To anyone who has been following health and wellness, particularly in the last 5-10 years, the issue of good quality sleep is perhaps the number one issue in good health. With a good night’s sleep we have the physical, mental and emotional energy to enjoy good health. Without it we are at an immediate disadvantage. There is a growing amount of evidence to show that sleep doesn’t just benefit health, it is essential for good health.

As an integral part of our wellness program, all our practice members are provided advice on healthy sleeping. We want them to put the eight hours they spend sleeping into healing, not re-creating the same problem.

During their sleep consult, we introduce to them the concept of the “Posture Pie”. The “Posture Pie” focuses on the activities which affect their spine during a single week (168 hours). The ideal break up of the “Posture Pie” is spending 38 hours at work, 56 hours sleeping and 74 hours at play. We spend almost one third of our week sleeping, so it’s important to make sure we are doing it right.

So what is the best postural position to sleep? Let’s have a look at the options.

1. On back with arms to side.

Stand naturally/relaxed with your arms are at your sides and your palms facing forward. Make sure your head is directly over your shoulders and there is no side tilt. Your feet should be approximately shoulder width apart. This position is considered the anatomical position and is the position most heath professionals recommended for spinal health.

In this position there is muscular balance in the body. The spine isn’t contorted. Joints aren’t tensioned. It is a healthy position to sleep in.

The height of the pillow is particularly important for back sleepers. The normal curve of a neck is C-shaped, just like a banana. It is therefore important to consider this when looking for a pillow. Anatomical pillows are available to maintain the normal neck curve. If those are not used, pillows should be small enough so as not to bring the chin toward chest, yet high enough so that the ear is sitting directly over the shoulder joint.

For those with low back complaints and also to aid in maintaining this posture, a pillow beneath the knees to slightly elevate is also a common recommendation.

If you snore, or worse, if you have sleep apnoea, this posture should be avoided.

2. Side-lying

Over half of us sleep on our sides. This isn’t bad– but it can be.

I tell my side sleepers to try to keep as close to anatomic position as possible. That means pillows sufficient to keep the head/neck in a neutral position and arms as near as possible to the body’s sides. It can be tough.

This is a good position for snorers. Spinal curves are maintained. Sleeping on the left may help relieve heartburn, while sleeping on the right may make it worse. Sleeping on the left side is also recommended during pregnancy to improve circulation to the heart — good for mom and baby (Note: If you have heartburn you need to do more than change your posture at night.)

But side sleeping can also create it share of troubles. Most side sleepers will do one of several things. Roll shoulder in with arm out or down, or elevate shoulder with arm up or out.

The rolled shoulder bit is something I encounter continuously. It is often apparent on visual exam. The sleeper has trained their shoulder to be dysfunctional. The sleeping position becomes the default waking position. The scapula rides high and loses motion. The humeral head is rolled forward and inward, making the biceps groove face inward. This can lead to or worsen any of the following which motivates our sleeper to see me: decreased shoulder motion, shoulder pain, painful arc syndrome, bursitis, tendonitis, tender points and/or trigger points, thoracic outlet syndrome etc.

And then there is the problem with the legs? Many side sleepers have the tendency to have their bottom leg straight, whilst the top leg flexes up and rotates down so that the top knee actually rests on the mattress. For those with hip or pelvic problems this can be a poor choice position as is creates too much rotation of the pelvis. For them I recommend a pillow between the knees, or a leg-spacer, to create a neutral anatomic position. A body pillow can help as well, for both arm and leg placement.

3. Prone/Stomach

No, no, no. Stop! Please….

One of the changes I encourage patients to make in their lives is to stop sleeping on their stomach. A surprising number of people are shocked to hear that this is detrimental to them.

If you don’t believe me, try walking around with your head turned to one side. It won’t take long for you to begin feeling pain, soreness, dizziness or neck/shoulder tension. Your body doesn’t like this standing up, and I promise you that it doesn’t like it when you’re lying face down with your head on a pillow either.

Stomach sleeping is the worst position for the spine and creates all sorts of problems. The most obvious and universal is their head has to turn to one side if they want to breathe, which distorts the alignment of the neck. Sleeping on your stomach also flattens the natural curve in the lower back. This position can exert unnecessary pressure on your nerves, which may cause pins and needles in the arms or the legs when you wake up.

4. Fetal

On your side with knees slightly bent is good. Drawing your knees up to your chest is not.
In the womb you had no need for spinal curves. In adult life, living life without them is impossible. Also, Mum was giving you your oxygen. Sleep like this now and you restrict deep breathing.

Good posture is important not only for your day-to-day comfort, it’s also vital to ensure you don’t strain your body during repetitive exercises. While more of us are becoming aware of the role of posture, we tend to focus on it during the 12 hours of daylight. But what about the 8 hours you spend sleeping?