Just like our bodies have been designed through many years of evolution to eat and exercise a certain way, to get plenty of safe sunlight and avoid chronic stress, to spend time engaged in meaningful movement and work, has it also designed us to lie down to sleep in a certain position? If you look at the human body, we’re clearly meant to sit and move in specific ways.
We are bipeds, so we walk upright. We hinge at the hips and knees, so we can sit with upright torsos and knee and hip flexion. When we pick up an object, we either hinge at the hip or squat down by flexing the knees. Our bodies only move along specific planes. We clearly can’t sleep upright, or on our heads. There are a limited number of possible anatomical permutations, and some of them have to be better than others. What’s the best way to sleep? What’s the best sleeping position?
Does a Primal sleeping position exist?
Esther Gokhale, posture expert who has studied the movement and postural patterns of traditional peoples all her life, says the key is to lengthen your spine. When you lie down on your back, you first touch the bed (or ground) with your sacrum, lay your forearms on the bed, and slowly lower yourself back, taking care to actively lengthen your spine—vertebrae by vertebrae—by pushing through your elbows. This is called “long lying,” and you really do feel longer than normal. If you lie down on your side, you must also consciously lengthen your spine and keep it lengthened and straight. I’ve tried this many times and it’s an incredibly comfortable way to lie down, especially for naps.
Physiotherapist Michael Tetley had the same question. He spent many months observing several groups of African tribesmen and other traditional populations and made some interesting observations about their sleeping habits along the way.1
Sleeping on the side was the most common, with most people either fully sleeping on their side or a combination side/stomach position. The visual juxtaposition of a mountain gorilla with a Kenyan man is striking, with both man and ape lying on their side with impeccable form and long, straight spines.
Next, he recommends sleeping in the recovery position, sort of a half-stomach, half-side sleeping position with the bottom arm looping across the front of the neck to the opposite shoulder for neck support and the outside arm resting gently on the ground or bed. In this position, the bottom leg is positioned as a resting place for the penis to keep biting bugs away from it.
He writes of Tibetan caravaneers sleeping on their shins when the ground is wet and cold, presumably because the lack of significant muscle in the contact areas reduces heat loss. tried this out and found it initially uncomfortable, but after sitting back with the hips and resting lightly on the forearms it wasn’t bad.
Then there’s the lookout position, where you use your arms as pillows while lying on your stomach. If you’re sleeping with a pillow, you can slide your hands underneath the pillow.
My favorite is the quadrupedal lying position. It looks awkward, what with the spine rotation and flexing, but it’s actually pretty darn comfortable. I did have to play around a bit. If you look at the picture, the bottom leg is drawn up pretty closely toward his chest. I found that letting it drop back a bit felt better. Either way, playing with that bottom leg position seems to be key to finding the sweet spot.
Lie on your stomach with both arms at your sides, palms facing up. Bring your right knee up toward your hip until your thigh sits at 90 degrees. Slide your right hand about halfway under your pillow, allowing your right shoulder to relax and fall toward the bed. Leave your left arm and leg in the original position.
Ultimately, the best sleeping position is the one that’s most comfortable for you. Whatever works, works.
There are certain conditions that call for different types of sleep positions, though. If you snore, have sleep apnea, or are pregnant, there are specific positions to favor and specific ones to avoid.
If you snore or suffer from sleep apnea, avoid sleeping on your back. Research shows that the lower jaw can shift backward in the supine position, cutting off your airway and triggering the snore.
One study found that in adults with apnea worsened by lying on their backs, sleeping on their sides normalized their AHI (apnea-hypopnea index, a measure of the number and severity of apnea episodes during a sleep session). Higher AHIs are worse, and side sleeping lowered them.2
However, this is dependent on what structures are responsible for your sleep apnea. If your apnea is related to tongue issues, sleeping on your side probably won’t help (in fact, no sleeping position will). If your apnea is caused by epiglottal collapse, sleeping on your side should have profound effects.3
The absolute worst sleeping position during pregnancy is supine—on your back. Studies show that back sleeping while pregnant is linked to a number of poor maternal and fetal outcomes:
However, back sleeping is probably okay for the first trimester, and maybe even the second. Most studies find that the risks increase after 28 weeks.
The safest way to sleep during pregnancy is on your left side with pillows arranged around you for support. I asked a few women with personal experience and they swore by these types of pillows. Why on the side?
It’s linked to the best health outcomes for mother and child.
Ultimately, as long as you avoid supine positions after 28 weeks or so, what’s most important is finding a sleep position that’s comfortable for you and allows you to get a good night’s sleep. The general consensus is that sleeping on your side—usually left—is best.
Is there one sleeping position to rule them all?
Not really. You could go to sleep on your left side and wake up on your back. Or go to sleep on your back and wake up face down. Point is, we move around a lot at night. As long as you’re well-rested in the mornings, aren’t snoring, don’t have sleep apnea, and fall asleep easily, you’ve picked the best sleeping position for you.
How do you like to fall asleep? What sleep position is your favorite?
Another thing you can try is sleeping at a slight incline. A 12% incline has been shown to reduce snoring and improve deep sleep and sleep quality. If your bed doesn’t tilt (most don’t), you can prop it up on risers or use pillows to create an incline as you sleep.[ref]https://pubmed.ncbi.nlm.nih.gov/35384849/
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