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March 07, 2019

Some things to consider before picking a position in bed

Side, stomach or back: Sleep on it to figure out what works

Opinion Sleep
03052019_thanuja_sleep_positions Photo credits, clockwise from top left:/Bruce Mars from Pexels; Vladislav Muslakov on Unsplash; and John-Mark Smith from Pexels

Sleeping positions: supine, top left; stomach-prone, top right; and fetal.

One of the questions I get asked is: “What’s the best position to sleep in?”

There’s an old doctor joke where the patient says, “It hurts when I press here. What should I do?” The doctor says he has a cure and replies, “Don’t press there.” Not the best joke, but the take-home message is, if it hurts, don’t do it.

If you’re having frequent awakenings and needing to reposition during the night, or if you are stiff and sore in the morning, then there’s a possibility the way you’re sleeping may not be what’s right for you.

So let’s take a look at some positions:


This position can have some cosmetic detriments. Your face is pressed against the pillow increasing the likelihood of wrinkles. Plus, there are oils and dirt in the pillowcase that can clog pores as your face lays against the pillow all night and increase the risk of acne. As you lay in this position, fluid pools and can cause puffiness in the face … particularly around the eyes.

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When you’re lying on your stomach, there may be a strain on the neck and lower back. Your breathing is affected as well since you can’t get maximal lung expansion if you’re lying on your chest.

If you do sleep in this position: Keep the pillow thin so the neck is not extended too much. You can decrease strain on the lumbar spine with a pillow under the pelvis.


This position can also increase wrinkles and acne by smushing the side of the face against the pillow. If you are in the fetal position and your knees are pulled up with your chin tucked in, you may prevent deep breathing and the back may arch unnaturally. There also may be uneven weight distribution on pressure points such as the shoulder, hips and legs causing pain or nerve impingement. You might get numbness or a pins and needles feeling in your upper or lower extremities if you are on your side too long.


Dr. Thanuja Hamilton is a board-certified sleep medicine specialist.

If you sleep on your side: Try to keep the back straight and avoid tucking the knees and chin in too much to allow for full expansion of the lungs. Have a thin pillow between the legs for neck and back placement. It can also prevent the top leg from pulling the hips and knees out of alignment. Stay on the left side which can improve blood flow, cause less strain on your internal organs and decrease acid reflux as compared to sleeping on the right. Sleeping on the right (and back) allows for more relaxation of the lower esophageal sphincter (the closure between the throat and stomach) causing it to open and allow acid to creep up from the stomach.

The good news is sleeping on your side is the optimal position for decreasing snoring and apneas (airway collapsing).

To train yourself to sleep on your side, you can try bumper belts which are belts that you wear around your waist that have a foam or inflatable bump on the back that prevents you from being able to lie on your back. There are also pillows with a center elevation that prevent you from being able to roll on your back.

You may want to consider a side-sleeper pillow that has a tunnel for you to put your arm through or other pillows that have indentations on the sides that allow your face to fall into an opening, so it’s not pressed against the pillow.

11132018_bedding_UnsplashPhoto by Krista Mangulsone/on Unsplash


There really is no right or wrong position for sleep, but if you ask me what my favorite position is, this would be the answer. The spine is in its most natural position. The weight of the body is more evenly distributed as compared to the side. The face is relaxed and not pressed against a pillow, and you’re not twisting your neck.

There are a couple of downsides to sleeping on your back. Aside from an increased risk of acid reflux, the problem with back sleeping is that there is an increased risk of snoring and apnea when the tongue and contents of the throat collapse into the airway.

If you sleep on your back: A soft tubular pillow such as a bolster or rolled towel under the knees can ease tension and promote the natural curvature of the spine. A wedge pillow or adjustable bed can decrease acid reflux and snoring by raising the head without bending the neck and avoids causing the chin to tilt down into the chest.

You can train yourself to sleep on your back with a wall of pillows on your sides or a weighted blanket. A wedge pillow also makes it easier to sleep on your back, and a pliable pillow such as buckwheat or even a U-shaped travel pillow can keep you from rolling to your side.

Regardless of the position, take a moment to unwind and relax before getting into bed. Stretch when you get out of bed. Change the sheets weekly. You can push it longer if you take nighttime showers, but keep in mind that other factors such as sleeping in the nude, night sweats, pets, kids or partners in the bed can affect cleanliness. Pillows should be replaced every two years and remember they can trap dirt and dust, so wash them, too. And make sure you replace your mattress every 5-10 years, or you’ll have an uneven, poor foundation to start with.

Dr. Thanuja Hamilton is a board-certified sleep medicine specialist with Advocare Pulmonary & Sleep Physicians of South Jersey in Mount Laurel. She will be writing occasionally on sleep topics.

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