What is the best sleeping position to help neck and low back pain?

When managing patients with spine pain, it is important to look at each person as a whole and help identify any modifiable risk factors that may be contributing to their pain. Sleeping posture on its own is unlikely to alleviate all of a patient’s symptoms, but it is important to use all of the tools we can to improve a patient’s pain. If a patient is able to get restorative sleep, pain tolerance will likely improve. This is also useful to assess in patients who have pain upon waking or who have difficulty sleeping due to pain.

There is limited reliable data on the best sleeping position for spine health, however, there have been few studies discussing the benefits of each. The most important factor when discussing sleep positions is that the patient is in a comfortable position that allows their muscles to relax and maintain neutral spine alignment. The most common sleeping positions are supine (lying on your back), side lying, and prone (lying on your stomach). 

Supine Sleep Position

Sleeping in the supine position is considered beneficial since pressure is distributed over a larger surface area, however, it is important to provide support to the neck and low back to maintain the natural spinal curves. This can be achieved with proper pillow placement.

It is common for people to use pillows that are too thick when lying on their backs. This causes the neck to be placed in excessive flexion and puts the neck in a position that counteracts the normal lordotic curve of the cervical spine. Using a relatively flat pillow, no pillow, or simply a neck roll to help maintain proper alignment of the cervical spine while lying flat on one’s back. Additionally, if using a pillow, the pillow should be positioned in a way to provide support from just above the shoulder blades/upper back to the top of the head, rather than only being placed under the head).

If a patient has pain in their lower back when lying flat on their back, it may be helpful to place a pillow under their knees when sleeping. This can take some pressure off the low back and may provide some relief of their symptoms.

Side-lying Sleeping Position

Side-lying is the most adopted sleeping position and can allow for proper alignment of the spine (cervical lordosis, thoracic kyphosis, lumbar lordosis) in the sagittal plane or when looking from the side. This position can allow for torsion or twisting of the spine since the center of gravity is higher, however, this can be mitigated by using a pillow between the knees and arms to provide support to the extremities.

Use a pillow that is supportive enough to maintain your neck in proper alignment. The pillow thickness should be enough to fill the space between your neck and the edge of your shoulder when your head is in a neutral position. Studies have suggested that this position is associated with less cervical complaints and possibly with less spinal complaints generally.

Prone Sleeping Position

It is not recommended to sleep lying face down since this does not provide proper support for the natural curves of the spine. This position should especially be avoided if you have neck pain since this requires the head to be turned to one side or the other.

Bonus point - Mattress type

Recent studies suggest a medium-firm mattress is ideal for sleeping since it provides enough support to maintain proper alignment. It is recommended to change mattresses every 7 years or so, however this is a loose recommendation. It may be helpful to look into getting a new mattress if your current one is no longer as supportive as it once was. You may want to think about this if you notice you have less pain when sleeping in another bed, such as at a hotel.

At the end of the day, the best sleeping position is whatever position provides the most comfort for each individual. Experiment with different positions and different pillows to find what works the best. Changing a patient’s sleeping posture may not completely relieve their symptoms, however, it may provide that little bit of extra relief and allow them to get one step closer to their goals.