Sleeping Strategies for Cervical and Low Back Pain

Cervical and lumbar symptoms like pain are the leading cause of musculoskeletal disability in most countries and most age groups. (1) Sleep is one potentially modifiable risk factor that can contribute to cervical and lumbar pain. Therefore, by modifying your sleep position you can potentially decrease the overall risk of cervical and lumbar pain. Most people spend approximately one-third of their life asleep. Therefore posture, positioning, and comfort is critical because these postures can affect the quality and length of time we sleep. According to researchers, sleep disturbances occur in about one third of the population in the United States. Sleep is important because it is needed for proper functioning of the body. Sleep is necessary in each one of us because without the proper amount of sleep it can impact our overall health and wellbeing. Sleep allows the body to repair itself and can also help with prevention. For example, prevention of weight gain, or heart disease. There are many other benefits to getting enough sleep such as improving brain function, improved athletic performance, help in the prevention of depression, boost the immune system, and decrease inflammation in the body to name a few. To sum it up, sleep is a vital component in everyone’s health and wellbeing no matter what age you are.

Things to Consider When Choosing a Sleep Position

  • Comfort is the first factor that should be considered. Position is a personal choice and if one is not comfortable this can have a huge impact on the quality of sleep.
  • Age can impact how we sleep. As we age many prefer to sleep on their sides. We also tend to move around less therefore spending more time in one position. One possible reason for this is as we age we tend to be less flexible, which can make one prone to more stiffness and pain. So, when we are young sleep tends to be a no brainer on position, we just hop into bed and often fall asleep without difficulty. By the time we hit middle age and older the position we choose can have an influence on the quality of our sleep. It is important to really know our bodies and assess our comfort positions before attempting to fall asleep.
  • Gender can also influence the position we sleep in. Men and women have different sleep experiences and needs throughout their life. The challenges we face as men and women are different and can also influence our sleep postures. Women tend to be more prone to insomnia and men are more likely to suffer from disordered breathing. Our hormones also influence sleep. The way men and women handle stress is different, women go through pregnancy which affects sleep posture, while men have protective instincts. Like many other aspects of sleep, men and women have different preferences and different needs when it comes to sleeping positions.

Positioning for Sleep with Back Pain

There are many factors that can affect sleep. As stated above many people suffer from musculoskeletal problems and often struggle with pain resulting in sleep disturbances. One common musculoskeletal problem is low back pain, which is a common cause of sleep disturbances. Poor bed posture can worsen ones back pain or even be the start of the problem. Position is key, the wrong position can place unnecessary pressure on the neck, hips and back. Education for proper positioning to help alleviate unnecessary pressure is vital to assist in a pain-free or pain reduced position. This will potentially limit one’s sleep disturbances and ultimately improve the quality of one’s life.

Which Sleep Position is Best?

According to they ranked supine (on your back) as number one. The number two position is on your side, then the fetal position and finally on your stomach ranked fourth.

Maintaining the natural curve of the spine is important. This means proper alignment is needed. Just like when we are standing the same principles hold true when we are lying down. We need to look at the head, shoulders and hips and make sure they remain in proper alignment along with good back support. One of the primary positions that help to achieve this is lying on your back, because it not only evenly distributes weight the full length of the body, but it also minimizes pressure points of the head, spine, and neck. Additional support in this position can also be achieved by placing a pillow under the knees. This will also help to maintain the natural curve of the spine. Unfortunately, many people are not comfortable or just unable to sleep on their backs due to some underlying issues like sleep apnea, or it causes excessive snoring which often wakes people up. Research has shown sleeping on your back is the healthiest option, however only about 8% of the population sleeps on their back.

Research shows that the most common sleeping posture is side sleeping, side sleeping is the posture that greater than 60% of European adults adopt for much of the night. (2, 3, 4) This position is often the position of choice among older adults and with people who have a higher body mass index. Even though this seems to be the most preferred position, this position can cause improper alignment on the spine and cause unnecessary strain on the back. However, side sleeping can also offer some healthy benefits depending on which side you choose. Right side sleeping is not the best position especially for the heart. When blood flows throughout your body it will eventually have to return to the heart, and it does this via the right side. Therefore, if you sleep on your right side you are applying increased pressure on those blood vessels on that side making it more difficult for the blood flow to return to your heart. Sleeping on your left side does not cause this increased pressure making blood flow return to the heart less challenging.  There are additional benefits for the stomach as well with left side sleeping. According to the Journal of Clinical Gastroenterology this position may reduce the risk of heartburn or acid reflux. The theory behind this suggest the reasoning for this is this position keeps the junction between stomach and esophagus above the level of the gastric acid.

According to, 41% of adults choose the fetal position for sleep. This position (especially for left side sleepers) improves circulation in your body and if you are pregnant it improves circulation to the fetus and prevents the uterus from pressing against the liver. This position decreases snoring, however, one needs to be sure not to curl up too tightly or breathing can be restricted in your diaphragm. This position may not be the best position for people with arthritis because it can cause excessive stiffness on your joints and back due to the prolonged curled position.

Finally sleeping prone (on your stomach) is the least desired position. Despite the position easing snoring, it is not so good for everything else. The reason being is this position puts pressure on muscles and joints which could lead to numbness, tingling, and unnecessary aches. This position can also cause some airway restrictions because of one’s head being turned to the side. Only about 7% of the population choose this position.

Sleep Time Recommendations (

“The NSF has committed to regularly reviewing and providing scientifically rigorous recommendations,” says Max Hirshkowitz, PhD, Chair of the National Sleep Foundation Scientific Advisory Council. “The public can be confident that these recommendations represent the best guidance for sleep duration and health.”

The panel revised the recommended sleep ranges for all six children and teen-age groups. A summary of the new recommendations includes:

  • Newborns (0-3 months): Sleep range narrowed to 14-17 hours each day (previously it was 12-18)
  • Infants (4-11 months): Sleep range widened two hours to 12-15 hours (previously it was 14-15)
  • Toddlers (1-2 years): Sleep range widened by one hour to 11-14 hours (previously it was 12-14)
  • Preschoolers (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13)
  • School age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11)
  • Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)
  • Younger adults (18-25): Sleep range is 7-9 hours (new age category)
  • Adults (26-64): Sleep range did not change and remains 7-9 hours
  • Older adults (65+): Sleep range is 7-8 hours (new age category)

How Exercise Helps You Sleep

It is not fully understood by researches how exercise improves sleep. Some things that have been verified is that exercise increases the amount of slow wave sleep you get. Slow wave sleep has a direct correlation to deep sleep. Deep sleep is where the brain and body have a chance to rejuvenate. It is the time when your muscles repair and grow. Exercise can also stabilize your mood and helps to relax the mind. In turn, this cognitive process is important for naturally transitioning sleep.

How Diet Can Help You Sleep

If you want a good night sleep, one needs to emphasize a balanced diet to include fresh fruits, whole grains, and low-fat proteins. A diet low in fiber and high in saturated fats could take a toll on your sleep by decreasing the amount of deep, slow-wave sleep that you get during the night. Be aware about the amount of sugar intake as well, too much sugar could result in wakeups during the night. Key vitamins are B vitamins which are found in fish, poultry, meat, eggs, and dairy. Research shows that B vitamins could help to regulate melatonin which is a hormone that regulates your sleep cycle. A proper diet can also control one’s weight. A reduction in body fat will make you less likely to struggle with sleep problems such as snoring, sleep apnea, insomnia, etc..


Spinal pain is a major and growing health problem with increasing rates of disability. (1) In the last two decades there has been an increase in imaging, opioid prescription, injections, and surgery with questionable benefit, (5-7) so it would make more sense to focus on the risks that can be changed. Changing physical risk factors like type of movement pattern, (8) level of strength and conditioning, (9,10) and sustained or repeated postures (11,12) are relatively risk free, cost effective, and show enormous potential. Sleep posture is an example of a sustained physical risk factor that is modifiable. (64.65) Other modifiable risk factors are one’s diet and level of exercise. The impact sleep can have on one’s daily life is significant, especially with having the ability to modify a risk factor. Modifying risk factors can have one of the greatest impacts on the health of the spine, as well as the health of our mental wellbeing. Sleep posture is not something one should just push aside along with the other low cost modifiable factors. The quality of sleep we get will have an huge impact on the overall quality of our lives.


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Written by Robin Sipp MSPT- Clinical Director of our Lewes Delaware location.

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