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What is The Best Sleep Position: The Truth

What is the best sleep position - cute kitten lying on back with paws above head - close up shot

What is the best sleep position?

In an age where the internet never sleeps, where we are always contactable, where we are all linked by phones and computers and tablets. Sleep has taken the back seat for a lot of us. However, we shouldn’t underestimate the power and importance of sleep.

Sleep is crucial to our wellbeing, both physical and emotional, as well as our ability to function. Sleep, diet and exercise have been described as the three pillars of good health. However, author Matthew Walker says that ‘sleep is the foundation on which all the other pillars stand’. But as much as 1 in 3 of us suffer from poor sleep.

So how is this affecting us?

Of course we are all familiar with the effects such as feeling grumpy, tired and a lack of focus, which can lead to difficulty concentrating and making decisions and therefore not working at your best. However, regular poor sleep can also have profound consequences on your physical health. Sleep deprivation puts you at risk of serious medical conditions such as disrupting your immune system, high blood pressure, obesity, diabetes and heart disease.

Lack of sleep can also slow recovery rates after illness, injury or surgery. This is why it is vital for us as physiotherapists to find out how a person is sleeping when they come into the clinic, as their recovery and rehab hugely depends on it. If sleep is a problem, we will always try to recommend ways to help, whether it’s advice about pain-relief, sleeping positions, meditation/relaxation, work habits or pacing activities during the day.

A variety of factors can cause poor sleep, such as health conditions like sleep apnoea, but generally it’s due to bad sleeping habits.

How much sleep do we need?

This age-old question does not have a definitive answer, however most of us need around 8 hours of good-quality sleep a night to function properly. However, some need more and some less. But generally, if you are waking up tired and longing for a nap during the day, chances are you haven’t had enough sleep.

Our body clock dictates our sleep patterns. We all have a built-in body clock that dictates our circadian rhythm – a 24 hr cycle that your body is naturally inclined to follow, and guides your desire for sleep, eating, drinking, our metabolic rate, and even our emotional state, or mood.

However, circadian rhythms vary from person to person. Some of us are morning people. Some of us are ‘night owls’, who are people whose circadian rhythm inclines them to sleep later at night and rise later in the morning, which in a morning-oriented society can sometimes be problematic.

Here is where jobs where you have flexible working hours can be very beneficial. And some of us, like me, are a bit of a mixture of both, where to really feel rested, we like to go to bed early and get up later. Who’s to say 9-10 hours is too much?!

Why is good sleep important?

I hope that most of us are familiar with those great mornings when you wake up feeling rested, refreshed, full of energy and alert. But did you know that having a good sleep is doing wonders inside as well. Regular good sleep boosts immunity, mental well-being, weight-loss, your libido, fertility, lifespan. So it is clear that a solid night’s sleep is essential for a long and healthy life.

But what can we do to improve it?

Catch up on lost sleep! This won’t happen overnight, but just starting by adding an extra hour or two a night at the weekend can have long-lasting benefits to your body for the week ahead.

Firstly, consider avoiding/reducing caffeine, energy drinks, alcohol and nicotine. With effects such as making it harder to enter your deep sleep phase and impairing your breathing when you’re asleep, these will only disrupt your sleep patterns further in the long run.

Secondly, consider your ‘sleep hygiene’! Try introducing a few sleep-promoting routines into your day and evening:

6 Simple tips for better sleep

  • Take a hot bath before bed – this will help to relax your body and mind, and induce a feeling of drowsiness;
  • Try to get a good amount of natural sunlight during the day, to help your body regulate your sleep pattern;
  • Keep the temperature in your bedroom relatively low;
  • Minimise screen time in the evenings – research has shown that cutting off screen time 30 mins to 1 hr before bed to reduce exposure to ‘blue light’ that can contribute to poor sleep;
  • If you can’t sleep, get up! Feeling worried about your inability to go to sleep ironically makes it more difficult to fall asleep. Consider allowing yourself 20 minutes, and if you still can’t sleep, get up and engage in some relaxing activity until you feel sleepy again.
  • Think about treating yourself to a regular relaxing massage – nothing can be better to wind you down after a busy work week.

What are the best Pillows and Mattresses?

Finally, consider what you are sleeping on – I’m always getting asked by my patients, “what pillow/mattress should I use?” Memory foam? The Emma? The Eve? A Tempur mattress? A Mammoth Mattress?

The truth is, a lot of companies make claims about their products, but there is no hard evidence for this. Really, it comes down to personal preference. Therefore, when people ask me this question, my heart almost sinks because it is not something I can give specific advice or prescriptions for.

It’s good to remember, we are all different. To illustrate this point exactly, I asked some of my physio colleagues across our three London clinics what they use and have quoted some of the responses below… As you can see, no two are the same!

“I like to sleep on my right side and find it difficult to sleep in any other position (even the left side for some reason). I recently bought ‘The One’ mattress from made.com in Charing Cross Road, I like it as it has a firm base with a memory foam top which isn’t too hot (this seems to be a big problem with memory foam).

My personal preference for pillows is to have a thin foam pillow with a goose down pillow on top. I find I can mould the feather pillow to my neck for comfort, then the bottom pillow continues to provide support when the feathers flatten down. Occasionally I get a niggle in my lower-back and find a pillow between the knees can be really helpful!”

Katriona, Chancery Lane & St John’s Wood clinics.

“I tend to sleep on my side and have a medium firm pocket spring mattress with a firm feather pillow. If I do stir in the night I tend to adjust my pillow pulling it down and scrunching it up into my neck if I feel it is not giving me enough support. I also always plump it up in the mornings to let it air and push the feathers centrally!”

Camilla, Chancery Lane clinic

“I used to be a tummy sleeper with no pillow but about 10 years ago I had a disc prolapse in my neck so I had to train myself to not sleep like that. I am now a side (mainly right) sleeper with 2 thin firm-ish pillows and a firm mattress. It took a while to change my habits!”

Lauren, Chelsea clinic

“I sleep on my front or on my side, I prefer a firm mattress and two pillows so I can bring the top one through to support my neck and head. I am reluctant to recommend a mattress to patients as it is so personal and I know people who have spent a lot of money trying to find the perfect mattress, same for pillows. I would recommend a mould-able (such as feather) or shaped pillow to give some neck support if you are a side sleeper.”

Suzy, Chancery Lane clinic

“I don’t think the mattress and pillow are particularly important. I have an old cheap ikea mattress that I’ve had for years and 2 old thin pillows stuffed together into a single pillow case. Makes it quite big and firm, my wife thinks it’s awful but it works for me. But I can pretty much sleep anywhere on anything. Habitual side sleep or on my front.”

Chris, St John’s Wood clinic

“I am a right side sleeper. I can sleep on my left but it feels slightly awkward. I use a medium feather pillow. We replaced our mattress last year. I was being seduced by ads for trendy new layered foam mattresses … and then I saw a Which endorsement for an Ikea pocket sprung one. £200 ish. Medium firmness. Arrived rolled, took a few days to settle – shape and smell – but very pleased so far.”

Megan, Chancery Lane clinic

“I am a firm mattress, side sleeper with 1 feather pillow kinda guy!”

Jamie, Chancery Lane clinic

Therefore, as physios, we prefer to focus instead on helping people understand their body and what to look out for when trying to achieve a supported and comfortable position.

Best position for side sleepers?

Make sure your head and neck are in a neutral/horizontal position – if a pillow is too high your neck will be angled upwards, and if too low it will drop down. If the latter happens, you may find that your shoulder tends to get squashed forwards, which can lead to shoulder discomfort. Check your shoulder is not on your pillow, as this encourages a rounded shoulder posture and the natural curve of the neck won’t be as well supported, which in turn may result in waking with neck/shoulder pain and or stiffness.

Best position for front sleepers:

As physios, we tend to recommend avoiding sleeping on your front, however as you can see from the quotes above, some of us do it ourselves… myself included! Therefore, if you choose to sleep on your front, my main advice would be to use a moldable not-too-high pillow, e.g. feather pillow, as this will give you support and comfort where you need it, whilst keeping the neck in a more neutral/horizontal position. However, if you do suffer with neck problems, this really is a position to avoid.

Best position for back sleepers

My main tips for back sleepers are to make sure you bunch your pillow up behind your neck (this is where a feather pillow is often the best for back sleepers). Also make sure you pull the corners of the pillow forward. This ensures your shoulders are not resting on the bottom end of the pillow. Using these 2 simple moves will ensure your pillow gives you the support in the right places when sleeping on your back.

What about extra pillows?

Some useful tips for extra pillows include:

  • A pillow between the knees for side-sleepers;
  • Placing a pillow under the abdomen in front sleepers;
  • Having a pillow under the knees when lying on your back – this can be beneficial for lower-back pain
  • Using a pillow for the arm(s) to rest on when lying on your back – useful for shoulder pain – especially post operatively.

Take-away Message

Listen to your body and your internal clock; sleep more, and sleep well!


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