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Sleeping Girl by Lazar Artasoff (1903)

A sleep position is the body configuration assumed by a person during or prior to sleeping.

The topic of sleep position has been covered throughout history and has produced a variety of studies, research papers, books, etc. The general consensus is that depending on a multitude of factors such as age and physical as well as mental wellness, someone’s sleep position can pose positive or negative effects. Extensive research has been done through tracking sleep clinically as well as surveying the general population. From the data, scientists have proposed several “optimal” and “sub-optimal” sleep positions depending on said persons mental or physical issues[1]. The most researched and mentioned sleep positions are the lateral (side sleeping, often in a fetal or semi-fetal configuration), supine (faced upwards), and prone (faced downwards) positions, as those positions come naturally when trying to sleep.

Sleeping preferences

The most common sleeping position in adults is the lateral position, followed by the supine and then prone position.[2][3] The lateral position preference tends to increase with age and body mass index (BMI).[2][3] This may be explained by physiological intolerance to the supine position, causing more awakenings and arousals during sleep than the lateral position.[4]

A Canadian survey found that 39% of respondents preferred to sleep in the “log” position (lying on one’s side with the arms down the side) whilst 28% preferred to sleep on their side with their legs bent.[5]

Effects on health

In infants

A baby sleeping on its back

In the 1958 edition of his best-selling book The Common Sense Book of Baby and Child Care, pediatrician Dr Benjamin Spock warned against placing a baby on its back, writing, “if [an infant] vomits, he’s more likely to choke on the vomitus.” However, later studies have shown that placing a young baby in a face-down prone position increases the risk of sudden infant death syndrome (SIDS). A 2005 study concluded that “systematic review of preventable risk factors for SIDS from 1970 would have led to earlier recognition of the risks of sleeping on the front and might have prevented over 10,000 infant deaths in the UK and at least 50,000 in Europe, the USA, and Australasia.”[6]

Sleep disorders can be partially treated with a change in sleep position.

Sleep Apnea

Obstructive sleep apnea (OSA) that can be addressed by a change in sleep position, most commonly by avoiding the supine position, is called positional obstructive sleep apnea (POSA), which accounts for 56-75% of regular OSA patients.[7] One of the treatments for POSA is positional therapy (PT), in which patients are influenced to avoid sleeping on their back.[8] The avoidance of the supine position is to prevent gravity from pulling the tongue into a position that can cause airway blockages.[9] In cases where apnea is not exclusive to the supine position, PT alone can be insufficient and other treatments are considered.[10] Snoring, which may be (but is not necessarily) an indicator of OSA, may also be alleviated using PT.[8]

Glymphatic system clearance

The glymphatic system, responsible for metabolic waste removal from the brain, is affected by sleep position. Animal studies have shown that glymphatic activity is highest during lateral sleep and lowest during prone sleep.[11] This has led to the hypothesis that the natural preference for lateral sleeping positions in mammals, including humans, is to ensure proper glymphatic function.[11]

Gastroesophageal reflux

The right lateral sleeping position results in much more reflux in the night than the left lateral position and prone position.[12][13] This is due to the stomach’s position and esophageal sphincter relaxation. Lying in the left lateral position is generally accepted to be ideal for managing the symptoms of GERD by reducing acid clearance time and acid exposure time.[14] A similar phenomena, laryngopharyngeal reflux, occurs from lying supine soon after eating food that relax the lower esophageal sphincter.[15] Elevating the head has been found to reduce esophageal acid exposure and acid clearance time.[14][16]

Sleep paralysis

Sleeping in the supine position has been linked to an increased occurrence of sleep paralysis.[17] The position taken while falling asleep is not linked to actual sleep paralysis events, just the eventual sleep position while experiencing REM disruption.[18] Reoccurring sleep paralysis can be treated using sleep position training.[19]

See also

References

  1. ^ Lokh, Sanna; wala (2024-05-30). “The Impact of Sleep Position on Health and Well-being”. Journal of Sleep Disorders & Therapy. 13 (5): 1–2. doi:10.35248/2167-0277.24.13.547 (inactive 15 April 2026). ISSN 2167-0277.{{cite journal}}: CS1 maint: DOI inactive as of April 2026 (link)
  2. ^ a b Sahlin, Carin; Franklin, Karl A.; Stenlund, Hans; Lindberg, Eva (October 2009). “Sleep in women: Normal values for sleep stages and position and the effect of age, obesity, sleep apnea, smoking, alcohol and hypertension”. Sleep Medicine. 10 (9): 1025–1030. doi:10.1016/j.sleep.2008.12.008. PMID 19345643.
  3. ^ a b Skarpsno, Eivind Schjelderup; Mork, Paul Jarle; Nilsen, Tom Ivar Lund; Holtermann, Andreas (2017-11-01). “Sleep positions and nocturnal body movements based on free-living accelerometer recordings: association with demographics, lifestyle, and insomnia symptoms”. Nature and Science of Sleep. 9: 267–275. doi:10.2147/NSS.S145777. PMC 5677378. PMID 29138608.
  4. ^ Rayward, Lionel; Ho, Selina W. K.; Green, Daniel; Little, J. Paige (February 2025). “Sleep disruption and sleep position: Increased wake frequency in supine predicts lateral position preference”. Journal of Sleep Research. 34 (1) e14325. doi:10.1111/jsr.14325. ISSN 0962-1105. PMC 11744251. PMID 39191505.
  5. ^ “Good health rests on a good night’s sleep/”. 20 May 2019. Retrieved 27 July 2019.
  6. ^ Gilbert, Ruth; Salanti, Georgia; Harden, Melissa; See, Sarah (2005-08-01). “Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002”. International Journal of Epidemiology. 34 (4): 874–887. doi:10.1093/ije/dyi088. ISSN 1464-3685. PMID 15843394.
  7. ^ Ravesloot, Madeline Jacqueline Louise (June 2024). “Positional Treatment of Obstructive Sleep Apnea”. Otolaryngologic Clinics of North America. 57 (3): 481–490. doi:10.1016/j.otc.2024.01.002.
  8. ^ a b Battaglia, Elvia; Poletti, Valentina; Volpato, Eleonora; Banfi, Paolo (2025-07-24). “Positional Therapy: A Real Opportunity in the Treatment of Obstructive Sleep Apnea? An Update from the Literature”. Life. 15 (8): 1175. doi:10.3390/life15081175. ISSN 2075-1729. PMC 12387201. PMID 40868823.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  9. ^ Mohamed, Abdelrahman MA; Mohammed, Omar Magdy; Liu, Shanshan; Al-balaa, Maher; Al-warafi, Leena Ali; Peng, Song Juan; Qiao, Yi Qiang (2024-06-07). “Oral appliance therapy vs. positional therapy for managing positional obstructive sleep apnea; a systematic review and meta-analysis of randomized control trials”. BMC Oral Health. 24 (1). doi:10.1186/s12903-024-04277-8. ISSN 1472-6831. PMC 11161918. PMID 38849827.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  10. ^ Omobomi, Olabimpe; Quan, Stuart F. (2018-05-01). “Positional therapy in the management of positional obstructive sleep apnea—a review of the current literature”. Sleep and Breathing. 22 (2): 297–304. doi:10.1007/s11325-017-1561-y. ISSN 1522-1709.
  11. ^ a b Gędek, Adam; Koziorowski, Dariusz; Szlufik, Stanisław (2023-09-07). “Assessment of factors influencing glymphatic activity and implications for clinical medicine”. Frontiers in Neurology. 14 1232304. doi:10.3389/fneur.2023.1232304. ISSN 1664-2295. PMC 10520725. PMID 37767530.
  12. ^ Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol. 1999 Aug;94(8):2069-73
  13. ^ Fujiwara Y, Arakawa T, Fass R (2013). “Gastroesophageal reflux disease and sleep”. Gastroenterology Clinics of North America. 42 (1): 57–70. doi:10.1016/j.gtc.2012.11.011. PMID 23452631.
  14. ^ a b Simadibrata, Daniel Martin; Lesmana, Elvira; Amangku, Bagus Ramasha; Wardoyo, Muhammad Prasetio; Simadibrata, Marcellus (2023-10-26). “Left lateral decubitus sleeping position is associated with improved gastroesophageal reflux disease symptoms: A systematic review and meta-analysis”. World Journal of Clinical Cases. 11 (30): 7329–7336. doi:10.12998/wjcc.v11.i30.7329. ISSN 2307-8960. PMC 10643078. PMID 37969463.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  15. ^ Özenoğlu, Aliye; Anul, Nejla; Özçelikçi, Büşra (2023-09-01). “The relationship of gastroesophageal reflux with nutritional habits and mental disorders”. Human Nutrition & Metabolism. 33 200203. doi:10.1016/j.hnm.2023.200203. ISSN 2666-1497.
  16. ^ Khan, Bashir Ahmad; Sodhi, Jaswinder Singh; Zargar, Showkat Ali; Javid, Gul; Yattoo, Ghulam Nabi; Shah, Altaf; Gulzar, Ghulam Mohamad; Khan, Mushtaq Ahmad (June 2012). “Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux”. Journal of Gastroenterology and Hepatology. 27 (6): 1078–1082. doi:10.1111/j.1440-1746.2011.06968.x. ISSN 0815-9319. PMID 22098332.
  17. ^ Cheyne, J. A. (June 2002). “Situational factors affecting sleep paralysis and associated hallucinations: position and timing effects”. Journal of Sleep Research. 11 (2): 169–177. doi:10.1046/j.1365-2869.2002.00297.x. ISSN 0962-1105. PMID 12028482. S2CID 37037694.
  18. ^ Fukuda, Kazuhiko, et al. “The prevalence of sleep paralysis among Canadian and Japanese college students.” Dreaming 8.2 (1998): 59-66.
  19. ^ Cui, Nanke; van Looij, Marjolein A.; Kasius, Kristel M. (2022-09-01). “Successful treatment of sleep paralysis with the Sleep Position Trainer: a case report”. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine. 18 (9): 2317–2319. doi:10.5664/jcsm.9996. ISSN 1550-9397. PMC 9435325. PMID 35473768.