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Why You Should Sleep on Your Back, Not Your Stomach

Your neck will thank you.

ByManouk van Egmondtranslated byJens van de Meulenhof

Vladislav Muslakov/Unsplash

This article originally appeared on Tonic Netherlands.

I sleep on my stomach, and I’ve been doing it all my life. The fact that some people can fall asleep in the fetal position or with their limbs spread out like a starfish is beyond my comprehension, as are the weirdos who can take a nap in an upright bus seat with their mouth wide open.

I thought my go-to sleeping position was so superior that I never questioned whether it was healthy or not until I stepped into an outdoor retailer last summer. I explained to a cheerful employee in a body warmer that I wanted to go camping but that I had no camping gear whatsoever. A sleeping pad seemed like a good start, so I tested an orange one. I laid down on my stomach, pulled up my left knee, and folded my arms under my head.

The attendant looked at me with a worried expression. “You don’t sleep on your stomach, do you?” he asked. “That’s really bad for your neck and back.” I was almost as shocked by his remark as I was by the sleeping pad's $200 price tag. Had I been endangering my health for more than 9,500 nights now?

To convince myself that my favorite sleeping position wasn’t a problem, I called Hidde Hulshof, a Netherlands-based physical therapist who specializes in sleep. He's also the founder of Slaapfysio, a platform that researches the influence of sleep behavior and sleep materials on physical complaints.

Tonic: Let's cut to the chase: I sleep on my stomach. Is that bad for my health?
Hidde Hulshof: Yes. Physically, it’s an unnatural position that's unfavorable to your neck and back. Your neck is turned in a way that locks your upper cervical vertebrae, which can cause headaches and neck problems. Moreover, this position puts pressure on your joints and the vertebrae in your lower back. Your lower back is concave, so if you sag into your mattress a bit, your lower vertebrae are positioned out of their natural shape, which can eventually lead to back problems.

So what exactly happens then?
The cartilage between the joints of your neck and lower back will wear and tear faster. As a result, the bones might rub against each other over time, which causes painful symptoms. In the worse case [scenario], you'll develop osteoarthritis, which is a chronic disease. Once you have [osteoarthritis], the pain won't go away.

Well, I've got a problem then...
The question is whether or not you're actually a stomach sleeper. The position in which you fall asleep may not be your actual sleeping position. There's lots of people who think they're stomach sleepers, when [in reality] they mainly lie on their side or back. I suggest you do a test with a physiotherapist or bed expert, or you should film yourself at night. Our tests show that only six percent of people sleep flat on their stomach.

What if it turns out that I do sleep on my stomach?
If you want to avoid health complications, it’s better to sleep in a different position. However, sleeping on your stomach doesn't necessarily mean you'll get problems. Moving around a lot at night makes a difference—some people lie on their stomach for three hours straight, while others shift into a different position after a few minutes. On average, we change our sleeping position 38 times a night.

What's the best sleeping position?
Your body weight is divided best when you sleep on your back. Moreover, [it doesn't put any pressure] on your spine, providing you're sleeping on a good mattress. A mattress that's too hard can't properly fill and support the hollow of your lower back, and a mattress that's too soft can also be problematic: The middle part of your body is heavy, and if it sinks into the mattress deeply, that puts pressure on your pelvic joints.

And what about people who sleep on their sides?
Sleeping on your side is also good. If you're a back sleeper who snores, it's better for you to lie on your side. When you sleep on your back, your tongue can loll back into your throat. This can make breathing so difficult that some people suffer from sleep apnea.

However, it's also possible that sleeping on your side can cause localized pressure on your shoulders or hips. For example, if you have a broad torso and sleep on a firm mattress, your shoulder can become uncomfortable. As a result, you might move into an intermediate position quicker, one where your upper leg is raised and the spinal column is rotated—that position is just as bad for your back as sleeping on your stomach is.

Is it possible to change our sleeping position?
Yes, but it won't happen simply by wanting it. You need an incentive. In the past, physical therapists would advise people to put a tennis ball next to their stomach when they tried to sleep on their side. Nowadays, you can place a kind of pregnancy pillow next to you. It's a snake-shaped pillow that prevents you from rolling onto your stomach or into an intermediate position.

What should I do if I want to continue sleeping on my stomach?
I'd advise you to use proper sleep support products, like a hard mattress, and maybe put a pillow under your pelvis and stomach to lessen the pressure on your lower back.

Research on this subject is still limited, so there aren't any hard numbers regarding the amount of people who sleep on their stomach and who develop back and neck pain. Several sleep experts, including Dutch doctors Hagit Raijter and Thomas Santosh, also assert that sleeping on your stomach is less healthy.