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April 01, 2014  |  Sleep Health

Correct Sleeping Position

Correct Sleeping Position

Originally posted on Soma’s old blog.


Did you know that nearly one third of our lives are spent in bed?

With so many hours reclined, what’s the best position to keep us comfortable, ensure a restful night and minimize some of those morning aches and pains? To understand the best support for your body, you need to first understand the spine. If you look at the spine from the side you’ll see four graceful primary curves:

  • The cervical (neck) curve, the thoracic (rib cage) curve and
  • The lumbar (low back) and the sacral (pelvis) curves.


When the spine is in its proper alignment and viewed from the side, the ears should align directly over the shoulders, the hips and finally over the ankles. This alignment of our curves is called neutral spine. Whether you view the neutral spine position from the back, front or side, you’ll see a nice straight line. The same concept applies to our sleep position. No matter what position we sleep in–whether on our back or side–the goal is the same: to align in neutral spine. The neutral spine alignment always falls in the same straight line — ears to shoulders and hips to heels, no matter if on our side or back. Now that you understand the goal of neutral spine positioning, let’s start with the most basic support– the mattress. The question many seem perplexed by is, “How firm should my mattress be?” Too soft of a mattress allows your spine to sag out of neutral causing our spine to look like a crooked line. However, the old mattress adage, “firmer is better” is no longer true. Too firm a mattress won’t accommodate our body shapes, again throwing us out of neutral and causing pressure points. You want to choose a mattress that will contour to your body. One that is soft enough to give or compress to our wider bony areas such as hips and shoulders but firm enough to fill in support to our narrower areas like the waist and neck. In other words, a mattress that will support you in neutral spine. If you were to lie on your side on a properly supporting mattress, your spine would look like a straight line. If you have low back pain, you may want to consider putting a pillow between your legs. Make sure the pillow supports both your knee and your foot. This will stabilize your legs and pelvis, eliminating any rotation of the low back out of neutral. The pillow should be big enough so that your knee and foot are level with that sharp-feeling front hip bone. Add a pillow to support your top arm and you should be cozy and comfortable. A long body pillow can support both the arm and the leg. The next question is typically about the pillow. Like the mattress, the concept is the same–to support the spine in neutral. When lying on your side, if the pillow is just right, your nose should be horizontal. If your pillow is too high, your nose will slope downward toward the floor; too low and the nose will point upward toward the ceiling. When lying on your back, the curve of the pillow should again just fill the curve of your neck. If too big, your nose will slope down toward your chest. Too high, and your nose will point up toward the ceiling. You want the ear to align with the shoulder so, you guessed it, the spine is in neutral. Tired of hearing it yet?

If you have a pre-shaped cervical pillow, the thing to remember is that there are two different sized curves on each end of a cervical pillow. The small curve is to support your neck when lying on your back. The large curve supports your neck in side-lying. So, if you change positions in the middle of the night, say from your back to your side, you need to rotate your pillow as well. Keep in mind that cervical pillows need to fit your build. A large man will not have the same pillow as a petite woman. The pillow needs to fit your size, so that when lying on your side, the large curve fits into the space between the mattress, your shoulders and your neck and holds your spine to–you guessed it– neutral. If you have certain physical conditions, such as severe arthritis or a disc herniation, you may want to meet with your physical therapist to adapt the position to meet your individual needs. And know that even if the position is perfect, if it’s not the position you are accustomed to sleeping in, your body and brain won’t like it. It won’t say “sleep time” to you and it may not feel natural even if it’s good. When this happens you have to retrain the brain! Try resting in the correct position for at least five minutes and then don’t worry about it. Eventually, in about three weeks, your brain will stop rebelling and recognize it as the position that signals sleep time and you’ll wake in the morning with a few less aches and pains.

John D’Amico D.Ac

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