Side Sleep Positions and Pain

Side sleepIt has always been frustrating for me to wake in the middle of the night with back or neck irritation and pain . It doesn’t happen often, thank goodness, but many of my patients tell me they have this problem. Not only is it my task to help them with their daily pain, improve their function etc but to help them reduce some of these same symptoms when they sleep.


Many times I’ll suggest a medium hard bed and sleeping on your side since studies have shown most people prefer a medium hard surface and the side position is better for back support. Medium hard surfaces appear to help people get to a deeper sleep and help them stay asleep longer. Side sleeping reduces snoring and helps many side step sleep apnea.


Sleep positions, our tossing and turning on this medium hard surface and in a side lying position can either reduce our symptoms or increase pain. See the images below. So what has happened to us that we have lost positions of comfortable sleep. Look to the bed you sleep on as well as the pillow you use. Being conscious of your own sleep postures is very important as well.


The surface you sleep on is all important but just as important are the positions you lie in. Both the firmness of the bed as well as the shape and position of the pillow you use can make a very big difference for overall comfort and deep sleep.

How to Pick the Best Postures to Sleep In? A Side View!

This is a good question and one I get quite often. Sleep positions can run the gambit and go full circle all around the body. What I mean is there are two sides, left and right; stomach and back.

Lets keep it simple first. The best first posture for you is the one that feels the best the longest. I would avoid sleeping on your back as research has shown that back sleepers eventually have more problems with snoring and sleep apnea. I find back sleepers usually pick this position because it hurts to sleep on their sides.

Having chosen your first position determine what body parts are doing?

Are you on your side? If you are,  are your hips and knees bent? Is your back bent forward at the hips? I would suggest a different position if your hips and knees are bent and if your back is bent forward.

Kind of like the image below.

A better position in the side lying posture might be to straighten the legs to where the knees and legs only have a slight bend and the back neck and head have a more normal posture as if you are standing.

Now from your low back to the top of your head your posture looks as if you are standing and looking straight ahead. More like this.

Sometimes clients ask me why and I show them the diagram below. A picture tells a thousand words. I explain and ask them why anyone would like to duplicate the same postures they assumed at work while they are trying to sleep and of course the spine does have those special normal curves. We suffer greatly if we fail to head mother nature and I’ll bet even your mother, telling you to “sit up straight”.  For many of us it was a constant refrain from our mothers when we were children. In the image below I am not sure about the Axis of Hypochondria but they have the rest of the information correct.

In the normal spine or an individual as seen from the side the normal curves are readily seen. Here is a great image showing several abnormal and one great posture. The plumb line helps!

I argue that a good sleep posture is as important as standing and waking postures are.

Remember the first position you choose should be comfortable for a very long time. There are few that can assume one posture all night long though. We all move about. There is so much that can be done to relieve pain and help muscles relax with good posture awareness when awake and as we sleep.

When I first developed the Totillow Posture Pillow I didn’t know how it might help. It helped me and a few patients I tried it on but it wasn’t until I sold a pillow to James O’Neil. His story of his painful neck for many years and years of poor sleep and how the very first night he slept 6 hours straight. His pain went from a seering + 10 pain to something that was almost unnoticeable.  See his complete story here.

Back Sleeping Postures

Back Sleep Posture Positions


by Dr. Lee Parimuha DC


Lying on one’s back is not recommended by most health care and sleep specialists due to the risk of developing sleep apnea. Gravity while sleeping on your back influences the soft palate and with normal breathing the soft palate can fall closing the airway enough to cause snoring. Snoring may increase over time causing more closure of the airways leading to less oxygen and increased likelihood of developing sleep apnea.


The Sleep apnea diagnosis are of three types, central, obstructive or mixed. Two of the best ways to decrease your chances of developing this disease is to loose weight and sleep on your side.


If you do sleep on your back use pillows under your knees and take most of the fill from the middle compartment of your Totillow Pillow. In this way the fill that is left can be gathered with the pillow fabric itself and placed under the cervical spine.


I recommend that the fill volume and pillow position be adjusted so that the back of the head will comfortable rest on the bed itself. The neck curvature is  supported by the pillow and the head is back, lying on the bed in an improved ergonomic position.


This better ergonomic position has the ears and head back and centered over the shoulders with the nose centered over the sternum. This might be the ideal ergonomic position when sleeping on your side, back or stomach and side combined position.


The side compartments on the pillow are not altered as is the center compartment fill is so the two side compartments encase the head like ear muffs. Many find this configuration rather comforting. The neck is supported and the head and ears snuggled between the two side compartments. This position also helps reduce ambient noises from the outside.


Not everyone can have their head back on the bed as I suggest since many of us already have their head in forward posture in relation to the shoulders. We have grown accustomed to this position and to force the head back to the bed might just cause more problems then it is worth.


If your normal head position is forward when standing and has been that way for awhile you may want to add fill so that in the lying on the back position of the head would be similar to the posture you have during the day.

Try this one. Have someone take a photo from the side of your head and neck while standing and another photo form the side while lying down on your back with the altered fill pillow. Compare the views and change the fill in the pillow so that both side views are similar. Always defer to your own need for comfort though as everyone’s need is different. Let your own comfort and ability to sleep all night be your guide.


The posture I recommend if you want to sleep on your back that may be kinder to you regarding sleep apnea development is the position called Back and Side Sleep Posture Position, Part 4. More in my next post.


Part 1: Side Sleep Posture Positions 

Part 2: Stomach Sleep Posture Positions 

Part 2 Pillows and Sleep Postures for Baby Boomers

By Dr. Lee Parimuha, DC

Part 2: Stomach Sleep Posture Positions

Simple do’s and don’ts may help you find a comfortable position while sleeping on your stomach. Do not sleep in this position if you have chronic pain syndromes or nerve pain. I originally used this stomach side lying position with good results for some of my patients that had low back pain or mild sciatic pain. If you have any of these symptoms please check with your doctor/therapist before trying these position suggestions. Continue reading

Part 1 Pillows and Sleep Postures for Baby Boomers: You know who you are!

By Dr. Lee Parimuha, DC

Part 1: Side Sleep Posture Positions.

As we age we have special needs. We take care of our body until we are 40, then we take care of it. Our hormones have dropped precipitously and now we don’t heal like we used to. Need I go on? Younger bodies can sleep most anywhere, not only do boomers have their routine before bed but, to have healthy deep sleep, many require different shaped bed pillows for comfort and support in the side sleeping position.

I recommend finding your favorite side. Many have found this position naturally and have been falling asleep in this one position for many years. By naturally I mean, “in this position I feel more comfort and less irritation or pain over time.” Continue reading

Better Sleep with Healthy Side Sleeping Postures

By Dr. Lee Parimuha, DC

Totillow Deep Sleep Side Sleeper Pillow Baby ImageThe joy of healthy sleep can’t be underestimated. In our fast paced stressful life a great sleep experience is becoming harder to find.

When was the last time you slept like a baby? I mean, really slept well, waking with new life and mentally, emotionally, physically ready for the day. That’s right. We all are a combination of parts. Like it or not. Believe it or not it’s all about the mental, emotional and physical parts that need to rest. How can we get the rest we need for all parts of ourselves on a consistent basis?

Pain and pain syndromes are the most common reasons for insomnia today. As we age, pain becomes a problem due to the natural aging process. Our hormone levels are only a shadow of what they once were. We experience more pain. We toss and turn trying to find that position where we find comfort. When if we find that position, for many of us, it doesn’t last long and we move again and the search continues. Continue reading

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