How do you sleep? Whether you curl up into a ball or snooze tummy down, sleeping positions are probably not the first thing you think about when you hit the hay. But the different ways we position our bodies for sleep can have profound impacts on our health, let alone our quality of sleep. Think of it as how maintaining the right form during exercises can prevent injuries — poor sleeping positions may lead to severe musculoskeletal strain, night-time awakenings, and even increased risks of chronic health conditions like heart disease.

We consulted with Vanessa Wong, a physiotherapist at Orchard Health Clinic, to learn more about the impact of sleeping positions on our health. Use the handy cheatsheet below for Vanessa's tips on adopting a recommended sleeping position that's right for you, or read on for more details!

Vanessa, what are some healthy sleeping positions that we can adopt?

Assuming no health or pain conditions, one of the best sleeping positions is to lie on your back with a small thin pillow supporting your head and neck. For most people, this gets your spine in a rather neutral position. Make sure your pillow is not too high as that can put too much pressure on your spine.

For people with lower back pain or tightness in the hips, it may also be helpful to have a pillow underneath your knees to take the pressure off your spine, giving your hip flexors some slack.

Another popular position is to sleep on your side with a pillow between your knees. This position supports the hips and keeps the pelvis in a neutral alignment. Ensure, however, that your pillow is at the right height — your shoulder should not be on the pillow. You will likely need a thicker pillow to support your head and neck too.

Sleeping on one side is especially helpful for women with larger hips and pelvis, as well as women in mid to late pregnancy. Take note not to curl up too much into a fetal position though, because this may put too much strain on the discs and restrict diaphragmatic breathing!

A small percentage of people prefer to sleep on their tummy, but this is not a recommended position as it usually means your neck is rotated to one side for a substantial amount of time during the night. This significantly increases the risk of nerve impingement injuries, and neck or shoulder pain.

You can try to break the habit by adopting the quarter prone position, which means sleeping on your side with bottom leg straightened out, top leg bent up, and tummy resting on a pillow or bolster. This can keep your neck properly supported by your pillow.

What about someone with sleep apnea or who snores?

Sleeping on your back may put you at a higher risk of developing sleep apnea and snoring. This is because the airway is more subject to collapsing due to internal and external factors, like the downward pressure caused by the weight of your neck or chest.

Sleeping on your side is the most ideal position to help prevent airway closure and improve symptoms of sleep apnea. When your body is positioned on its side during rest, the airways are more stable and less likely to collapse or restrict air. However, this position does not always come naturally to everyone. It’s common for some people to start on their side and fall onto their back afterwards, where sleep apnea and snoring is at its worst.

To combat this problem, try using a special pillow like a contoured one or a memory foam pillow. These pillows hold their shape, which can help guide your body and head into the optimal lateral position. Elevating the head of your bed by four inches may also help reduce your snoring by keeping your airways open.

Apart from getting physical therapy, those with sleep apnea can also consider working with a breathing therapist, who will be able to teach you better breathing mechanics to improve your overall sleep.

Do you often meet patients whose pain is exacerbated by how they sleep? What are some of the conditions they experience?

On average, about 15% of our cases are somewhat sleep-related pain. The most common conditions we see in the clinic which are aggravated by poor sleeping positions are generally varying degrees of neck-related injuries. But in more severe and chronic cases of stiff neck, or prolonged use of the wrong pillow, a person can develop cervical radiculopathy or brachial plexus injuries, more commonly known as ‘pinched nerve’ in the neck. This can cause symptoms like pain or tingling down the arm, fingers, or hand. I’ve also seen patients with shoulder-related pain like subacromial bursitis or acromioclavicular joint injuries (i.e. an injury to the top of the shoulder), who struggle to get quality sleep as a result of choosing poor sleeping positions.

How can these patients improve their sleeping positions to avoid adding to their pain?

Having the right support from a mattress of suitable firmness, as well as correct pillow height and positioning, helps to prevent injuries related to poor sleeping position.
For people who suffer from any form of joint pain or arthritis — especially in the back, shoulders and hips — make sure your mattress is not too soft. This can prevent it from providing adequate support to your spinal column, which puts additional stress on your peripheral joints.
Good sleep hygiene can tremendously improve your sleep quality. Try to set a regular sleep schedule, improve your breathing mechanics, exercise regularly, maintain a healthy diet, and remove blue light technology gadgets an hour before sleep.

About Vanessa Wong

As one who lives by the mantra, “movement is the best medicine”, it’s no surprise that Vanessa would find her calling in physiotherapy. Her portfolio spans helping professional athletes, desk-bound workers, and those suffering from chronic pain with neck and shoulder issues, dysfunctional breath patterns, as well as sports and gym-related injuries — an interest spawned from her own enthusiasm for fitness.