Intentional Stress Challenge: Sleep Ergonomics

Progressive challenge series focused on sleep posture. Ergonomics while sleeping is an important consideration that can improve spinal alignment, physical health, and sleep quality.

Sleep Posture

There are any many considerations when determining sleep optimization such as consistency, consumption, temperature, and light exposure. We can systematically optimize our routine to control many of these factors. Another opportunity for improvement is our sleep posture. 

Do you ever wake up with a sore back or neck? Why do you think that is? Pre-existing injury aside, I bet it’s because of the position you sleep in.

Ergonomics or considerations of human interactions with other systems is a growing field. We now know sitting long durations is not only bad for our metabolic health but also for resilience of our neck and back. Spending extended time in unnatural positions, particularly ones that increase pressure in specific areas, is detrimental to our health of our spinal column to include its bones, muscles, tendons, and nerves. 

Alignment of the spine is imperative for optimal functioning and prevention of pain. Aside from acute injury, asymmetries along the posterior chain (backside muscles) contribute to the majority of problems people have anywhere from the upper neck to the lower back. As an asymmetry persists, pressure on the vertebrae of the spine and risk of subsequent nerve issues increases. 

Reversing these problems is only possible by determining the underlying cause.

We spend approximately a third of our lives sleeping. Many then spend a majority of their day sitting.

The goal of any physical ergonomic strategy is to encourage natural spine alignment and positioning of the head, shoulders, and hips in relation to each other. Chronically spending time in positions that turn the head, twist the hips, imbalance the legs, or place unequal pressure anywhere on the spine, can lead to adverse effects.

Negative impacts of prolonged sitting can be combated by frequently getting up to move, standing instead of sitting, or even deep squatting. These alternatives are not viable during sleep. 

What is your preferred sleep position? Stomach, side, or back? All can be improved ergonomically to encourage proper alignment.

Stomach Sleeping

Okay, I kind of lied… If you’re a stomach sleeper, there isn’t much you can do to aside from buying a massage table that allows for you to lay in the prone position and breathe through that opening for your face without turning your head. Gravity would still pull the shoulders unnaturally forward, however, leading to eventual issues so even that suggestions stinks. 

Stomach sleeping is awful for your structural health.

There just isn’t a way to encourage proper alignment or positioning of the spine in the prone position. Gravity and our need to turn our head to breathe is inevitably going to cause asymmetries along the posterior chain. 

Unless you’re an astronaut in outer space, stomach sleeping is going to cause some degree of issue. 

Side Sleeping

I learned of the importance of sleep posture many years ago when I was primarily sleeping on my stomach. I worked to become a side sleeper due to developing neck issues, however, I then started noticing soreness in my lower back most mornings. I began implementing a ten-minute deep squat hold or the McGill Big 3 exercises every morning to help ease the tightness and soreness I would often wake up with in my lumbar region. What I failed to recognize was my focus at night was all on my head and back alignment and not my hips. I was sleeping with one leg bent and the other straight. 

Picture source

The position I was sleeping in is apparently called the provocative side sleeping position (I know, weird name). Neck and upper back alignment are maintained in this position, but the legs are asymmetric causing the hips to be twisted. My intention to improve sleep posture, particularly to relieve tension in my neck, solved one problem while unintentionally causing another.

Ideal side sleeping is done in what’s called the fetal side position. You don’t need to be curled up in a ball like the standard fetal position, but the goal is to have the legs slightly bent and on top of one another to prevent any torsion in the lower back. 

Picture of the fetal side sleeping position

Picture source

Pillow selection is crucial for any sleep position. The goal with any pillow should be to provide a comfortable surface for your head that is neither too thin nor thick.

Proper pillow size should prevent any form bending or turning in the neck.

Selecting a pillow for side sleeping is best done in relation to your mattress firmness. Softer mattresses often require thinner pillows for side sleeping since our bodies sink into the bed more. Harder mattresses may need a thicker pillow so our head doesn’t droop down toward the bed.

Additional pillows can also be used to encourage stability in a particular position. I often place a pillow behind me to discourage rolling to my back when in the fetal side position. There are fantastic body pillows that also promote proper posture while side sleeping that are especially useful for pregnant women, those with sleep apnea, or anyone wanting to maintain a side position. 

If you have or think you may have sleep apnea, sleeping on your side is highly recommended. While back sleeping is an excellent position for many, those with sleep apnea are prone to increased airway blockage risk from gravity pulling the tongue and other soft tissue down into the throat. CPAP machines on a high-pressure setting can help to mitigate some of the risk of airway closure, but side sleeping is still the ideal position for this condition. 

Back Sleeping

Back sleeping is the ideal position when it comes to sleep posture. 

Use of a pillow often is not necessary, and sometimes even discouraged, when sleeping on your back. Like side sleeping, the primary purpose of a pillow is to comfortably support the head and maintain proper alignment. 

If a pillow is unnaturally propping your head up and causing tension in your neck, it’s doing more harm than good. 

Pillow selection, again, should be considered based on mattress firmness. Medium-firm mattresses are reportedly best when balancing the comfort and stiffness needed to support proper spinal alignment for back sleeping.

With practice and patience, I have trained myself to become a back sleeper most of the time. When I’m congested or having a hard time sleeping on my back for any reason, I’ll sleep in the fetal side position. I now regularly wake up feeling recovered and energized (when you don’t count the nights my kids jack up my sleep quality in other ways…).