Is There a 'Best' Sleep Position?


By: Kim Rivera Huston-Weber

It's surprising to no one that sleep is crucial to our overall well-being. But can something like our sleep position improve our health? Does sleeping on our side or back help lower our risk for certain conditions? We explore whether there's a "best" sleep position that can help you hack your overall health.

First: Does your sleep position matter?
"Positioning during sleep can affect many aspects of health, including sleep disordered breathing, gastroesophageal reflux, musculoskeletal pain, neurological health, and even cosmetic wrinkles of facial skin," says Philip L. Pirtle, a pulmonologist and sleep medicine specialist with Houston Methodist. "Sleeping on your stomach, on your side, or fully supine [on your back] has different effects on each of these conditions."

While Dr. Pirtle says that there isn't a "worst" or "best" sleep position for general health, there are general benefits and downsides to sleeping in certain positions.

Side sleeping
This sleep position is a fan favorite. Many surveys and studies show that side sleeping is by far the most popular sleep position. And perhaps for good reason.

"Sleeping on the side seems to have the least negative impact on health," Dr. Pirtle says.

Side sleeping is associated with several potential health benefits. Interestingly, the side of the body a person sleeps on can affect what benefits they may receive.

"There is reasonably good evidence that sleeping on the side or with the head slightly elevated is associated with a lower incidence of neurodegenerative disease than sleeping fully supine," Dr. Pirtle says. "This does not mean that sleeping supine causes dementia, but there is an association."

It's thought that the central nervous system collects waste throughout the day while we're awake. During sleep, cerebrospinal fluid will flush out this waste, including beta amyloid, a protein that clumps together and creates the plaque associated with Alzheimer's disease. Side sleeping, specifically on the right side, may help people clear this waste easier and better than other sleeping positions.

Trying to sleep while waiting for an antacid to kick in during an episode of heartburn can be a monumental task. For those with gastroesophageal reflux disease (GERD), sleeping on the side may help ease the issue.

"Sleeping on your side can make GERD less prominent," Dr. Pirtle says.

Noticing a trend yet? Side sleeping can be used along with other treatments to combat a common sleep disorder.

"Sleeping on the side is known as positional therapy for obstructive sleep apnea and can lower the tendency to obstruct and have inadequate breathing," Dr. Pirtle says. "For most people, though, this should not take the place of actual therapy such as CPAP or a mandibular advancement device."

Side sleeping is also recommended for those of us experiencing occasional aches and pains. According to Dr. Pirtle, sleeping on the side with a small pillow between the knees is the recommended position for dealing with neck and back pain.

Back sleeping
Back sleepers, we hate to break it to you, but there's not a lot of good news. Sleeping on your back, also called supine sleeping or back sleeping, does have benefits, but the downsides may outweigh them.

"Interestingly, sleeping fully supine can be beneficial for people with back pain and is the least likely to lead to facial wrinkles," Dr. Pirtle says. "But sleeping supine can worsen gastroesophageal reflux and is typically worse for people with obstructive sleep apnea, and for risk of neurodegenerative disease."

Back sleeping is associated with higher rates of snoring, especially in people with untreated obstructive sleep apnea. When we sleep on our backs, the position of the tongue and jaw can face downward, crowding the airway.

But for those with chronic back issues, maintaining a neutral spine position with a pillow or towel under the knees while lying on the back can help prevent stiffness or pain.

Stomach sleeping
If stomach sleeping is your preferred position, you are rare indeed. Called the prone position, sleeping on your chest and stomach is one of the least popular sleep positions. Various surveys and studies show that only 10% to 20% of people prefer sleeping on their stomach. And maybe it's fortunate that the number is that low.

"Sleeping on the stomach seems to have negative impact on several aspects of health," Dr. Pirtle says.

While stomach sleeping may help people keep their airway open, which may help decrease snoring and mild breathing issues while sleeping. That said, stomach sleeping might be the worst position for the spine. While on the stomach, someone would have to turn their head to one side to breathe easily. This can put stress on the neck and flattens the natural S-shaped curve of our spine while we sleep. This can make the position the worst for those with neck and back pain.

Worried about aging gracefully? Stomach sleeping also puts you at risk for "sleep lines," or "sleep wrinkles," horizontal or slanted lines on the fact that develop as we sleep. While more of a cosmetic issue than anything that can cause discomfort, the lines can develop for stomach and side sleepers alike.

Should I change my sleep position to be healthier?
Not necessarily, Dr. Pirtle says.

"While sleep position can have an impact on several aspects of health, maintaining a restful, organized sleep schedule is likely the most important in terms of overall health benefits," he says. "If your sleep is restful, and you have no overt symptoms such as sleep disordered breathing or gastroesophageal reflux, then changing your sleep position is not necessarily beneficial, especially if it disrupts your established sleep pattern."

Don't sleep on good sleep hygiene
Sleeping poorly in the short term or long term can have repercussions for our health. Dr. Pirtle recommends getting evaluation and treatment if you (or someone you love) are concerned that you may have sleep disordered breathing. Being cranky and having no gas in the tank during an afternoon is one thing, but the impact of untreated sleep disordered breathing can be very severe.

Paying attention to our overall sleep hygiene is important to getting quality shuteye, too. That means limiting screen time before bed, making sure your room is quiet and without distraction (no TV, even on mute!), dark or has minimal light, and giving yourself adequate time to wind down from your day. Regularly washing your sheets and vacuuming your mattress can help keep allergens such as dust, dander and pet hair at bay, so they don't disrupt your sleep.

And the most crucial part of any sleep hygiene routine? Prioritizing your rest.

"The most important aspect to sleep hygiene is to maintain a regular, restful schedule of sleep with adequate time asleep," Dr. Pirtle says. "Positioning can be part of maintaining that regular, restful sleep schedule."

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