thinking about a mattress, remember that comfort is the product’s ability to keep you in alignment over time. You are the only one who knows whether a firm bed or a softer one is more comfortable for you.  One important thing to know: as you age, your comfort preferences will likely change. As we get older, and pain issues become more common, we often need a softer mattress. It has to do with their skin. As we age our skin gets thinner (less fat) which means less cushion on our bodies during the night.

If you experience stiffness or pain in the morning, even a night of sleep that feels comfortable, then your mattress is not delivering you the right support.

Keep this in mind: firmness does not equal support. From extra-soft to super-firm, support comes from a well-constructed mattress made with high-quality materials that keep your spine in allignment.

Beyond comfort and support, there are three things I want you to consider as part of selecting a mattress that encourages good sleep posture.

  1. Body type. Tall, heavy, and large-framed people need to pay extra attention to support, durability, and pressure-relieving capabilities of a mattress. With extra support and pressure relief in a high-quality mattress, you can maintain a strong sleep posture and your sleep will improve—as will how you feel when you wake. Read about my top picks for mattresses for large body types
  2. Pain issues. Pain makes it harder to fall asleep and stay asleep. And feeling pain at night compromises sleep posture, as we toss, twist, and turn ourselves in search of relief. If you experience chronic or intermittent body pain, seek out a mattress that delivers support and pressure relief for your specific pain centers. Here are my picks for the best mattresses for hip pain, the best mattresses for back pain, and my guide to how to sleep with back pain. (Back pain is what sends Americans most frequently to their doctors office, and 80% of us will suffer from back pain at some point in our lives, says the American Chiropractic Association.)
  3. Activity level. If you’re an athlete or a high-activity person for whom recovery is important, then selecting a supportive mattress is critical for you. It will make a difference in helping your body rebound stronger after hard workouts, while it also facilitates the sleep posture you need to stay limber, loose, and pain free. Here are my recommendations for mattresses for athletes and very active people.

How often do you need to replace your mattress? Every 8-10 years. People tend to sleep on their mattresses way too long. I get it. You’ve got a bed, you don’t think much—or at all—about replacing it. It’s a critical investment for health, but one that plenty of people put off for financial reasons.

Your body will tell you when it’s time for your old mattress to go. If you’re experiencing pain and stiffness regularly—3-4 times a week on a routine basis—it’s time to start looking for a new mattress, even if you haven’t had it for 8-10 years.

I always encourage my patients to buy the highest-quality mattress they can afford.  Lower-cost mattresses can meet your needs, but they won’t deliver sufficient support for as long as a more expensive ones, and you’ll need to replace it sooner.

If buying a new bed isn’t in your budget right now, consider adding a mattress topper. Mattress toppers are great tools for customizing your existing mattress, adding firmness or softness to a mattress that isn’t meeting your current needs, give some additional life to an older mattress. Here’s my guide to selecting the right mattress topper for you.

Your pillow matters, too. Select a pillow that supports the natural curve of your neck, and allows you to keep your head in alignment with your shoulders and hips. Avoid high pillows that elevate your head out of alignment—this leads to muscle strain not only in the neck but in your back and back and shoulders.

 The right pillow can be especially effective in helping alleviate back pain. Research shows that for patients with low back and lumbar pain, supportive pillows can reduce pain significantly, beyond what physical therapy often can do.

I recommend an ergonomic pillow like Everpillow, which is customized to suit different sleep styles and has been helpful especially for lower back pain.  

Finding the right sleep position for your optimal sleep posture

Let’s talk sleep position. There isn’t a single right one for everyone. But I will say, I think there is definitely a wrong one when it comes to achieving a healthy sleep posture. And that’s stomach sleeping. (Sorry, all you stomach sleepers–don’t worry, I used to be one as well.)

Why? When sleeping on your stomach it’s nearly impossible to maintain alignment in your spine. Your body is apt to sink at the stomach and pelvis, putting stress on your lower back. And stomach sleepers also often have their heads set too high, creating stress at the neck. (A very flat pillow, or no pillow at all, is best for stomach sleeping if you need to sleep in this position.) Stomach sleeping also puts the most pressure on joints, and typically causes the most moving around during sleep. The other sleep positions are all compatible with good sleep posture, and your choice will depend on your comfort and preference, as well as your individual health conditions.

Back sleeping

Not many of us sleep on our backs —the National Sleep Foundation estimates about 8% of us are back sleepers–but back sleeping may actually be the optimal sleep position for many people. And it’s definitely conducive to a healthy sleep posture. Sleeping on the back distributes weight evenly, with no excessive pressure on any given part of the body. From a back-sleeping position, with the right mattress and pillow, our bodies can fall quite naturally into alignment.

Back sleepers: using a pillow (not too big or thick) under your knees can help to keep the natural curve of your lower back, helping your back muscles relax and relieving pressure on your spine. 

Back sleepers don’t move around as much during the night as sleepers in other positions, which aids in maintaining a good sleep posture and contributes to more refreshing sleep.

For people with physical pain or stiffness, back sleeping can provide relief. People with arthritis often find it easier to sleep soundly and more comfortably on their backs. There are some big exceptions, though. If you have back pain, it can be uncomfortable–and counterproductive—to sleep on your back. (Try side sleeping instead, after talking to your doctor.) And some types of neck pain may also be aggravated by sleeping on your back. When it comes to sleeping well with pain, it’s a good idea to try different positions to determine what gives you the most comfort and relief from tension.

Who else shouldn’t sleep on their back? People who snore or have obstructive sleep apnea. Sleeping on your back can aggravate snoring, and make the airway more likely to collapse, leading to more frequent episodes of apnea. People who snore or have sleep apnea are better off sleeping on their side. In people with OSA, avoiding back sleep has been shown to reduce blood pressure.

If sleep posture were the only consideration, a back-sleeping position would be the optimal choice for most of us. But there are other factors to consider. Each of us must weigh the drawbacks to back sleeping like the ones I’ve discussed above, and also benefits from other sleep positions, as well as our own comfort.

Side sleeping

Side sleeping has a lot of benefits, and it’s a comfortable position for many people.  Side sleepers tend to turn in bed more than back sleepers, which can break alignment if you don’t know how to turn yourself properly.

If you’re a side sleeper who turns in your sleep, you can help maintain alignment by rolling your body in a single motion and as a complete unit, rather than turning at your waist to move your upper body, and having your lower body follow.

Side sleepers may find that a pillow between the knees helps keep the spine in alignment, and hips in line with shoulder tops. Just make sure it’s small enough that you can turn easily, and keep your head, shoulders, and hips aligned as you roll. 

There are a number of health conditions that can benefit from side sleeping, which in addition to its comfort make it an appealing option:

And there are even specific benefits for sleeping on the right side or left side:

Left side sleeping is beneficial if you have acid reflux. Studies show acid reflux is worse when people lie on their right side. Pregnant women are advised to sleep on their left side, to help circulation and blood flow to the placenta. Left-side sleeping may help digestion.

Side sleeping appears to be good for heart health. Research shows that in particular right-side sleeping may lower nervous system activity, which reduces heart rate and blood pressure. And studies show that people with heart failure tend to avoid sleeping on their left sides.

There are some drawbacks to side sleeping. You’re more likely to develop wrinkles than if you sleep on your back, because of the pressure put on the side of your face. You’re also more likely to disrupt circulation in your arm, because of the pressure of your body. This can cause that annoying pins-and-needles tingling sensation, which can disturb your sleep at night.

Fetal position

This is a curled-up variation of side sleeping. When it comes to sleep posture, the fetal position can work, but you need to take care not to overdo it, and avoid curling up too tightly. Curling up too tightly breaks the important lining up of your head, shoulders, and hips, and can leave you feeling stiff the next morning. A too-tight fetal position for sleeping also restricts breathing, preventing your diaphragm from functioning properly. 

To improve sleep posture, I’d like to see sleepers who rest in the  fetal position stretch out and transition to a side-sleeping position. If this is your preferred sleep position—and for many of you it apparently is—try using a body pillow to keep your body in a loose curl.

And remember, like healthy sleep itself, a great sleep posture is the result of all you do throughout the day. Paying attention to your posture during all your waking activities, from sitting and standing to walking the dog and going for a run, will help keep your spine aligned, your muscles and ligaments relaxed, and free of the stiffness and discomfort that so many of us take to bed at the end of a long, busy day.

Sweet Dreams,

Michael J. Breus, PhD, DABSM

The Sleep Doctor™

www.thesleepdoctor.com

 

 

 

 

 

 

 

References

 

American Chiropractic Association. Back pain facts and statistics. https://www.acatoday.org/Patients/What-is-Chiropractic/Back-Pain-Facts-and-Statistics

 

Baldini, Ellie. (December 3, 2020). How to find the best mattress for hip pain with expert insight from The Sleep Doctor. The Sleep Doctor™ Blog. https://thesleepdoctor.com/2020/12/03/best-mattress-for-hip-pain/

 

Baldini, Ellie. (October 23, 2020). Here are the best mattress toppers available online. The Sleep Doctor™ Blog. https://thesleepdoctor.com/2020/10/23/best-mattress-toppers/

 

Baldini, Ellie. (October 29, 2020). Rest and recover with The Sleep Doctor’s 7 best mattresses for athletes. The Sleep Doctor™ Blog. https://thesleepdoctor.com/2020/10/29/best-mattress-for-athletes/

 

Baldini, Ellie. (October 14, 2020). What’s the best mattress for heavy people? The Sleep Doctor™ Blog. https://thesleepdoctor.com/2020/10/14/best-mattress-for-heavy-people/

 

Baldini, Ellie. (July 24, 2020). How to find the best mattress for back pain, according to The Sleep Doctor. The Sleep Doctor™ Blog. https://thesleepdoctor.com/2020/07/24/best-mattress-back-pain/

 

Berger, M et al. (1997). Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients. Journal of Human Hypertension, 11(10): 657-64. https://pubmed.ncbi.nlm.nih.gov/9400908/

 

Breus, Michael J. (October 1, 2020). I have a Hastens bed. Here’s why it’s worth the cost and more. The Sleep Doctor™ Blog. https://thesleepdoctor.com/2020/10/01/hastens-mattress-bed/

 

Stony Brook University (2015, August 4). Could body posture during sleep affect how your brain clears waste? ScienceDaily. https://www.sciencedaily.com/releases/2015/08/150804203440.htm

 

Fujita, M et al. (2000). Effects of posture on sympathetic nervous modulation in patients with chronic heart failure.Lancet, 25: 256(9244): 1822-3.

Leung, Richard S.T. et al. (2003). Avoidance of the left lateral decubitus position during sleep in patients with heart failure: relationship to cardiac size and function. Journal of the American College of Cardiology, 41(2): 227-230. https://www.jacc.org/doi/full/10.1016/s0735-1097%2802%2902717-1

Parker Pope, Tara. (2010, October 25). The benefits of left-side sleeping. The New York Times.https://well.blogs.nytimes.com/2010/10/25/the-benefits-of-left-side-sleeping/

Prommanon, Bundit et al. (2015). Effectiveness of a back care pillow as an adjuvant physical therapy for chronic non-specific low back pain treatment: a randomized controlled trial. Journal of Physical Therapy Science, 27(7): 2035-2038. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540812/

Tuomilehto, Henri. (2009). Avoiding the supine posture during sleep for patients with mild obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine, 180(1): 101-102. https://www.atsjournals.org/doi/full/10.1164/ajrccm.180.1.101a