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  • Dr. Eric Carlsen

11 Best and Worst Sleep Positions for Older Adults

older couple asleep in bed

Try this: Bend your wrist as far back as you can toward your forearm. How long can you hold it there?

Probably not long, maybe a matter of seconds says Scott Bautch, D.C., a Wisconsin-based chiropractor and president of the American Chiropractic Association’s Council on Occupational Health.

Bautch asks people to do this to prove a point. “You wouldn’t watch an entire football game with your wrist stretched as far as possible, your arm way above your head, or your pelvis twisted to one side,” he says.

That’s because, during the day, you often change positions to save yourself from discomfort. But at night, many people fall asleep in these compromising positions, unaware of the pain it’s causing until it wakes them.

“These positions become painful because they test your range of motion, which tends to narrow with age,” Bautch says.

That’s why it’s so important to sleep in a neutral position, meaning no body part is stretched, squeezed, or awkwardly placed, says Kathleen Walworth, P.T., D.P.T., a physical therapist and geriatric clinical specialist with Athletico Physical Therapy in Brooklyn, Michigan.

Fixing your sleep posture can help relieve pain right away or even prevent it from happening in the first place, Bautch says. But it’s not just about orthopedic issues. Adjusting your sleep position can also help improve breathing and circulation, relieve heartburn symptoms, and boost the overall quality of life.

So whether you’re dealing with joint pain, a stiff neck, or sleep apnea, there’s a position that can help—or hurt—you. Here are the best and worst ways to sleep for common ailments.

1. Back Pain

Best: On your back with a pillow under your knees.

Worst: On your stomach.

Why: “Back sleeping is easy on your spine,” says W. Chris Winter, M.D., author of The Sleep Solution: Why Your Sleep Is Broken and How to Fix It.

He compares a back sleeper to someone floating in water: The spine’s primary curvature, the soft C-shaped curve you were born with, is emphasized. Our bodies like that. Flip over to your stomach, and you accentuate the secondary S-shaped curves (neck, lower back) that develop early in life. Our bodies don’t enjoy that so much.

Sliding a pillow under your knees helps by taking pressure off your lower back. If you’re a habitual side sleeper, slip a pillow between your knees for a more neutral posture. And if you’re devoted to your belly, try placing a pillow lengthwise underneath you, from mid-chest to hip, Walworth, suggests. This will help reduce the awkward curves.

2. Stiff Neck

Best: On your back or side with a pillow that holds your head in neutral.

Worst: On your stomach.

Why: Stomach sleepers turn their heads to the side to breathe, Bautch says, and rotating your neck like that is awkward and painful.

“lf I said to you, ‘Turn your head to the right and keep it that way for eight hours,’ you’d say, ‘Oh, that’s really bad!’ But you’ll sleep that way.”

An even bigger pain in the neck: trying to find the right pillow among the countless options. People often choose one that’s way too big, Bautch says. That pushes your head out of alignment, aggravating or even leading to neck pain.

To find the perfect pillow, lie down and take a selfie. If you see wrinkles on your neck, the pillow is too big, Bautch says. A neutral position means your neck will be straight.

If you’re a stomach sleeper, try hugging a body pillow. “It provides the comfort of having something tight against your stomach but gets you on your side,” Bautch says. “Stick with it for three to six weeks to train yourself to be a side sleeper.”

Already got a crick in your neck? Try these four neck stretches.

3. Shoulder Injury or Pain

Best: On your good side or back with a pillow to support your bad shoulder.

Worst: On your bad shoulder.

Why: Rotator cuff issues are common among older adults, and they can be tricky to treat, Walworth says.

The shoulder is the most mobile joint in the body,” she says. “It has the highest degree of freedom, so it doesn’t take much to get into a compromising position, especially if the shoulder is not moving the way it should.”

You’ll be more comfortable if you keep your bad shoulder in a neutral position. For side sleepers, tucking a pillow under your bad arm prevents it from falling forward. For back sleepers, propping your bad shoulder up on an extra pillow keeps it from slipping back.

4. Hip Pain

Best: On your back with a pillow under your knees, or on your good side with a pillow between your knees.

Worst: On your bad hip.

Why: For back sleepers, a pillow under the knees takes the pressure off your hips. For side sleepers, a pillow between the knees helps keep your hips and back from sagging and rotating, Bautch explains.

Choose a medium-firm pillow, Walworth suggests, adding that women may need a thicker pillow than men due to their wider hips. However, if you’ve had a hip replacement, you may have further precautions, so talk to your doctor.

If you insist on lying on your bad side until you can’t take it anymore, at least make sure you have a supportive foam mattress or mattress top, Dr. Winter says. That will distribute the pressure more evenly than a traditional coil mattress.

5. Knee Pain (That’s Not Due to Knee Replacement)

Best: On your side with the good knee and a pillow between your knees, or on your back with a pillow underneath them.

Worst: On your bad knee.

Why: Placing a pillow between your knees keeps them from stacking, cushioning them so they don’t rub together. If you sleep on your back, putting a pillow under your knees creates a slight bend, taking pressure off the joint, Walworth says.

“Having just a bit of a bend can bring a lot of relief,” she says. The exception is if you’ve had a knee replacement.

6. Post-Knee Replacement

Best: On your back with a pillow under your legs lengthwise so knees are straight.

Worst: With knees bent.

Why: If you’re post-op, you want that knee as straight as possible, Walworth says.

“It’s important to get range of motion back, especially the extension of the leg,” she says. Placing a pillow horizontally under the knee allows it to bend, leading to something called “flexion contracture” where it stays stuck in that bent position. Then your physical therapist has to help you get out of it, Walworth says.

For comfort, you can still put a pillow under your leg, just make sure it’s lengthwise so it runs from ankle to hip, spanning the knee so it’s still straight.

7. Sleep Apnea

Best: On your side or elevated on your back.

Worst: Flat on your back.

Why: Obstructive sleep apnea, which is the most common form of the condition, happens when your airways collapse and seal off when you suck in a breath, meaning the air can’t reach your lungs.

When you sleep flat on your back, gravity can cause the walls of your airway to collapse, constricting airflow, Dr. Winter says. Gravity may also make your tongue fall back and partially obstruct your airway.

Sleeping on your side, on the other hand, may help stabilize and open your airways. Some patients can even treat their sleep apnea this way, as opposed to using a continuous positive airway pressure (CPAP) machine, says Sara Benjamin, M.D., an instructor of neurology at Johns Hopkins Medicine.

If you’re committed to back sleeping, try elevating the head of your bed or snoozing in a recliner. One study found that elevating the head of the bed just slightly—by 7.5 degrees—improved symptoms in sleep apnea sufferers. You can do this by placing small wood blocks or even books underneath both sides at the head of the bed.

Talk to your doctor about what’s right for you. What you shouldn’t do: ignore sleep apnea. Untreated sleep apnea can lead to injuries due to excessive daytime sleepiness and heart problems.

8. Heartburn

Best: On your left side with torso elevated.

Worst: Flat on your back or on your right side.

Why: Also known as acid reflux, heartburn essentially happens when stomach acid backflows into the esophagus or further up. When you’re flat on your back, it’s much easier for that to happen.

That’s why doctors recommend elevating the head of the bed (ideally more than 30 degrees) or sleeping with a wedge, says Walworth, noting that you must elevate your entire torso.

“Elevating just the head won’t do anything,” she says. “You want to get all the way down to the esophagus.”

Even better, sleep elevated on your left side. A 2015 study published in the Journal of Clinical Gastroenterology found that when people slept on their left side with a sleep device that safely elevated their head and neck, they had less esophageal acid exposure than those who snoozed on their right side.

This may have to do with the position of your stomach inside your abdominal cavity, Walworth explains. When you lie on your left side, it can allow fluid and materials to pool farther away from the esophagus area—making them less likely to rise up through it.

9. Carpal Tunnel

Best: Any position where your wrist is neutral.

Worst: On your side with your wrist curled and tucked underneath you.

Why: Carpal tunnel syndrome happens when the nerve that runs through the carpal tunnel, or the passageway from the wrist to the hand, becomes compressed. When you sleep with bent wrists—such as when resting your head on your hand—that’s exactly what can happen.

Doctors typically recommend wrist splints, Dr. Winter says. They’ll limit your ability to flex your wrist, keeping it in a safe, neutral position. But if you’d rather not sleep in a splint, just try to avoid any position where your wrist is curled or stretched.

10. Poor Circulation

Best: On your left side.

Worst: On your right side.

Why: Some evidence suggests that sleeping on your left side improves circulation, Dr. Winter says. That’s because the system responsible for transporting blood back to the heart is located on the right side of the body. And unlike the system that pumps blood from the heart throughout the body, it’s a fairly low-pressure system, he explains.

“It’s not pumping back to the heart so much as it’s trickling back. So if you sleep on your right side, you may compress the system, restricting that return to your heart.”

That’s why Dr. Winter recommends sleeping on your left side for anyone with circulatory problems or heart failure. Not sure if you have poor circulation? Check out our guide to six signs your blood flow is restricted. If you notice any, talk to your doctor before making any major lifestyle changes.

11. Kyphosis (or Hunchback)

Best: On your side with a pillow under the curve in your back.

Worst: On your stomach.

Why: Kyphosis, the condition in which the upper spine takes a C shape, affects between 20 and 40 percent of older adults, with prevalence and severity increasing as you get older, says research published in the Journal of Orthopaedic and Sports Physical Therapy.

This spinal disorder can limit mobility, increase the risk of falls, and make it difficult to get a good night’s rest. Walworth recommends side sleeping with a pillow under the curve in your back for added support.

“You’re not as flexible as you once were,” she says, “so you want as much support as possible.”

Lying on your stomach puts your spine in a state of extension—in areas that don’t extend so easily anymore—and should be avoided.

Credit: Silver Sneakers, Jerilyn Covert


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