The Best Sleeping Positions for Better Health

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One of the things I hear most often at the office is “I tweaked my neck / my back / my shoulder while I was sleeping.”

As surprising as it sounds, many people never learn how to position themselves for a good night’s rest that doesn’t lead to injury. They wake up with pain that wasn’t there before they went to sleep — or pain that has gotten much worse.

Fortunately, research shows that small adjustments to your sleeping position — and often just one properly placed pillow — can dramatically reduce stress on your body. Let’s take a look at the findings.

First Principle: Keep the Spine Neutral

Almost every study reaches the same conclusion: The goal isn't necessarily a specific sleeping position — it's maintaining a neutral spine.

Imagine the posture a physical therapist would encourage when you're standing. That's approximately what you want while lying down.

• Your head should not be bent forward, backward, or sideways.
• Your hips should remain level.
• Your shoulders shouldn't collapse inward.

When alignment is maintained, muscles can finally relax — rather than spending hours overnight preventing joints from twisting.

Side Sleeping: The Best Overall Choice for Most People

For most adults, side sleeping is generally considered the best compromise between comfort, spinal support, and overall health.

Recent systematic reviews found that side sleeping can reduce spinal stress — when alignment is maintained.
Poor side-sleeping posture, on the other hand, can actually increase neck and low back pain.

Ideal side sleeping looks like this:

• Head centered — not tilted toward the mattress
• Nose aligned with the center of your chest
• Knees slightly bent
• Hips stacked
• Shoulders stacked
• Avoid curling tightly into the fetal position

Add a Pillow Between the Knees

This is one of the simplest interventions with the biggest payoff. Without support, the top leg falls forward, the pelvis rotates, the lumbar spine twists, and SI joints become stressed. Placing a pillow between the knees keeps the pelvis level and reduces rotational stress.

For many patients with SI joint pain, pregnancy-related pain, hip arthritis, and lumbar disc irritation, this one change can be remarkably effective. A full-length body pillow often works even better because it supports both the upper and lower body simultaneously.

Positioning the Arms

Many shoulder injuries occur because people sleep with one arm overhead, a shoulder tucked underneath the body, or an arm trapped beneath the pillow Instead, hug a body pillow. This unloads the shoulder joint while keeping the upper back from rotating excessively.

Back Sleeping: Good for Some People

Recent reviews suggest that sleeping on your back generally promotes the best spinal alignment and is associated with lower rates of low back pain than stomach sleeping. Advantages include minimal spinal rotation, even weight distribution, reduced pressure on shoulders, excellent neck positioning — with the correct pillow.

Adding a pillow beneath the knees:
• flattens the lumbar curve
• decreases tension on the low back
• often reduces morning stiffness

Many physical therapists recommend this routinely for patients with lumbar arthritis or disc irritation.

Stomach Sleeping: Usually the Worst Choice

Nearly every spinal specialist agrees on this one. Sleeping face-down forces prolonged neck rotation, lumbar extension, and shoulder compression. Recent systematic reviews continue to associate prone sleeping with increased low back pain.

If you're a lifelong stomach sleeper and cannot immediately change:
• place a thin pillow beneath the pelvis
• use the flattest pillow possible beneath the head
• gradually transition toward side sleeping over several weeks.

Pillow Height Matters More Than Pillow Brand

People spend hundreds of dollars searching for the "perfect pillow." Research suggests something more important than a particular brand or style: the correct pillow height.

Systematic reviews found that appropriate pillow design can reduce neck pain and disability, but no single material is universally best. Maintaining proper cervical alignment appears more important than an ultra expensive pillow.

• Side sleepers need the tallest pillow. The pillow should completely fill the space between the ear and shoulder without pushing the head upward.
• Back sleepers need a medium-height pillow. The neck should maintain its natural curve. Your chin should not point toward your chest.
• Stomach sleepers should use an extremely thin pillow—or none at all.

Many of you know that I’m a huge fan of buckwheat pillows for exactly the reason that they can be molded very specifically to each individual — and you can adjust them according to different positions you may shift into over the course of the night.

What About Mattresses?

Research is remarkably consistent. Extremely soft mattresses are rarely ideal. Extremely firm mattresses aren't either.
Most evidence favors medium-firm support which provides adequate spinal support, pressure relief, and fewer painful pressure points

The best mattress is ultimately one that allows you to maintain neutral alignment in your preferred sleep position.

When Morning Pain Is a Red Flag

Occasional stiffness happens. But consider coming in for an evaluation if you consistently wake with:

  • neck pain

  • headaches

  • numbness in the hands

  • shoulder pain

  • low back pain

  • pain that improves after 20–30 minutes of moving around

These are often clues that your sleep setup — not just your daytime posture — is contributing to the problem.

Want to address your pain and discuss optimizing your sleep position? Schedule with David at his City Park office in Denver.

References

  • Relationship Between Sleep Posture and Low Back Pain: A Systematic Review (2025).

  • Effect of Pillow on Pain, Disability and Sleep Quality in Patients with Chronic Neck Pain: A Systematic Review (2025).

  • The Effects of Pillow Designs on Neck Pain, Waking Symptoms, Neck Disability, Sleep Quality and Spinal Alignment: Systematic Review and Meta-analysis (2021).

  • Sleep as a Prognostic Factor in Low Back Pain: Systematic Review (2024).