Sleeping Positions 101

Dr. Katherine Mullen, MS, DC



We spend about ⅓ of our life sleeping, which equates to almost 230,000 hours. That’s a lot of time, so it’s important to think about how your body can be affected. The position that you sleep in can be a factor in why you wake up with neck or back pain and why it is not getting better. There are 3 main positions we sleep in: on our back, side or belly. Here is our advice on the best ways to enhance your preferred sleeping position:


Back: Sleeping on our back, face up, is considered to be the most optimal sleeping position due to equal distribution of weight along the spine. We suggest adding a pillow under the knees in order to keep the spine in the most neutral position. Your head should be placed in the middle of the pillow to support the neck and limit the muscular strain. When choosing a pillow, look for a thinner one that is going to keep the head in a neutral position. You don’t want your head to be flexed too far forward to extended back because this will create straining of the muscles that support the head. Using a pillow with a crater in the center, such as the TriCore Pillow, for the head can help keep it in the neutral position. When choosing a mattress, it is best to have a medium firmness mattress if you sleep on your back because it helps support your spine while keeping it in a neutral position.


Side: If you are a side sleeper, one thing to keep in mind is to make sure you consistently switch sides. If you only sleep on one side, that side is going to have increased stress on it and will ultimately lead to problems down the road. We suggest that a pillow should be placed in between the knees and ankles in order to help maintain proper spinal alignment. When choosing a pillow, look for a thicker one that is going to help support the head while also keeping it in a neutral position. If it’s too thick, it will create too much lateral flexion in the neck, causing strain on the neck muscles and even shoulders. It is best to have a soft-medium firmness for a mattress for this sleeping position to help support both your head and low back.


Belly: Sleeping on face down on the belly is the least recommended sleeping position, because it causes stress on both the neck and low back. Sleeping on your belly puts the spine in an unnatural position, especially because the head needs to be turned 90 degrees to one side or the other. This position also flattens the natural curve of the spine, causing muscles of the neck to turn on and support the head when they should be relaxed. If you do sleep on your belly, it is recommended that no pillow or a very thin pillow be used.


We generally do not recommend belly sleeping as it can lead to long term neck and back pain even in the best circumstances. Please consult with your chiropractor on the best position for you. Sleep tight!


Katherine Mullen, DC, MS is a chiropractic physician with a masters in sports medicine. She has a special interest in the treatment of athletes through chiropractic and rehabilitative care. She is also certified to perform pre-participation physical exams (PPEs). Stay connected with Dr. Mullen on Instagram @washparkchiro or @katherinemullen


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