the
washington
post
.thursday,
november
11,
2021DC14
Wellness
pillow, it tends to kind of flex your
neck forward, and that may put
undue stress on parts of the cervi-
cal spine and discs and muscles,”
he said. “If you’re somebody who
really likes to sleep on your back,
then you may want to experiment
with a narrower pillow rather
than one of the big, super fluffy
ones.”
Rachel Salas, a sleep neurolo-
gist at the Johns Hopkins Center
for Sleep and Wellness, also rec-
ommended using a second pillow
or a rolled towel under the knees
to prop them up, which can re-
lieve some pressure on the lower
back.
But the supine position is not
for everyone, such as people who
have obstructive sleep apnea or
snore. “Sleeping on your back can
obviously make snoring and ap-
nea worse, just because of the way
gravity works against you when
you’re on your back,” Salas said.
Snoring, which is often associ-
ated with sleep apnea, usually
happens when a person’s airway
is obstructed, said Rafael Pelayo,
a clinical professor in the sleep
medicine division at Stanford
University’s School of Medicine.
“The biggest thing about snoring
is the tongue, and so the tongue
will slide back when you sleep on
your back.”
Although positional therapy,
which uses various techniques to
help people stop sleeping on their
backs, is a treatment option for
milder sleep apnea, Pelayo said, it
may not be sufficient in moderate
or severe cases.
Those who are pregnant also
should avoid sleeping on their
backs, especially during the lasttrimester, Morgenthaler said. At
that stage, the uterus is large
enough to put pressure on the
inferior vena cava, which is one of
the major blood vessels that re-
turn blood flow to the heart. Sleep
apnea and disordered breathing
can also be more common among
those who are pregnant and are
further reasons to avoid sleeping
on the back.On your side
“For the most part, sleeping on
the side seems to be the most
natural way of sleeping for a lot of
people,” Pelayo said.
Side sleeping is often the rec-
ommended position for people
who can’t sleep on their backs
because of an underlying health
condition or pregnancy, experts
said. And depending which side
you sleep on, it could help lessen
symptoms of pain, heartburn and
reflux, as well as potentially in-
crease comfort for people with
heart failure.
If you have shoulder or hip
pain, avoid sleeping on the side
that’s bothering you, experts said.
For chronic back or neck pain,
Pelayo said, sleeping on the side
might be beneficial, because it
can take the pressure off painful
areas.
Sleeping on your left side and
with your upper body slightly
elevated is the ideal position for
people with heartburn or reflux,
Salas said. “It all kind of centers
around where your organs are.”
(Some research has suggested
that s leeping on the right side can
exacerbate those symptoms.)
In this position, the majority of
the stomach is below the esopha-gus, said Raj Dasgupta, a pulmo-
nary and sleep specialist and
spokesperson for the American
Academy of Sleep Medicine. “You
want gravity to be your friend in
most cases,” he said.
Sleeping on the left side may
also be better for pregnant indi-
viduals, Dasgupta said, because it
can take pressure off the critical
blood vessel that supplies the
heart.
Sleeping on the right side, how-
ever, could be more comfortable
for people with enlarged hearts,
according to a 2003 study pub-
lished in the Journal of the Ameri-
can College of Cardiology.
Morgenthaler said pillow loft
(its height/thickness) is an impor-
tant factor in ensuring comfort-
able side sleeping. If you’re sleep-
ing on your side without a pillow
or using one that’s too thin, that
could cause the head and neck to
be flexed on one side and extend-
ed on the other, he said. “You want
a pillow that’s sufficiently thick so
that your neck is in a more neu-
tral-type position, and it turns out
that, on average, that’s about sev-
en to 10-ish centimeters.”
A pillow between the knees
could also help with discomfort
or osteoarthritis, Dasgupta said,
which may be exacerbated by
sleeping with your legs folded
together.On your front
People who snore or have sleep
apnea may have an easier time if
they sleep on their stomachs, be-
cause it can help keep the airway
more open, Morgenthaler wrote
in an email. But the downside of
the prone position is that it tendsBY ALLYSON CHIUSeveral months ago, Mark L.
Keam started to notice a sharp
pain in his neck that radiated
down his left a rm and was accom-
panied by an “electric shock” sen-
sation and constant tingling.
“While I was sleeping, every
time I would turn one way, I
would feel that really sharp pain
even more,” said Keam, 55, a Dem-
ocrat in the Virginia House of
Delegates. Once, he said, the pain
in his arm was so intense that he
cried out in the middle of the
night, alarming his wife.
Keam, who has since been di-
agnosed with a condition that
causes compressed nerves in the
neck, said his symptoms were
probably exacerbated by his sleep
position of choice: For as long as
he can remember, he’s fallen
asleep on his stomach — “a little
like a frog” — with his head
turned to one side.
Following advice from his doc-
tor, Keam said, he is attempting to
join the legions of back and side
sleepers, though fighting the “au-
tomatic impulse” to flip on his
stomach hasn’t been easy. “The
pain is definitely better,” he said.
“I haven’t woken up because of
pain so much as woken up be-
cause I feel like I’ve been in the
same position for a little too long
and my body’s starting to get
uncomfortable.”
While the position in which
you fall asleep is just one piece of
the sleep-hygiene puzzle, experts
said it can be key. As in Keam’s
case, the wrong sleep position
could exacerbate an underlying
medical condition, while the right
one might alleviate symptoms
and increase comfort.
Here are the pros and cons of
different sleep positions, and how
to pick the best one for you. We
also have advice from experts
about appropriate pillows for
back, side and stomach sleepers,
and tips for learning how to stay
in a new position.On your back
For generally healthy people,
sleeping on your back, or in the
supine position, may help with
spine alignment, the experts said.
It can also help prevent or ease
back and neck pain, because it
provides more support.
It’s i mportant, though, to make
sure you have a quality mattress
and an appropriate pillow,
said Timothy Morgenthaler, co-
director of the Center for Sleep
Medicine at the Mayo Clinic.
Many people who sleep on their
backs may develop neck pain be-
cause they’re using a pillow that’s
too thick, he said.
“If you are on your back and
you have a 10-centimeter-thickto “create a lot of pressure on
various muscles and joints,” he
said, because people who sleep on
their fronts typically have their
heads turned to one side and their
arms in unusual positions or
pinned underneath their torso.
Dasgupta agreed: “You can
imagine your neck is on the side,
gravity’s pushing down on your
spine, so I’m really not a big fan of
sleeping on your stomach.”
Given the potential increased
strain on the body in this position,
Morgenthaler said, stomach
sleepers may want to avoid using
“very thick” pillows, so they don’t
put added stress on the cervical
spine, shoulders or lower back.
Still, experts emphasized that
sleep positions are individual and
that y ou should go with what
works for you. “What you want is
comfort, and that comfort will
help you sleep deeper,” Pelayo
said.
If, however, you’re realizing
your sleep position is not ideal,
remember that it may take time to
get used to a different way of
sleeping. And, Pelayo noted, it’s
important to remember that you
naturally move in your sleep.
“Even if you wake up in the same
position when you first started, it
does not mean that you don’t h ave
a journey throughout the night
changing positions,” he said.
Strategically placed pillows
and devices intended to help you
stay in a certain position may be
helpful, experts said. There are
belts and vests designed to make
sleeping on your back uncomfort-
able — a more modern approach
to the method of sewing a tennis
ball into the back of a T-shirt —
and wearable technology that can
sense if you’re on your back and
emit vibrations prompting you to
turn on your side.
Keam, the Virginia delegate,
said he’s largely relied on pillows
to keep him from rolling onto his
stomach, but isn’t u sed to the new
position yet. “Now that I’m think-
ing so much about my sleep pat-
terns and my sleep position, I feel
like I can’t sleep that comfortably,
because it’s n ot natural anymore.”
Learning to sleep in a new
position could initially “cause a
little bit of disruption to your
sleep,” Morgenthaler acknowl-
edged. “But if there’s a good rea-
son to change position, you can
accommodate so long as you don’t
have some skeletal reason that
prevents you from doing it.”
Making even minor changes
to how you sleep can have an
effect, Dasgupta added. “Getting
good sleep sounds so easy and
simple, but it’s actually much
harder than you think,” he said.
“My view is that every little thing
counts.”
[email protected]How to choose the best sleeping position — and why it matters
THE WASHINGTON POST ILLUSTRATION/ISTOCK