< Back

What is the best sleep position? And what pillow to choose?

By October 13, 2021No Comments

On average we spend 1/3 of our day asleep, which is a considerable amount of time to neglect when it comes to changing our lifestyle for the better.  We always hear about posture and workplace ergonomics and how this affects our necks and spine, and this too takes up about 1/3 a day (dependent on how long you work).


So could we be causing our bodies harm when trying to get that golden beauty sleep? We often get into the most comfortable position, but often this is a trick. If you are twisted one way, then your body gets used to that position, and thus becomes comfy and feels ‘normal’, so you are just feeding the pattern of dysfunction without even knowing it. This will continue and then become a habit, to which is even harder to change. Often you will hear “oh I have always slept on my front”.


Below should hopefully shine some light on this topic, and give you some tips should you need to change the way you sleep. Of course, this information is in relation to physical positioning and we understand there is a multitude of other reasons for sleep quality. 

Side Position


Back Position



Sleeping position shown

On your back (supine)

Sleeping on your back is the second most common position, and is often the one you see commonly in movies or commercials when people are at rest or sleeping calmly. 

Using this position evenly distributes the weight throughout your body and avoids unnatural or unneeded curves within the spine. Sleeping like this can also relieve congestion of the sinuses or nose. 

This position however can exacerbate snoring and obstructive sleep apnea. This is the second best position we recommend, but this is when we sleep on our backs correctly, and there are a few common mistakes with this position.

Either having your knee out to one side can add compression to the hip joint. Additionally, turning your neck to one side can cause a strain pattern.

The best way to adopt this position:

  • A small pillow under the knees helps stop the knee from falling outwards but most importantly reduces pressure into the lumbar spine. 
  • A more firm mattress will be better due to not dipping in the middle as much. 
  • A small pillow under the neck and head, otherwise the neck is forced into too much flexion (forward bending).

On your front or stomach (prone)

This position is not advised in the clinic, when we sleep on our front or stomach we never just lay there flat on our face and the rest of our body in a plank position. We end up looking like a lizard crawling up a wall. Head rotated, thorax twisted, pelvis lifted on one side, and hip/knee out to one side.

This causes a twisted position which the body gets used to and thus making you unsymmetrical. A test would be while on your front to switch over your preference (ie if you rotate your head right then turn it to the left) and you will quickly feel uncomfortable and a lack of movement when compared with your preferred side. 

This twist happens all the way down your spine to your hips and can predispose you to complaints in the future. Additionally, overarching of the lumbar spine can occur due to our body being the heaviest in the middle. Also, turning the head to one side while lying down can limit blood circulation and reduce the size of the airway.

There are some benefits; sleeping on your stomach can reduce snoring and diminish sleep apnea. Overall this sleep position is not recommended.

Poor sleeping position front

On your side (side-lying)

There are two ways to sleep on your side, you have either the fetal position or normal side sleeping. Fetal position is when you have your knees above 90 degrees (closer to your chest). 

The fetal position is not recommended due to being tightly curled while sleeping can limit space for the diaphragm and restrict breathing, and can increase the curvature of the lumbar spine.

Our most recommended sleeping position is on your side. With the right mattress, the spine can remain elongated and relatively neutral while on your side. Side sleeping may also reduce heartburn. 

Great for pregnant women due to the support of the baby and reduction in organ pressure on the mother. This position may not be suitable for people with shoulder pain or lateral (outside) hip pain.

If you find your midsection dipping or bending down towards the bed too much, you can try rolling up a towel or a very thin pillow under your waist to give more support.

Best way to adopt this position:

  • Use of small pillow between knees – keeping knees together helps balance hips and pelvis and stops the rotation of the pelvis. Great for lateral hip pain relief

  • Use of a medium to large pillow for the head and neck – due to the space between the shoulder and neck being larger, thus keeping the spine straight

  • Use of a medium softness to soft mattress, to cater for the curvature of the hips and shoulders, more important for people with more curves

If you are concerned your sleeping position could be contributing to your pain or general mobility then please consult your sleep specialist or health care practitioner for more guidance

Best Sleeping Postion shown

How do I make the change?

Seems easy right? Well, this can be very difficult. As mentioned above a bad sleeping position can turn into a habit. Then you are both changing it physically but mentally as well. 

If you go cold turkey it can seem very disruptive and uncomfortable to change, and often makes changing the habit harder. What we suggest is that you take small steps and changes over a few weeks

Going into the optimum position for 10-15 mins before going to sleep for a week will get your body used to being at rest in this position. Often we have patients that try the new position on the sofa or watching TV, so their body can get used to it. 

Do not get annoyed or frustrated if it doesn’t change straight away, go back to your normal position to get a good night’s sleep and try again the next night. Sometimes people sleep a certain way for 20 even 30+ years, so make sure you talk to either your practitioner or sleep specialist in ways you can modify your position.

Pillow Height

See above for reference with your sleeping position. If you sleep on your side you need a medium to large pillow to fill the space between your neck and shoulder, so your neck does not curve closer to the mattress. Thin or smaller pillow for sleeping on your back (supine), as there is much less space to support.

Type of pillow

At the clinic we let the patients choose what type of pillow they want, one factor we look out for is the height (as mentioned above). The other main factor we ask patients to look at is how it holds up overnight. We don’t want the pillow to deflate or depress too much overnight. So choosing a firm or stable pillow that holds its shape overnight is best.

We recommend organic hypoallergenic pillows or any pillow with minimal or no toxins.

If you have any further questions about the topics covered above or any other questions on how Osteopathy can help you, then please do not hesitate to reach out. 

Our Osteopathic clinic is situated on the North Shore in Auckland. A list below are the areas we serve:

  • Albany
  • Rosedale
  • Glenfield
  • Browns Bay
  • Takapuna
  • Milford
  • Wairau Valley
  • Mairangi Bay

About The Author

William Pearson principal Osteopath at Inline Osteo is a multi-skilled Osteopath with experience in treating people of all ages, from babies to older individuals, and everyone in between.

Masters of Osteopathy (UK), Sports Therapy Degree, and years of clinical experience

William Pearson Osteopath