This article was originally published in Positive Health issue 135 – May 2007

Sleep is essential to life. It “knits up the ravelled sleeve of care” said Shakespeare. But sleep is a complex behaviour and, like any other function of life, it can, and often does, become disordered. When this happens, it is difficult to drag oneself out of bed and to face life’s challenges. To avoid this occurrence, and to wake up refreshed and rested with a pain-free body, let us investigate some practical conditions conducive to a peaceful night.

First of all, mattresses matter. Comfortable sleep requires a comfortable mattress. But comfortable in this context does not mean soft. The heaviest part of the body is the pelvis, and lying down for hours on a soft support means that your pelvis will sink more than the other parts of your body. This state of affairs causes the lower back to curve unduly. If you sleep on your back, your lumbar lordosis (concavity) will deepen each and every night; the spine will inevitably adopt a harmful shape. Since undue lordosis is the primary stage in the process of distortion of the body, and since most musculo-skeletal pains and malfunctions originate from misshape, choosing a good mattress is worth the trouble. It does not need to be so-called orthopaedic, but it needs to be firm – without being uncomfortable – so that your pelvis stays correctly aligned with the rest of your body.

Now that you have acquired a good mattress, in what position are you going to sleep on it? Apart from some strange ones (verging on the acrobatic), there are three main sleeping positions: on the back (supine), on the front (prone) and on the side. Of these three, the supine position is definitively the best; the prone, the worst. Thanks to the ‘Back to Sleep’ campaign launched in the early 1990s, parents were advised to place their babies on their backs when laying them down to sleep. This campaign was intended to lessen the risk of cot deaths, as the prone position formerly recommended was, and still is, thought to be the main cause of cot deaths. Unfortunately, the question of tragic cot deaths is not that simple and babies sleeping on their backs are still victims of cot death. Nevertheless, the sleeping-on-the-back habit is to be strongly recommended, if only for the reason that sleeping on the front provokes back troubles and feet distortions. Sleeping on the front causes your spine to arch and the back muscles to shorten. Unfortunately, prone sleeping learned in childhood is very difficult to alter in adulthood. Yet, it is worth the effort, as any efficacious treatment for back pain that you might be receiving can be seriously compromised by sleeping in a prone position. Sleeping on your side is a good enough position.

What remains to be discussed is the case for or against pillows, so let’s talk pillows. In the minds of many people, pillows seem to be associated with comfort, even luxury: the more and the softer, the better. The pile of thick and soft pillows people put under their head when going to bed is amazing. This gives a spurious comfort as it cultivates even further the already common malposture adopted during the waking hours in which the head and neck are leaning forward. Ideally, when lying on your back the three convexities of your spine (the back of the head, the shoulder-blade area and the sacrum) should be aligned on the same plane. So, if you have the good habit of sleeping on your back make it an even better one by sleeping without any pillows. Sadly, after years of bad posture and the resultant shortened dorsal musculature, it is not always practical or possible to lie down on your back without a support under your head. The concavity in the nape of the neck is often too deep and the head is painfully thrown too far back (in relation to the neck). In some cases, the head cannot even reach the mattress. In these conditions, try to wean yourself slowly off the pillow habit. The function of the pillow(s) should be to tilt the head forward independently of the neck in order to decrease the concavity of the latter. To this end, the pillow should be firm and be placed under the head (not under the neck). I do not recommend the so-called orthopaedic pillows that are supposed to support your neck. First, the neck does not need any support; second, if supported, it will be prevented from moving back towards its normal shape. If you sleep on your side, a pillow is necessary to keep the neck aligned with the rest of the spine. But what if, while sleeping, you alternate between a back and a side position? Well, then you will have to juggle with pillows all night.

Sleep tight but not so tight that your muscles might ‘bite’!