A Guide to Optimal Sleep Positions
- Jess Baker
- Dec 22, 2025
- 3 min read
There are three classic sleep postures.
Twenty to 30% of us sleep on our backs, known as SUPINE. Supine sleep postures can exacerbate obstructive sleep apnoea and can be unsuitable for those with chronic lower back pain. However, this posture is the most favourable position for the head and cervical spine. Some people may wish to place a pillow under the knees to encourage a more comfortable lower spine position.
PRONE is the least favourable sleep position. When sleeping on your stomach, the cervical spine is at end range rotation to allow for breathing which can lead to overload of the joints and musculature of the neck. The lumbar spine can also be affected by the increased extension of the lower back decreasing fluid diffusion in the spine and resulting in poor collagen production and spine health.
Side-lying is the most comfortable sleep position for 60-70% of the population. Some negative impacts that may include asymmetry and overload, increased cramps and spine stiffness. Most people will be more biased to one side for a range of reasons.
If choosing to sleep on your side, there are some modifications that can be made to ensure the most neutral spine position possible.
Place your top ankle behind the heel on the underneath leg. This created a ‘heel-lock’ which prevents the lower trunk from rolling forwards and places the pelvis in a neutral position where the top hemi-pelvis in stacked on top of the bottom one.
Ensure the knees and hips are bent as much as possible in comfortable range. Increased flexion at these joints creates a larger base of support providing stability.
Place the hand of your underneath arm against your top shoulder. This prevents the upper trunk from rolling forwards.
Placer the hand of the top arm between the thighs. This increases the trunk stability by connecting the upper and lower body.
Some people may try to use a pillow between their knees for similar reasons. However, a pillow can move a lot during the night as you move. Having to replace the pillow can break up your sleep more versus placing yourself back in the side lying position above.
Other Supported Sleeping Positions
Quarter supine. Lie on your side and roll back a little onto a pillow placed behind and along your trunk. Great option for those who find supine difficult to sleep in or need to avoid side lying due to injury or post-surgery.
Quarter prone. Lie on your side and roll forward a little onto a pillow placed along and in front of your trunk. Great option for those who need to wean off tummy sleeping or need to avoid side lying due to injury or post-surgery.
Your Sleep Environment
Our sleep system, including a mattress and pillows, supports our body when we are not conscious. It is important that this system fits each person as an individual to support the body in the most neutral position possible.
There are many different types of mattresses on the market from Tempur to latex, coiled and pocket spring. Pocket-spring mattresses have better support than the old-school coiled systems. Most latex or memory foam central core systems are non-heat retentive and return to shape quickly. For couples requiring different comfort levels, toppers can be used on the light person’s side of the mattress. It is always best to do your own research based on what suits you, as well as the other person in your bed.
Pillows interplay closely with type of mattress and sleep postures. Polyester or latex pillows are the recommended type for best support, avoiding feather pillows. Pillows should be changed every 2 years due to build up of dust mites, bacteria and skill cell build-up. For a side-sleeper with a firm mattress and wide shoulder width, a higher profile pillow will provide the most supportive position. Someone who sleeps on their back, has a smaller frame or has a softer mattress will require only a mid-to-low profile pillow.
Your sleep environment is an investment but one your body will thank you for. A $10,000 investment in a good mattress every 8-10 years only costs you a few dollars per night, and to think we spend a third of our lifetime in bed. Consider pillow and mattress companies that allow returns for extended periods to give a real opportunity to try and see if it suits.
In any case, sleep posture should be addressed first before changing your sleep environment.
Our team of physios and remedial therapists can advise on sleep postures that would be beneficial for your needs, and we have a variety of pillows for you to trial, and APA endorsed mattresses to recommend.
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