People often underestimate how important sleep is to their overall health. If you’re reading this, you’ve taken a great first step to optimizing your sleep. A bad sleep position can cause things such as back and shoulder pain, snoring, and even acid reflux. Have you tried different pillows but still wake up in pain? Let us help you get in the right position for you. Here we’ll review the benefits of different sleep positions, where the pillow actually goes, and what people often can get wrong.
Reflux
Sleep this way
- The best sleeping position for reflux at night is lying on your left side.
- You’ll want to position your pillow so that the head and the upper body are raised as a slope.
- Instead, use a wedge or raise the head of the bed.
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- What you don’t want to do is just add extra pillows under the head that bend the neck.
- It’s always best to avoid lying flat right after you eat.
- You’ll also want to avoid eating a big late meal and sleeping on your right side.
Why it works: Lying like that causes the stomach to sit below the esophagus. The gravity boost helps keep stomach acid down, whereas lying on the right side tends to make it worse.
A 2022 study found that participants lying on their left side experienced shorter acid exposure time with faster acid clearance compared to right side and back sleeping.
Snoring and sleep apnea
People often group snoring and sleep apnea together but what you may not realize is that not all snoring means that you have sleep apnea. Sleep apnea is a serious but common sleep disorder. Symptoms of sleep apnea are repeated interruptions or shallow breathing during sleep. Snoring may be a warning sign of sleep apnea but is not indicative that you are having trouble breathing.
Sleep this way
- The best position for snoring and sleep apnea is sleeping on your side and always avoiding sleeping on your back.
- You might even try a body pillow that can help you stay more comfortably on your side.
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- Severe sleep apnea still needs evaluation and treatment.
Why it works: When you sleep on your back the tongue and the soft tissues in the mouth and throat fall back and can lead to a more narrowed airway. But if you sleep on your side it keeps it more open.
Clinical trials found that side sleeping led to fewer apnea events for those affected by positional sleep apnea.
Lower back pain
Sleep this way
- To help manage this pain, try sleeping with a pillow between your knees or on your back with a pillow underneath your knees.
- You can try placing a pillow between the knees, making them hip-width apart, and placing the head pillow at your shoulder gap.
- If you’re lying on your back, you can try a pillow under the knees to help give you additional support while you rest.
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- You’ll want to avoid sleeping on your stomach.
Why it works: Both of these positions allow you to keep your spine in a neutral position and it takes the arc out of the lower back. That’s because the arches of the back become exaggerated along with the twisting of the neck and a sagging mattress.
A 2021 study suggested that sleep position leads to better alignment and comfort.
Neck pain
Sleep this way
- An ideal position for neck pain is lying on your back or on the side.
- Choose a lower, flatter pillow under the head that also supports the neck.
- If you lie on your side, a taller pillow that fills the shoulder gap so the head sits level is also a helpful option.
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- With neck pain, you’ll want to avoid sleeping on your stomach.
- Don’t use a pillow that is too high or too flat for the position that you’re sleeping in.
Why it works: With both, you’ll need to ensure that the head and neck are in line with the spine. That keeps the neck in a neutral position instead of being bent up or dropped down overnight. That’s because it twists the neck.
A 2021 systematic review and meta-analysis concluded that participants using supportive pillows saw less neck pain, waking pain, and disability as a result of the shape and height of the pillow.
Shoulder pain
Sleep this way
- If you’re living with shoulder pain, try sleeping on your back.
- You may also try sleeping on the opposite side of the painful shoulder, being mindful to never sleep on the painful shoulder itself.
- If you sleep on your back, a small pillow or even a folded towel under the affected arm can help keep it slightly away from the body but still supported.
- If you sleep on your side, hug a pillow so the top arm rests supported.
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- Make sure it’s not tucked underneath you.
- You also don’t want to use a high pillow that pushes the shoulder forward.
Why it works: If you lie on the affected shoulder, it compresses it all night long. However, by sleeping on the other side, you take some of that pressure off.
There isn’t recent clinical evidence to show that a sleep position and pillow placement have a proven impact on shoulder pain. However, clinically it avoids direct pressure and compression to the painful shoulder.
Hip and knee arthritis
Sleep this way
- Try sleeping on your side with a pillow between your knees.
- You can also try sleeping on your back with a pillow under the knees.
- If you use a pillow when sleeping on your side, make sure that the top leg stays level with the hips.
- If you sleep on your back, use a pillow that’s thick enough to place under the knees to ease the pull, but don’t use a big roll that can bend it too much.
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- Always avoid sleeping on your painful hip.
- You’ll also want to skip sleeping on your stomach or in a position that keeps your knees crossed all night.
Why it works: Both of these options keep your hip and knees aligned and that takes pressure off the painful joints.
Similar to shoulder pain, there’s no direct clinical evidence that a specific sleep position reduces hip and knee arthritis pain. Pillow placement does keep the hips level, preventing the top leg from pulling the pelvis out of alignment.
Pregnancy
Sleep this way
- Especially in later pregnancy, sleeping on the left side can help.
- When you sleep on your left side, place a pillow between your knees, a pillow under your belly for support, and one behind the back so you don’t roll flat.
- The head pillow should keep your neck neutral.
- A pregnancy body pillow can help you get in the right position.
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- You always want to avoid sleeping flat on your back in later pregnancy.
- Stomach sleeping is also not an option when it becomes uncomfortable.
Why it works: It takes the pressure off of the large vein in the body that returns blood directly to your heart. It also helps improve blood flow to the uterus.
However, sleeping on the back may be associated with late stillbirths.
Sinus congestion
Sleep this way
- Sleeping on your side with your head elevated helps the mucus drain from the sinuses instead of pooling.
- Use pillows to keep your head and upper body raised at a slope.
- Always keep the neck neutral and skip extra pillows that can bend the neck forward.
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- You’ll also want to avoid lying flat or face down while you sleep.
Why it works: That’s why when you lie flat, it can make congestion feel worse. We do know that elevation lets gravity help with drainage, and that can lead to symptom relief.
There isn’t strong clinical evidence related to sleep position and sinus drainage.
Shortness of breath lying flat
Sleep this way
- Try keeping your head and upper body elevated during sleep.
- Place pillows to keep your upper body raised as a slope, or consider using a wedge or raise the head of the bed.
- As long as you keep your neck neutral, you can also try pillows that support the arms and the back so you’re not sliding down.
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- With shortness of breath, you don’t want to lie flat on your back or just stack pillows that only bend at the neck.
- Make sure to let your clinician know if you’re experiencing new or worsening shortness of breath when lying flat.
Why it works: When we lie supine, it allows fluid and pressure to shift in a way that makes breathing harder for some people. Sitting up and working with gravity can help ease that.
There’s strong clinical evidence that proves that lying flat increases congestion in the lungs and sitting up relieves it.
Position by ailment at a glance
What a pillow is actually doing
Your pillow should help maintain a neutral alignment of your spine. This means your spine is in a straight line with no flexion (head dropping too low) or extension (head tipped up).
One easy way to check this position is to make sure your ear, shoulder and hip are all in line. The height of a pillow should fill in the space between your head and the mattress (or head and shoulder when sleeping on your side).
For most people, this means back sleepers do best with a flatter, lower profile pillow and side sleepers prefer something a little taller. Often, the same pillow that works for one position doesn’t work for the other.
When position is not the answer
It’s important to get checked out right away if you’re having trouble breathing, new or worsening symptoms, or pain that wakes you up at night. A wedge pillow or side sleeping position may help some people with shortness of breath. However, breathing problems when lying flat on your back can be a sign of many different conditions and it’s important to have them checked out by a clinician.
Pain that wakes you up at night or doesn’t get better with good pillow support and sleeping positions should be evaluated by a clinician.
Wedge pillows and side sleeping can help with some sleep apnea symptoms, but they’re not a substitute for medical treatment. Talk with your clinician if you think you may have sleep apnea.
The Bottom Line
If you’re experiencing sleep apnea or shortness of breath when lying flat, please contact your clinician for a proper diagnosis and treatment plan as soon as possible. Don’t expect the perfect position to solve all your sleep problems on its own. There’s mixed scientific evidence on how sleeping positions affect quality and comfort.
So, don’t worry if you don’t find relief with just one position. Try out a couple of them, and follow the recommended pillow placements.
It can also take a few nights before you start feeling a difference. Hopefully, you’ll feel a little better tomorrow thanks to finding a better position to fall asleep in.
Stephanie Wright, RN, BSN, is a Registered Nurse with more than 15 years of experience in critical care, mental health, managed care, and clinical leadership.
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