A good night’s sleep is essential to your health, and an important part of your overall well-being. People spend about a third of their lives in bed, so it’s vitally important to get it right when it comes to back health. Back pain can significantly affect a person’s ability to get the quality and amount of sleep they need. Furthermore, poor bed posture can worsen or even be the cause of backache in the first place. This is because certain positions can place unnecessary pressure on the neck, hips, and back.

This blog will provide an in-depth review of different sleeping positions and types of beds and the impact both have on your quality of sleep.

Sleeping positions

Before looking at the positions to sleep better, it is important to address a few crucial things. First and foremost, you should be comfortable. For a good night’s sleep, waking up feeling properly rested and not in pain is the most important thing. If any of these positions cause issues, don’t hesitate in letting me (or another osteopath) know so that alternative suggestions can be made and you find something else that works for you.

Secondly, I know it’s not always possible to control what position you get into once you’ve fallen asleep. However, this is where perseverance comes in, if you keep trying, your body can adapt in a week or two. Pillows are always a good ally, to stop you rolling one way or the other.

Here are some positional tips that can help you get a better night’s sleep:

1. The Classic: Lying on your back.

Lying on the back is probably the best all-around sleeping position for a healthy back. It ensures good spinal alignment from the head and cervical vertebrae, through the thoracic and lumbar, all the way down to the pelvis. Because the back is the body’s largest area, weight is most widely distributed in this position, minimising pressure hot spots. This doesn’t suit everyone though, some people don’t feel as ‘nested’ as in other positions so, they struggle to get to sleep on their backs. Also, snorers may find that this position exacerbates the problem.

For people who like back sleeping, it’s definitely worth adding a pillow under your knees. It loosens the hamstrings a little and takes some pressure off the lumbar lordosis.

2. The Foetal Position: Lying on your side with your knees up a little.

This is a fairly intuitive position to get into if you have lumbar disc issues as it slightly flexes the low back and opens up the gaps in the facet joints.

Again, a good tip in this position is to use a pillow, however, this time put it in between your knees. This stops your top leg dropping forward and rotating the low back. It also aligns your hips and pelvis better, and feels more comfortable on the upper knee.

Try to swap sides from time to time if you’re lying in the foetal position.

3. Face Down: Lying on your stomach. 

I normally ask people to avoid this position, it’s usually quite problematic for the neck as well as the low back. Unfortunately, for a lot of people, it’s the only position they can fall asleep in, or any other position makes them snore. If you’re one of them, reach for that extra pillow again and put it under your low stomach and upper pelvis to take the pressure off the low back. This is a good idea if you’re having a massage too. Front lying needs a much flatter pillow (or even no pillow) under the head too.

If you’re someone who falls asleep on their back or side, then rolls over in their sleep and wakes up on their stomach, try hugging a large pillow against your chest and stomach to keep you in position. Another reason sleeping on the front is considered bad is because the head is usually turned to one side. This twists the spine and places additional stress on the neck, shoulders, and back. To avoid this, you can try lying face down. Place a small firm pillow or tightly rolled-up towel under the forehead, or better still a face pillow, allowing room to breathe. In this position, you should still place a pillow under the stomach.

4. Reclined Sleeping.

If all else fails, you can try sleeping in a reclined position. People with spondylolisthesis, for instance, may resort to this after finding it comfortable falling asleep in a recliner chair. There are beds available that can be sat up slightly. So, this is worth investigating.

What about the perfect bed for sleep?

There are so many different opinions about beds that I don’t even know where to start, nonetheless here’s mine.

Spend some time and effort (and dare I say money) choosing a bed and mattress. People seem happy to spend thirty times or more on a car than a mattress, but remember, a third of your life is spent in bed! 

It’s really difficult to choose a mattress on a twenty minute trip to the bed store, so really take your time, spend an afternoon there, take your shoes off, try different sleeping positions, not just lying on your back! Do your research before you go, but make sure the review sites you look at aren’t secretly run by a bed company, or affiliated to one.

Firmness

Try not to be seduced by softness. Lots of people jot down the name of a mattress they’ve found comfortable in a hotel, and while this can sometimes be a good indicator, you should know that hotels buy mattresses to give you a couple of nights feeling like you were sleeping on a cloud, but these mattresses are usually not supportive enough to be using full time, especially if you have low back issues, which can be aggravated over weeks and months. Often the mattress in a big hotel chain is not available to buy for the public as they are specifically manufactured for different hotels’ standards.

A fairly firm mattress is usually a good idea, perhaps with a shallow in-built topper. This can give you the support you need for your low back while the topper takes the pressure off bony prominences and allows shoulders and hips of side sleepers to sink in a little. I suggested a built in topper as they are usually better segmented and don’t allow stuffing to move around and bunch up as much. However, removable toppers give you more scope to adapt by removing it if needed, and also allow you to flip the mattress.

Mattresses that are fully stuffed as well as sprung are good and supportive. Price is a good indicator for a quality mattress. £1,500 for a king size mattress is not excessive. While we’re talking about price, beware of anything that seems too good to be true. The “Winning awards” mattresses need to be checked as to which award, and who’s giving it!

Memory Foam Mattress

Patients have different opinions about memory foam mattresses. While some patients swear by them, others do not get along with them. I’d like to reiterate the price, if you’re set on a memory foam mattress, find the one with better quality, so it doesn’t start to develop a permanent dip where you lie. It’s all about density which is measured in pounds of pressure per cubic square foot. More is normally more expensive and better quality, but at the same time is also more supportive and feels harder. 

There can be a problem with memory foam mattresses feeling too hot. While many of the better brands have addressed this to an extent, many memory foam mattresses have become hybrids so, it’s not just 100% foam any more.

Platform Bases

Mattresses should be changed about every 8 years, but you can keep the same bed base, of course, as long as it’s not damaged. Divans have pretty thin wood tops that can crack or bow so, check it carefully. 

In my opinion, a platform base is always the best. If the base is sprung, the whole mattress will start to fold which is usually not what they’re designed to do. A slatted base is slightly better than a fully sprung one, but still not as good as a solid base.

Pillows

Finally, I should mention pillows. Pillows are very subjective to the person, and especially to any neck/upper back/shoulder girdle conditions they may have. 

As a rule of thumb (and this is painting with a very broad brush) people seem to usually have too much pillow depth more often than too little. One medium depth pillow is usually best if you don’t have any specific issues. I find feather works well as you can punch and mould it to the right height and shape, so there is some support under your neck but that’s very much a personal preference.

I rarely see anyone who gets on well with memory foam pillows (there are the odd one or two) or sprung pillows.

The price of a good feather pillow is probably about £50, but as I said right at the start, I want you to not only be in a good position, but also comfortable and pain-free during the night and the next day, so if a £5 pillow works for you then that’s absolutely fine. Don’t forget most pillows can be laundered regularly which may give (especially feather pillows) some of their volume back.

If you are experiencing neck pain though, get your neck examined and treated first and ask your osteopath what pillow they would suggest for you specifically going forward.

BE ‘BED FIT’

The healthier and stronger your back is, the better night’s sleep you will get and the better your back will be when you get up in the morning.
Core strengthening exercises will help support the back during the night and prevent back spasms. Gentle stretching before bed can increase flexibility and help to relax the body and reduce stress.

Take care getting in, and especially out, of bed. Take your time. When you wake up in the morning, allow a few minutes to get your muscles and joints moving fully instead of leaping out of bed at the alarm. Roll onto your side then use your arms to push you upright while your legs drop over the side, then sit there for a minute moving gently before slowly standing up.

Perhaps most importantly, if you do have a back or musculoskeletal issue, get it checked. A health professional can assess why you’re suffering and help treat the symptoms. They can suggest the correct investigations, treatment and exercises, as well as further helping you to choose that all important correct mattress.

Booking an appointment with an osteopath could be the start of ending your back pain for good!