Is Side Sleeping the Best Position?

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A Variety of Sleeping Positions

“How do you sleep?” seems like a simple question at first – that is until you ask “What does ‘how’ mean?” It can mean:

“How well do you sleep?”
“How can you sleep?” (considering certain factors).
What [bed/mattress] do you sleep on?” or
What is your sleeping position?”

Most of us know there is more than one sleeping position. Some of us sleep in a supine position (on our backs). Some in a prone position (on our stomachs). More (40%) sleep in a lateral position (on our sides).

Not all sleep positions are equal. Look at several mattresses online. Some manufacturers rate one model or sub-model as better for back sleeping, a second mattress for side sleeping, and a third for side sleeping. The independent bed evaluation and rating site, Sleep Like the Dead, grades mattresses on a number of points, including suitability for side sleepers, stomach sleepers, and back sleepers. Some other independent reviewers say the mattress being reviewed is for you or not for you based on your sleeping position.

What Is Your Sleeping Position?

If you ask ordinary people this question, some will answer with their sleeping position. Some may say, “I don’t know. I just sleep.” Others will say, “They’re much the same. Whatever works for you.”

For some time, sleeping on one’s back was considered the “proper” way. Animals slept on their sides or their bellies; people slept on their backs. The truth was that even “proper people” did not always sleep on their backs. Normally, when people sleep, they tend to shift until finding a comfortable position. Some people just can’t sleep on their backs. Therefore, sleep posture depends on factors such as a person’s build, physical conditions, and the bed slept on.

Whatever sleeping position you use, it should enable you to get the time to sleep for the rest you need.

What Sleeping Position Is the Best?

Several sleep experts have been saying that no one sleeping position is the best for everyone. Many chiropractors prefer back sleeping. Why? When sleeping on your back, the spine lines up laterally (side-to-side). Firmer mattresses were prescribed because they did not let the middle section sag. In fact, it became folk wisdom that firmer was better. But many sleepers still had back pain, even with the firmest of beds.

Seeking a Solution

For over a century, engineers, chiropractors, home-grown innovators, bed manufacturers, and others have been seeking bedding solutions to back pain. Here are a few:

Pocket Coils

In 1900, James Marshall patented pocket coils (also called encased coils). He designed them for his wife, who suffered back pain. Bonnell coils, which were common then, are tied to each other, and when one is compressed, it pulls down those next to it. By letting coils respond individually, the ones not pushed down by the hips can support the lumbar.

Waterbeds

In the 1970s, waterbeds became popular. Like pocket coils, they evenly distributed support, but were less expensive.

Memory Foam

Memory foam mattresses hit the market in 1991, and in a few years they overtook waterbeds. They were more conforming than either pocket coils or waterbeds. Instead of pushing back (as coils do), they “remember” the shape of the sleeper. With memory foam, latex foam also grew in popularity. It has less of a heat retention problem as well as less odor. It is more responsive than memory foam, but has no “memory’ and pushes back on the sleeper.

Sleep Medicine

One thing pocket coils, waterbeds, and memory foam had in common was that they were marketed to back sleepers. But many people were still sleeping on their stomachs or sides, and with memory foam, it was now easier to tailor a mattress for stomach and side sleepers.

Enter the Doctors

Beginning in the 20th Century, chiropractors became involved in mattress design, some as consultants and testers, some as designers. This was while innerspring mattresses were dominant. Chiropractor involvement continues to the present. At the same time, the medical field of sleep research was growing, and in the 21st Century it is being integrated with other medical specialties. Research now indicates the relative advantages and disadvantages of each sleep position.

What Research Shows

As stated above, not all sleep positions are equal, and this is borne out by medical research. For instance, your most comfortable sleep position may not be the best one for your health. The WebMD article “What’s the Best Position to Sleep In?” says, Unfortunately, the position that you find most comfortable might end up causing health problems, ranging from aches to sleep apnea.”

Here are pros and cons of the basic sleep positions:

On the Back

While back sleeping usually keeps the spine laterally in line, sleeping flat leads to pressure on the hips and stress on the lumbar. A pillow is also needed to lift the head just enough to keep from overextending the neck. For this reason, many back sleepers have been using pillows to elevate the head and the upper torso to restore the natural front-back curve of the lower back. Alternately, a narrow pillow can support the lumbar. Now wedges and adjustable bases are available to lift the upper body. They can also elevate the feet to a “zero gravity” position for the best blood circulation.

However, back sleeping is a disadvantage for sleepers with obstructive sleep apnea. The tongue and throat muscles tend to fall back into the throat, blocking airflow. One solution for this is the sleep apnea setting on several models of adjustable beds. Another solution is to sleep in a different position.

On the Stomach

There are some reasons people sleep on their stomachs. The major one is breathing, especially for those with sinus congestion or obstructive sleep apnea. Of course provisions must be made to facilitate breathing. Some chiropractors have treatment tables with an opening for the face so patients can breathe face-down. That is not an affordable option for home beds, but there are other means:

  1. The sleeper is positioned close enough to the head of the bed to allow the nose to be over the edge (not for beds with headboards).
  2. A pillow under the shoulders keeps the head high enough for the user to sleep facing down.
  3. A pillow under the shoulders raises the sleeper just enough to turn the head to one side, supported by a thin pillow.
  4. A body pillow allows the sleeper to keep the face open while lying prone.

A disadvantage of stomach sleeping is back strain. One solution for this is an abdominal pillow to support the lumbar. Here is a role for body pillows.

On the Side

By far the simplest solution to breathing problems in bed is side sleeping. The face is naturally open, and the tongue does not fall against the throat.

The disadvantage of side sleeping is lateral back support. Side sleeping requires a mattress with more give to allow the shoulders and hips to sink in while still supporting the lower back. Also, the neck needs to have the head raised enough to keep the cervical spine in line with the thoracic (chest) and lumbar (low back) spine. This is especially a problem on firm mattresses, but can be compensated for with a lumbar pillow and the right height head pillow.

Another disadvantage is shoulder pain specific to the side slept on. This is because the shoulder and arm on that side are immobilized while the weight of the thorax (chest) bears down on the shoulder (see research in the next part).


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