Have you ever woken up feeling achy and stiff? Is your back, particularly your lower back, what hurts the most in the morning?
If so, you are not alone. According to the CDC, low back pain is the most common type of pain reported, with 25% of adults reporting low back pain in the last three months.
A significant number of people experience back pain as a result of poor sleep posture. This is one of the most talked about topics on blogs and forums. But in the scientific research community, there is limited available research that directly addresses the connection between sleep posture and back pain.
Fortunately, we have just enough scientific data to begin discussing this topic. So today we will discuss sleeping positions, particularly as they relate to back pain.
Most of the information in this article comes from a 2019 scoping review of research which sought to find the most high quality studies addressing back pain and sleep position, synthesize the data, and provide recommendations for future studies. A link to the study is included at the end of this article.
(If you’d like to see this content in a video, watch my YouTube video here.)
Different Kinds of Sleeping Positions
Depending on which article or blog post you read, you may see anywhere from 3-9 sleeping positions listed. Furthermore, this is such a popular topic that there are tons of articles claiming your sleeping position can indicate the type of person you are.
Unsurprisingly, there is little scientific evidence to back that up.
For our introductory purposes, we only need to know the three main types of sleeping positions:
- Supine (back)
- Prone (stomach)
- Side lying
Supine, or sleeping on your back, is often attributed with low back pain because our lower back is usually improperly supported in this position.
Prone, or sleeping on your stomach, is often attributed with cervical spine pain (neck and top of back). This is frequently caused by sleeping with your head turned to one side, which keeps your spine in a curved position throughout the night.
Side lying is arguably the most common sleeping position. A review of sleep position studies found that more than 60% of Europeans sleep the majority of the night on their side. Because side lying is so common, some researchers have further characterized it into symmetrical and asymmetrical side lying. This just takes into consideration the symmetry of the spine throughout the night.
These are the most common sleeping positions in adults. And, as we will discover later in this article, the position you sleep in doesn’t really matter. What matters most is that your body is properly supported.
The Problem with Studying Sleep Positions
There have been very few clinical studies that, in general, address sleep positions and their health benefits because it is a difficult topic to study.
First, it is highly unlikely that anyone remains stationary throughout the night. In other words, we usually change sleep positions while we are asleep. I’m sure you can think of several instances where you fell asleep in one position, and woke up in a completely different position. This makes it more difficult to accurately study a particular position.
Second, most research studies only rely on self-reported sleep positions. Participants will answer questionnaires which allow the participant to self-report which sleep position they think they use. This can, of course, lead to huge inaccuracies since the self-reported sleep positions are usually not corroborated with scientific data.
Third, most sleep studies are completed over a relatively short period of time. This means that the data gathered is from a small sample size, in terms of long term effects of waking up with pain due to sleep posture. The sleep community really needs longitudinal studies which track participants, their sleep position, and their waking pain over the long term. This will provide more insight into how sleep position and pain are related, as well as how changing sleep position can alleviate pain.
Finally, we need broader research studies that address the connection between sleep position and pain. Many studies exist that address the connection between sleep position and a particular ailment, notably sleep apnea. For example, numerous studies have researched how sleeping on your back worsens the symptoms of sleep apnea. But this is only helpful for those who deal with sleep apnea, and not the entire population.
Why We Wake Up With Back Pain
Back pain, both cervical and lumbar, is the most common precursor to musculoskeletal disabilities. This is true across all ages, and all around the world. Interestingly, women self-report back pain at a higher rate than men.
One of the reasons we wake up with back pain is due to increased pressure on our spinal tissue. During the day, our spinal tissue has an increased compression load because of gravity and muscle contraction. At night, the pressure on our spinal tissue lessens, which makes our spine more flexible. Because our spine is more flexible, we often find ourselves in unusual positions. These unusual positions, with our spine out of alignment, creates new pressure on our spinal tissue and ligaments. In severe, habitual cases, the shape of the spine can be altered.
Prone sleeping is believed to drastically increase the pressure on our spinal tissue. On the other hand, side lying has often been considered to put the least amount of pressure on your spine.
It’s important to note, though, that based on current research there is no agreement on a direct correlation between sleep posture and back pain.
How To Reduce Back Pain from Sleeping
No matter which position you sleep in, the most important thing is to keep your spine in alignment and supported.
We want our head, shoulders, and hips to be aligned, and any gaps between our spine and the mattress to be filled in.
For supine sleepers, a thin pillow should be used to keep your head and neck supported, and in alignment with the rest of your body. Another thin pillow may be placed under your lower back where there is space between your spine and the mattress. This will, hopefully, alleviate the lumbar pain often associated with supine sleepers.
For prone sleepers, a pillow should be placed under your lower abdomen and hips to prop your spine up into alignment. Prone sleepers often have their spines curved too much throughout the night. Additionally, a soft cylindrical pillow (or rolled-up towel) should be placed under your forehead to keep your neck in alignment, and also allow you to breathe. This may require some training, as prone sleepers are used to sleeping with their head turned to one side.
For side lying sleepers, a pillow that does not prop your head up too much is important. Like all sleep positions, we need our neck to be in line with the rest of our spine. Additionally, a small pillow placed in between your knees may help relieve some pressure on your spine and keep it symmetrical.
Of course, mattress and pillow choice play a huge role into this, but that is a different topic for another day.
The most important thing to remember is that sleeping position doesn’t matter. Proper spinal alignment and support is what matters.
I hope that more research will explore the general connection between back pain and sleep position, since it is a rather under-researched topic, surprisingly.
If you experience back pain when waking up, maybe try one of these suggestions. It may take some getting used to, but maybe it will help you feel better.
- Identifying Relationships Between Sleep Posture and Non-Specific Spinal Symptoms in Adults: A Scoping Review
- How Should You Sleep If You Have Low Back Pain
- Acute Low Back Pain (CDC)
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