When it comes to back and neck health, alignment is everything. During the day, that’s tough to maintain — what with all the bending, lifting and, let’s be honest, slouching. But at night, the right sleep position can help your spine settle into its natural curve.
We asked an expert to rank the best (and worst) sleeping positions for your back and neck health, and how to adjust each for maximum support.
Best overall: On your back
“Back sleeping is often considered the best position for overall spinal alignment,” says Gerard Girasole, MD, director of Orthopaedic Spine Surgery and medical co-director of Connecticut Orthopaedic Institute at St. Vincent’s Medical Center.
Just make sure to use a pillow that supports the natural curve of your neck so your head stays in line with your spine. Cervical or contoured pillow are shaped to follow the curve of the neck, and work great for back sleepers.
And if you’re still struggling with with back pain?
“Place a pillow under your knees as well,” says Dr. Girasole. “That flattens out the natural curve of your spine a bit, which relieves stress on your lower back.”
If that doesn’t work, try the next option — side sleeping.
> Related: 6 Bad Posture Habits That Are Hurting Your Spine
Best if you have back pain: On your side (with support)
If you have back pain, side sleeping might be your sweet spot — but details matter. The key is keeping your spine in its natural ‘S’ shape, where muscles can relax and the vertebrae and discs aren’t under extra pressure.
“Side sleeping can reduce pressure on the spine, but only with the right support,” says Dr. Girasole. “Keep your knees slightly bent, and pay attention to where you place your pillows.”
Try:
- Pillow between your knees to prevent hip and lower-back twisting
- Pillow between your neck and the mattress to keep your head level (not tilted up or down)
- Small pillow under your waist if there’s a gap between it and the mattress
> Related: Tired of Waking Up With Neck or Back Pain? Try These 5 Tips
Worst sleeping position for your spine: On your stomach
“Stomach sleeping arches your lower back and forces your neck to twist to one side — both of which can stress your spine,” says Dr. Girasole. “Unless it’s the only way you can fall asleep, you should try to avoid this position.”
If it’s your only option, you can protect your spine with a few adjustments.
Try:
- Thin pillow under your pelvis
- Very soft pillow — or no pillow — under your head
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Choosing your pillows
Clearly, a healthy sleeping position for your spine isn’t just about how your body is arranged — it’s also about the scaffolding that surrounds you. So don’t settle for just any pillow.
“It’s very important to make sure the pillow you use is correct for the specific position you sleep in,” says Dr. Girasole.
When you’re pillow-shopping, look for:
- Correct size and shape: Fills its target space without pushing your spine out of line
- Adjustability: Options to add/remove fill to get the loft just right
- For head and neck: Contour or cervical shapes that support proper alignment
- Supportive, breathable materials: Like latex, memory foam or adjustable shredded foam
> Related: How to Choose the Right Pillow for Neck Pain
What’s the “best” sleeping position for you?
You don’t have to take out a loan on a new mattress or overhaul your entire routine for a better night sleep. Ultimately, finding a healthy sleep position for your spine is really about figuring out what fits your body.
“If your spine stays neutral, that’s the goal,” says Dr. Girasole. “Whether you’re on your back or your side, it’s really about supporting your natural alignment.”
If you wake up stiff or sore, talk to your health team for advice. Even small tweaks — most of them pillow-related — can make a big difference.
And when you relax into bed each night, your spine can relax too.
