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Posture and spinal alignment in sleep: getting it right

Finding a comfortable posture at night is key to getting good sleep and waking up well rested. If you’re suffering from pain in the morning or difficulty getting comfortable at night, that could be a sign that your posture and sleep position are not quite right.

So, if you have identified that your sleeping situation isn’t ideal, what next?

Studies have shown that the link between sleep position and pain is often highly personal, and that working with a health professional to develop a plan is very important.1 Your chiropractor can help you to do this.

But before that, there are many ways to improve your sleep, and one key step to take is to ensure your mattress and pillow are working for you.

Choosing a mattress

A good mattress is the first step. Generally speaking, a mattress of mid-firmness is a good place to start2, though whether you fall on the slightly firmer or slightly softer end of the scale is a matter of your personal preference and needs. One study where participants’ beds were replaced by medium-firm mattresses specifically layered with foam and latex based on sleeping position, showed significantly decreased physical discomfort, back pain, and stiffness.3

When choosing a mattress, do your research on the features available within your price range, and test various options in person before committing if you can. When you invest in a good mattress, it’s not only an important purchase, but a relatively expensive one, so it pays to take the time to get it right.

Choosing a pillow for your sleep position

To maintain good spinal health, understanding how to support your regular sleeping position is important. Sleeping either on your side4 or on your back are the best options to keep your spine alignment neutral. If you regularly sleep on your tummy, you should be aware that this can cause extra pressure on your lower back, due to the natural curve of your spine.

Whether you’re a back or side sleeper, a good pillow can make a big difference to protecting your posture while you sleep. Ideally, when shopping for a neck pillow, opt for a contoured pillow fitted to you, to best support your neck and keep your spine in a neutral alignment.

If you’re a side sleeper

  • A good neck pillow should fill the gap between your neck and the mattress. The distance between your neck and the mattress is fairly large when sleeping on your side, so look for a higher support option.

  • It may help to keep a body pillow between your knees to help support your hips and lower back, while keeping your pelvis neutral.

If you sleep on your back

  • The distance between your neck and the mattress is smaller, so a lower support neck pillow will work to keep your spine neutral.

  • Try tucking a pillow under your knees. This will reduce pressure on your hamstrings and lower back.

There are pillows made from many different materials, such as latex, memory foam and traditional foam. Which one you choose will depend on your personal preference and just like a mattress, it’s best to shop in person if possible.

Call in the experts

If in doubt about how to set yourself up for successful sleep, don’t hesitate to call in an expert – your chiropractor. This is especially important if you do suffer from back, neck, hip, or shoulder pain, or if you have a chronic musculoskeletal condition which is affected by sleep.

Start by booking in for a pillow fitting and bring your pillow in to see if it’s correct for your needs! Come into Realign Health, to have your pillow assessed and check out the high-quality pillows we have available in the clinic.


1 SJ Gordon, KA Grimmer, P Trott, Sleep Position, Age, Gender, Sleep Quality and Waking Cervico-Thoracic Symptoms, The Internet Journal of Allied Health Sciences and Practice, 2007

2 A Radwan, P Fess, D James, J Murphy, J Myers, M Rooney, J Taylor, A Torii, Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials, Sleep Health, 2015

3 BH Jacobson, A Boolani, G Dunklee, A Shepardson, H Acharya, Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain, Applied Ergonomics, 2010

4 D Cary, K Briffa, L McKenna, Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review, BMJ Open, 2019

WH Lee, MS Ko, Effect of sleep posture on neck muscle activity, The Journal of Physical Therapy Science, 2017


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