Stomach Sleeping -- Perhaps Your Back's Worst Nightmare
After my first decade in practice as a chiropractor, and seeing occasional patients who were not at all responding to care as expected, I discovered that most often they had a common underlying problem: they were stomach sleepers -- for either all or some portion of the night.
As soon as I became aware of a patient's sleeping habits, and recommended side or back sleeping instead, their back and neck conditions showed signs of rapid improvement. The results were so markedly positive, I eventually wrote an additional question on the front of my intake medical history forms directly asking patients "Do You Sleep on Your Stomach? [ ] Yes [ ] No".
In so doing, I could identify this problem on a patient's first visit. I began to tell people at the outset that if they continued to sleep on their stomach, even for as short a period as 5 minutes during the night, I probably would not be able to help them with their back and neck conditions. This conveyed the message pretty clearly on how important it was to begin work immediately to completely eliminate this habit.
It's amazing, but in 34 years of practice treating hundreds of people, I've found only 2 patients who were not able to completely discontinue stomach sleeping! It appears that there is a part of the mind that remains aware at night – ever so subtly -- when we are turning in our sleep. Thus, we can teach ourselves new sleeping habits, even in later adulthood, and in my experience it has been quite possible "to teach old dogs new tricks".
Stomach sleeping may be defined as any position where, in part or as a whole, your chest and stomach are in contact with the bed, and your head is turned to the side. So many patients ask if the semi side-lying position with one leg up and one arm up at 90 degrees counts as stomach sleeping, and the answer is definitely "yes".
As a demonstration of how the stomach sleeping position is truly stressful, I often suggest to a patient during their 15-20 min. initial history taking interview, that if the stomach sleeping position is so comfortable, why not turn their chair a full 90 degrees sideways and conclude the rest of our interview with their head facing me, fully turned towards their shoulder. Some of them try it for a moment, but after a short while we both laughingly agree that no one would ever sit and talk to someone in the same kind of position their neck is when they sleep on their stomach. In other words, if we had a choice -- and we were not unconscious -- we would prefer a position with much less rotation of the head! If our neck stiffens in a few minutes while fully turned, imagine the effect of hours spent with our heads in such a position all night.
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From an anatomical perspective, sleeping with a full neck turn, especially with slight backward pressure as we lay on our stomach, shuts down many of the nerves exiting our spine in the neck region. This probably contributes to a dulling of consciousness and the senses, and sleep sets in. But this also causes spinal nerve pressure, which sets off cascades of abnormal reflexes, interfering with the brain's communication with vital parts of the body, such as the thyroid gland, organs in the throat and upper chest, and triggering muscle spasms in the shoulders, arms, and hands. Many people who wake up with stiff necks or who get recurring headaches or neck pain can relate to these effects. Recurring shoulder problems or numbness in the arms/hands are also very common. Even if you don't wake-up with any noticeable problems, your weakened neck ligaments, irritated nerves, muscles, and joints may become easy targets for the slightest provocation by activities later in the day. I had an 18 year old boy with intractable chronic neck pain who had developed clear arthritis, due only to a history of stomach sleeping; he never had any past injuries to his neck nor had he suffered any accidents or sports related trauma. Not uncommon also were so many patients I've treated, young and old, whose complaints of recurring headaches finally cleared up after discontinuing stomach sleeping.
In addition to causing injury to the area of the neck, another portion of the spine which is typically traumatized in stomach sleepers is the lower back. The region of our spine our rib cage is connected to (the thoracic spine) has vertebrae which are designed for turning; however the 5 adjacent vertebrae below this area (the lumbar spine), are built primarily for forward and backward bending, and they turn very little. So when we stomach sleep, this transition area ends up suffering the most damage with our back twisted at night. Thus spasm, nerve irritation, and weakening of the lower back at this vital spot can lead to problems early on in active individuals, especially athletes who do sports such as golf, racquet sports, baseball, etc., which involve a lot of turning of the torso. It is a very common area of the spine to develop disc degeneration and arthritis early in life. In addition to lower back pain, the nerves in this region supply the bladder, pelvic organs, and lower digestive tract, which can also become targets of regular irritation.
The best way to avoid the myriad of adverse consequences of stomach sleeping is to retrain ourselves to sleep on our side or back. Some people find that willpower and positive intention alone are sufficient to change the habit. Other people need props like a pillow "wall" that alerts them when they are turning at night. Some others find taping a Ping-Pong ball or similar object to their nightshirt provides a needed reminder if they are turning onto their stomachs in their sleep.
So what is the ideal way to sleep on one's side or back? Here are some postural hints to maximize your support and comfort... While side sleeping, it is good to use one pillow under your head that can be ‘puffed-up’ to keep your neck more level horizontally, and another pillow between your legs to take pressure off the hip and back muscles. While back sleeping, it is good to use one thin pillow under the head, which allows the head to sink down, avoiding any propped-up neck position. Additionally, another pillow can be placed under the knees, raising them slightly to take pressure off the lower back. With regard to pillow type, I recommend either a ‘down’ or ‘down alternative’ filling, allowing it to be flatter for back sleeping while also being more ‘puffy’ for side sleeping. I haven't personally found that the well advertised contour cervical pillows have been very helpful for my patients. I don’t believe they truly re-shape the neck curvature, and often they have appeared to aggravate certain neck conditions in some individuals. Thus, I am of the opinion that the most comfortable pillow is the best way to go. With regard to recommendations for the best mattress and pillow types, please see the article on this website:
"TIPS ON HOW TO CHOOSE A GOOD MATTRESS"
So even during the portion of our day in which we are largely unconscious, it is clear that a lot can happen due to the effects of poor posture, especially if we consider 1/3 of our lives could be spent in positions which may be aggravating our spine and nervous system. Ignorance is definitely not bliss, especially for the many patients I’ve treated who suffered the pain and effects wreaked by stomach sleeping -- not only interfering with their day-to-day activities, but also compromising their athletic performance. Stomach sleeping can clearly create long term damage to the spine and nerves, speeding degeneration and arthritis, and likely aggravating organ systems in our body. It's important to consider taking time now to develop proper side and back sleeping postures which can contribute substantially to our long term health, vitality, and wellbeing. It's a relatively easy fix!