Three main sleeping positions

Human beings sleep in a variety of different positions, but these positions can be broken down easily into three main categories: on the side, on the back, and on the stomach. Sleeping position is somewhat like posture in a sense that we typically fall into a position that naturally feels comfortable. And, when we feel comfortable and relaxed we are able to more easily drift off to sleep. Unfortunately, maintaining these positions throughout the night can have some drawbacks – and change can be difficult! As therapists, we frequently find that an individual’s sleeping position may be contributing to their complaint of pain to some extent. Below we will take a look at the advantages and disadvantages of each primary sleeping position to determine if adopting a new style might be the right decision for you.

Side Sleeping

Various research estimates that although adults will shift positions throughout a night of sleep, they will typically spend the majority of the night sleeping on their side. This position can certainly be helpful in the relief of back pain. Side sleeping posture will maintain the spine in a relatively neutral position – assuming a properly firm mattress and appropriately sized pillow. This prevents the bony and soft tissue structures of the spine from being excessively stressed. Furthermore, a side sleeping position can be especially beneficial for pregnant women. Pregnancy will contribute to greater relaxation of the ligaments that help hold together the spine and pelvis. Women who are pregnant may find the side sleeping position especially beneficial for decreasing low back pain, sacroiliac joint pain, and pelvic instability. The side-lying sleeping position can be helpful for more than just orthopedic complaints, too. Research has indicated that lying on the left side can improve symptoms associated with gastroesophageal reflux disease (GERD). There are a few instances where sleeping on the side might be a position to avoid, however. For example, patients with shoulder or hip injuries can find that sleeping on the side, on top of the involved hip or shoulder, causes significant irritation in the form of pain and/or numbness to these areas.

Back Sleeping

A back sleeping posture is the second most common sleeping position for adults on average. This position will also facilitate a neutral spine and decrease back pain, assuming your mattress is properly supported and your pillow is not too large. With ‘fluffy’ pillows the neck can be forced into more of a flexed position, which can contribute to postural issues and increased neck pain. A back sleeping posture may also be beneficial toward decreasing the effect of GERD, as long as the head and neck are positioned above the stomach. A great way to adopt this position is through the use of a wedge pillow. This type of pillow will allow the cervical spine to remain in neutral, but still allow the proper head and neck elevation. One disadvantage of the back sleeping position is the effect of gravity. When lying on the back can cause the tongue to fall backward into the airway, which may promote snoring, shallow breathing, and episodes of sleep apnea. For back sleepers that experience sleep apnea, it is highly recommended that they attempt sleeping on their side to reduce symptoms.

Stomach Sleeping

Sleeping on the stomach is typically the least popular sleeping position for adults. This is a good thing, as this posture tends to lead to more problems. In order to continue breathing while sleeping on the stomach, a patient must turn their head to either the right or left. This may create too much strain on the cervical spine and lead to pain. Furthermore, this position tends to flatten the natural curvature of the spine, which can contribute to lower back pain. Cosmetically stomach sleeping can also be detrimental, as this position is associated with more facial wrinkles over time. Although there are many negatives to stomach sleeping, it isn’t all bad. Stomach sleeping can help to open the airway, which may decrease disruptive snoring.
In summary, it may be extremely difficult, yet beneficial, to change our dominant sleeping position. While each position offers various advantages and disadvantages it appears, based on the available evidence, that side-sleeping is the best position overall. This position can provide optimal spinal alignment and promote digestive health.


  1. Skarpsno, E. S., Mork, P. J., Nilsen, T., & Holtermann, A. (2017). Sleep positions and nocturnal body movements based on free-living accelerometer recordings: association with demographics, lifestyle, and insomnia symptoms. Nature and science of sleep, 9, 267-275. doi:10.2147/NSS.S145777
  2. De Koninck, J., Lorrain, D., & Gagnon, P. (1992). Sleep positions and position shifts in five age groups: an ontogenetic picture. Sleep, 15(2), 143-149.
  3. Kaltenbach, T., Crockett, S., & Gerson, L. B. (2006). Are lifestyle measures effective in patients with gastroesophageal reflux disease?: an evidence-based approach. Archives of internal medicine, 166(9), 965-971.
Austin Burlage, DPT graduated from Concordia University – Wisconsin, with honors in 2018. He gained experience through a diverse background of clinical experiences particularly involving treatment of the shoulder and knee. He is especially passionate regarding the treatment of vestibular disorders resulting from concussions or benign paroxysmal positional vertigo (BPPV).