Proper Sleep Positions
by ACE Physical Therapy and Sports Medicine Institute

“What are the best sleeping positions?” Physical Therapists answer this common question on a regular basis. The answer can depend on the status of an injury, the stage of rehabilitation and on personal sleep patterns. The key is getting enough sleep. If we don’t get enough sleep, our health can be affected, our disposition changes and the quality of our life will be adversely affected.  The body heals much faster and efficiently when it is given the proper amount of sleep.

Typically, adults need 7-9 hours of sleep per night, and adolescents need 10 – 12 hours per night. There are different cycles of sleep, and the “deep sleep” cycle is the time when the body heals itself. Shortened sleep or disturbed sleep may prevent you from entering this “deep sleep” cycle and this can make it more difficult for the body to repair itself.

Sometimes our sleep is hindered because we are not comfortable. An injury or rehabilitation of a body part can make it difficult to rest. The entire body must be able to relax and certain sleep positions are better suited to help us relax. The key to comfort is remembering the anatomy of the spine and protecting its natural curves.  Sleeping in one position for a prolonged period time can put a considerable amount of stress and strain on the different parts of the spine.

The spine has 3 primary curves.  The neck (cervical spine) and low back (lumbar spine) are curved in a “C” shape and are positioned in the same direction and plane.  When someone lies down to sleep these curves must be protected or undue stress and strain can be placed on the joints and soft tissue of these areas.

Back sleeping:
The spine is in a neutral position and there is no extra weight on the chest or pressure on the skin.  This makes breathing easier and can help to reduce skin irritation.  The biggest pit fall is the fact that most people snore loudest when sleeping on their back.

Side sleeping:
Providing the pillow is not too thick or thin the spine is in a neutral position and great for people who have one body part that is injured.  The injured side can be avoided.  Placing a pillow between the knees reduces the pain that can develop from putting two body parts together.  Pregnancy requires side sleeping as it progresses and most people snore less aggressively and frequently when they are on their side.

Stomach sleeping:
This position can protect the lumbar spine “C” curve providing that the mattress is firm.  If someone has a lumbar spine condition that warrants the use of a predominant extension rehabilitation program, then this position might be ideal.   Unfortunately, the cervical spine is jeopardized when one sleeps on the stomach.  The pillow must be thin and possibly not used at all.  Stomach sleeping can make it harder to breath, but most people do not snore when they are on their stomachs.

Sleeping after an injury or surgery can be a challenge.  Some helpful hints that might make it easier to sleep following certain procedures:

Shoulder surgery:
The involved shoulder must be protected and will usually be in a sling for 3-6 weeks.  The orders might be to keep the arm still at all times. Regardless of the surgical procedure, the shoulder is going to be painful, and it will be difficult to get comfortable.  The patient is usually instructed to sit up at night and use a reclining chair.  Patients might choose to stay in the bed and prop pillows behind the back to keep from lying flat.  A small pillow should be placed behind the involved shoulder blade because during sleep the surgically corrected arm will tend to “fall” backwards even when the sling is in place. This posterior movement is painful and will prevent deep rest.

Knee/ankle surgery:
The recovering leg/ankle must be propped up on pillows above the heart. This may be hard to accomplish, but it will help to reduce swelling and in turn the pain will not be as great in the absence of a lot of swelling.  The patient can put ice on the knee or ankle during sleep.  The use of an “ice machine” (pumps ice water through a pad that wraps and fastens to the involved body part) reduces the mess that bags of ice can create.  Keeping the involved leg on a stack of pillows can be tricky; therefore if you have to do this for more than a night or two, you might consider elevating the end of the bed.  This can be done the night prior to surgery and the bed can be put up on cinder blocks.

Different sleeping positions can make you more comfortable and enable you to get a “good night’s” sleep.  Unfortunately, improper sleeping positions can cause you to sleep poorly and lead to harmful health and personality changes.  If you are not sure what sleeping position will be best for you and your current health status, speak to a Physical Therapist and for help suited to your condition.