Side sleeping
The most commonly recommended, and for good reason.
- Advantages: keeps the airway more open than back sleeping — helpful for snoring and mild apnoea; reduces reflux compared with lying on the right or on the back; easier on the lower back than stomach sleeping.
- Disadvantages: can compress the shoulder and hip; the face side can develop lines over years.
- Support: a pillow between the knees keeps the pelvis level; one under the waist supports the lumbar curve; the head pillow should be thick enough to keep the neck roughly level with the mattress; a pillow in front of the chest stops the upper shoulder rolling forward.
Back sleeping
- Advantages: the spine is evenly supported and nothing is compressed; good for those with facial or shoulder sensitivity.
- Disadvantages: the tongue and soft tissue fall backward, worsening snoring and apnoea; reflux is worse lying flat; the lumbar curve can be unsupported.
- Support: a pillow under the knees reduces lumbar load; a thin neck pillow keeps the head from tipping forward; a wedge under the upper body helps reflux.
Stomach sleeping
- Advantages: it can reduce snoring, and some people find nothing else comfortable.
- Disadvantages: requires sustained neck rotation, which produces neck and shoulder problems; it extends the lower back; it compresses the chest and limits breathing depth.
- If you cannot change it: use a very thin pillow or none, and place a pillow under the pelvis to reduce lumbar extension.
Specific situations
- Snoring or apnoea: side sleeping. See sleep and pain for positional support detail, and ask for assessment if snoring is loud or pauses are observed.
- Reflux: left side, with the upper body slightly raised.
- Lower back pain: back with knees supported, or side with a pillow between the knees. See Feldenkrais for lower back pain.
- Neck pain: avoid stomach sleeping; match pillow height to your side-sleeping shoulder width. See Feldenkrais for neck pain.
- Pregnancy: side sleeping, usually left, supported with pillows. See pregnancy insomnia.
- Shoulder pain: avoid lying on the painful side, or support the upper arm on a pillow so it does not fall forward.
Changing a lifelong position
Forcing a change rarely works, because the position your body prefers is often the one it has organised itself around. Rather than commanding a new position, make the target position easier to stay in with pillows, and be patient — most people who successfully change do so over several weeks, gradually.
If your current position is uncomfortable and you cannot find relief, Feldenkrais work addresses the underlying holding rather than the position itself — reducing the effort you use to maintain yourself, so that more positions become comfortable.