Sleep

According to Healthline, “sleeping on your back may be a simple, cost-effective solution to a host of ailments: from sleep issues to pain and health woes”.

And, according to the Sleep Foundation, it’s considered the healthiest way to sleep. Sleeping on your back keeps your spine aligned, your muscles elongated, and your joints extended.

I tell my patients this, the ones with Musculo-skeletal issues (that’s about 2/3 of them), and they come in week after week for good pain relief that lasts a few days instead of a month, or a lifetime.  Why doesn’t it last?

Because, the “pattern of contraction” that was just corrected by your good doctor – that relieved small to large spasms throughout the entire pattern (all the players – the main injured muscle to the smaller compensator muscles) – just begin to remember their pattern of non-contraction and healthy movement and then WHAM!  ….. they get all crumpled up, oxygen- and nerve-conduction-starved and go right back into their learned safety mode.

 

Think about what your body looks like when it is on its side.  One hip and SI joint askew from the other – one side squished, shoulders rounded and uneven, legs curled up without any chance of stretching out the back of the neck, pectoral muscles, lumbar spine or ham strings and calves.  We are asking too much of the body all day and then cutting off its restorative life lines at night.  Give your body a chance to realign EVERY night.  Sleep is either a 1) therapy or 2) an injury reinforced or waiting to happen.

Besides thousands of years of Ayurvedic and East Asian or Naturopathic clinical evidence, the testament of anyone you know that has healed from a back, neck, shoulder, or hip injury, and the endorsement of PTs, Osteopaths, and pretty much EVERYone from Japan, there is actually scientific evidence now that…..

 

THE SCIENCE BEHIND BACK SLEEPING:

 

Back sleeping, more officially known as supine sleeping, offers a host of health benefits.

Back sleeping can benefit you by:

• keeping or getting your spine aligned
• reducing tension headaches
• reducing pressure and compression on the chest
• relieving sinus buildup
• preventing wrinkles and irritation on your face

When it comes to infants, the American Academy of Pediatrics recommends babies sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS).

This could be due to the knowledge that, when infants sleep prone, or on the stomach, it increases:

• nasal bacterial load
• respiratory work of breathing
• upper airway secretions

A 2019 review found that back is associated with less spinal pain than side or stomach sleeping for adults.

According to a 2017 studyTrusted Source, most people prefer to sleep on their sides as they approach adulthood. Interestingly, the study noted that children, while changing positions more often sleep more on their backs than most adults.

The same 2019 review mentioned above noted that more than 60 percent of European adults are lateral, or side sleepers.

Still, there are plenty of reasons to make the switch, even if you sleep on your tummy or your side. Here are just a few.

Reduces back and neck pain

Back sleeping helps reduce pressure on your spine. This position mimics standing up straight.

Sleeping on your stomach with your head to one side is akin to having your head turned in one direction for hours while sitting or standing, causing soreness. It also compresses the spine because your neck is tilted back.

It’s much easier to give your spine rest by lying on the back, using pillows for comfort, and maintaining the natural curve of the spine.

A 2017 study noted that sleeping on the back with both hands at the sides or on the chest is the best way to prevent pain.

 

Andrew Weil, MD, of Very Well Health offers this:

Why sleep on your back?  Easing neck pain and back pain while you sleep involves maintaining these body parts in a neutral, or straight, position. Extending your muscles, tendons, and ligaments too far in any one direction while you sleep can cause stiffness, muscle spasms, and pain when you awaken.¹

Sleeping on your back puts your spine in neutral alignment with the least amount of stress on your neck and back. It evenly distributes your body weight to avoid exerting pressure on your joints and preventing aches in your neck or back. In addition, a supine position allows outstretched ligaments to shrink and recover back to their normal positions.²

When sleeping on your back, use these strategies to ensure your neck and back remain pain-free:³⁴

• Keep your arms in similar positions to maintain evenness in your spine.
• Use a pillow to support the natural curve of your neck while allowing your head to sink deeper. Or, roll a towel under your neck and use a flatter pillow for your head.
• Using a pillow under your knees can support your spine’s natural curve and take some pressure off your lower back.

Improves breathing

If you’re lying on your belly or side, you may be crowding your breathing space.

The diaphragm is the muscle responsible for breathing, and compressing it makes your breathing shallower.

Multiple studies have linked deep diaphragmatic breathing while waking with:

• reduced stress
• improved mood
• improved attention span

Slow, deep breathing results in melatonin production, a hormone that promotes relaxation, induces sleep, and increases parasympathetic nervous system activity.

May reduce breakouts

Face washing, keeping hands away from your face, and reducing sugar consumption are frequently discussed solutions for clear skin. What about what happens while you sleep?

Pillowcases absorb sebum from the skin and hair as well as product residue. These are easily transferred to the face while sleeping.

This can contribute to skin issues, like:

• blackheads
• whiteheads
• redness and irritation

While satin, silk, or copper pillowcases may help, why not avoid pillow-skin contact altogether?

Back sleeping keeps the face away from the pillowcase and, by extension, the dirt and oils that can irritate it.

May prevent wrinkles and lines

Sleeping on your face can pinch, pull, and irritate your skin, resulting in wrinkles. When your face is directly on the pillow, the resulting friction can cause wrinkles and lines.

The same applies to the neck, which can get scrunched and tweaked while sleeping on your stomach.

Back sleeping also helps keep your skin care products on your face and off of the pillowcase.

By back sleeping, you avoid face-to-pillow contact and keep the neck straight, preventing the premature development or deepening of wrinkles and lines.

May reduce puffiness

When lying on any part of your face, fluid pools in that area.

Fluid buildup causes puffiness around the eyes and swelling in the face. By lying on your back, you discourage this pooling and reduce puffiness.

Be sure to elevate your head a bit to help control where the fluid goes. This can help you avoid bags and puffiness, so you can wake up looking as rested as you feel.

Generally can relieve sinus buildup

Sleeping with your head elevated above your heart helps to relieve congestion and prevent clogging of your nasal passages. When the head is down, mucus pools in the sinuses.

If you prop up your head, gravity will do its part to help drain mucus and keep your airways clear.

According to a 2016 reviewTrusted Source, this position also helps with acid reflux, also known as gastroesophageal reflux disease (GERD).

For some it prevents tension headaches

Similar to its effect on your neck and spine, back sleeping takes the pressure off of your head.

Cervicogenic headaches, or headaches rooted in the cervical spine, start in the neck and are often mistaken for migraines. Symptoms may include:

• throbbing pain on one side of your head or face
• stiff neck
• pain near the eyes
• pain when coughing or sneezing
• light and noise sensitivity
• blurry vision
• upset stomach
• pinched nerves

By keeping your head, neck, and spine in a neutral position, you alleviate pressure and avoid pain.

Pro tips: Even while sleeping on your back, it may be habitual to turn your head. Use pillows to give neck support and prevent your body from giving in to temptation.  More and more pillows are utilizing a hollowed out design that make this much easier.  Or, try using a feather or feather-like pillow that billows up on either side of the head!

Another tip that I have learned from my patients is that women have a bit more of a challenge – likely due to feeling more vulnerable – try putting a pillow over the belly at night.  It acts like the comfort of a weighted blanket and provides a nice resting place for the hands, as well!

 

If you have pain or just want to avoid it in the future and decide to give back sleeping a chance to help you, have multiple pillows and a rolled-up towel, for the neck, perhaps, handy.  Commit to success.  This is your life with pain or without!

Other tips:

Try putting a pillow under your knees or a rolled up towel under your lower back. This will help to support your body in areas with natural curves and shift pressure from your back.

There are also plenty of products on the market that can help your transition to supine sleeping go as smoothly as possible.

Wedge pillows can help with head elevation, and a bolster pillow can go under the knees to support the lower back.

It can also help to create a bedtime routine to simplify falling asleep in an unfamiliar position, similar to sleeping in a different bed.

Consider:

• Start on the day you have had a muscle-tension relieving acupuncture treatment for a much easier transition
• a warm beverage
• low lighting in the hours before bedtime
• meditation
• relaxing scents, like lavender
• less screen time before bed
• Lower the temperature in the room

Takeaway

Back sleeping offers multiple benefits that are hard to ignore, including:

• improved breathing
• reduced back, neck, shoulder, and even knee and hip pain
• smoother, clearer skin

 

Much of this information had been Medically reviewed by Alana Biggers, M.D., MPH

People with sleep apnea, GERD, or pain that prohibits them from lying flat may find they get a better night’s sleep in a recliner rather than a bed.  It is suggested that this is done temporarily with the goal of eventually lying flat – often a gradual change from head and knees lifted to lying flatter in increments over time is the answer.

 

One last note to those with a spiritual bent.

I heard an Eastern ‘Master’ or ‘Guru’ speak many years ago and talked of the ‘evolutionary’ sleeping position being supine, or sleeping on one’s back.  He claimed that as those progress spiritually, they naturally start to sleep on their back, “facing the heavens all through the night and aligning their spine for the best conduction of divine energy received in the dreaming state”.

I didn’t really take this in until I had a patient who said, that, since doing the yoga therapy movements I’d taught her and sleeping on her back, not only did her posture improve completely, but, that all her “shame is gone”.  Sleeping on her side was not only keeping her in chronic neck and shoulder pain, it seemed that the body language was keeping her in fear and pain.  It certainly suggests to the mind, perhaps to the unconscious mind, “I am in danger”, where sleeping on one’s back suggests, “I have nothing to fear” (I am sleeping with the divine)!

Written by Dr. Nancy Hiller, 5 October 2024

 

 

 

 

 

Resources

 

Healthline

Sleep Foundation

Life MD+

15 years of Clinical Practice and Case Studies

 

First do note that sleeping in intervals is ‘normal’.  Getting up to go to the bathroom and then taking 2 minutes or 20 to go back to sleep is ok.  You may need an hour or more, but, just make sure you have the ability to sleep until you have rested and feel energized for a new day (6-10 hours depending on the individual – men are generally 6-8 hr people while women need more sleep – 8-10 hours).

• Bring a body ready for rest by expending physical energy during the day and giving the heart the workout it craves: Walk (outside, treadmills don’t count), uninterrupted – stopping for the dog to sniff, pee, and poo doesn’t count either, or bicycle, swim for a steady 30-60 minutes every day  (or at least 150 minutes per week)– we want the heart rate up!  A bit of sweat and shortness of breath and we know the body is getting what it needs to rest later.
• Train the body to go into ‘rest and digest’ (as opposed to the ‘fight or flight’ we seem to enter too often throughout the day). Alternate Nostril Breathing is a perfect and fast way to get there.  Vagus nerve stimulation e.g. stroking the sides of the neck/scm muscles firmly while taking full, slow breaths (always IN the nose and OUT the nose to stimulate a calming effect – no mouth breathing please)
• Stretch for 5-10 minutes before bed – stretch calves, hamstrings, quads, side stretching standing or while doing a child’s pose, slow and steady and move with the breath– any movements that help you undo your day.
• Cut off time for Caffeine! – most need to cut off coffee, tea, chocolate and other caffeinated items by 11:00 a.m. or 12:00 noon to enjoy a deep sleep at night! Some need to avoid it altogether.
• Cool down the room you sleep in. Studies show the old natural way of winding down in darkness and coolness promotes good sleep and we can warm up the room in the morning when we’re ready to move again (special cooling mattresses, mattress toppers and sheets can add to this effort).
• A heavy or heavier blankets/covering tells the body to be still and quiet
• Sleep on your back so you 1) do not cut off your oxygen by cramping your lungs and 2) do not promote tossing and turning when pinching off nerve and blood supply by sleeping on the side or stomach. Back sleeping has many benefits and once you get used to it, less pain, more oxygen, less wrinkles, and better sleep are the four big benefits!
• Take melatonin in small doses – studies show less can be best. Try 0.5-1 mg. of melatonin before bed and ½ or 1 more if you wake up and have trouble sleeping.  Many of us make less melatonin as we age.  Sleepy time teas with Ashwaganda and/or Chamomile help many.
• Write down any racing thoughts in the head before you sleep and end with a comforting thought e.g. “I will think about this again between 7:30 and 8:00 a.m. or between 1:15 and 1:30 tomorrow afternoon. In the meantime everything is just fine in this moment and through the night.”
• Stay away from anxiety promoting foods/beverages like alcohol, cane and corn sugars or eating after 8:00 at night. Drink plenty of water and be loving toward your digestion (see ideal, anti-inflammatory diet on the website — https://acupuncturemed.org/mediterranean-diet/).
• Contact a board certified herbalist if you need a little help in this transition to better and deeper sleep. Acupuncture, along with other vagus nerve stimulating therapies help immensely, too!

Ooops, that’s 11!

 

Written by Dr. Nancy Hiller, August 30, 2024