How Your Sleeping Position Affects Your Body
Sleep is when your body rests, repairs, and recovers. But if your sleeping position puts stress on your joints, muscles, or nerves, you may wake up feeling worse, not better as an Austin physical therapist can share.
Many people don’t realize that how they sleep can cause or worsen pain in the neck, shoulders, back, hips, or even the jaw. That stiffness or soreness in the morning might not be just from aging or activity, it might be from the way your body is positioned for 6 to 8 hours every night. Of course, when you have a particularly rough night you feel the immediate pain in your neck or back. However, you might not realize that how you sleep affects your body over time too, not just those single nights where you do something slightly different.
What Happens During Sleep
When you sleep, your muscles relax and your spine decompresses. But this also means your body depends more on your mattress and pillows for support. Poor alignment during sleep can lead to:
- Joint compression
- Muscle imbalances
- Nerve irritation
- Increased stress on ligaments
- Circulatory restriction
Over time, these stresses can add up, especially if you already have musculoskeletal issues.
Sleep also affects your hormonal system, immune function, and tissue repair processes. Growth hormone peaks during deep sleep, and this hormone plays a vital role in muscle repair and recovery. But poor sleep quality from pain or discomfort can blunt this process. Each position does something a little different to your body, so here’s the breakdown:
Sleeping on Your Back
Pros:
- Keeps spine in a neutral position
- Reduces pressure on shoulders and hips
- Good for people with acid reflux (with head slightly elevated)
- Distributes body weight evenly
Cons:
- Can worsen snoring or sleep apnea
- May cause lower back pain if the legs aren’t supported
- May lead to mouth breathing or jaw discomfort
Tips:
- Use a small pillow under the knees to reduce lumbar strain
- Choose a pillow that supports the curve of the neck
- Try elevating the upper body slightly if you have reflux
PT Insight:
Back sleepers with low back pain often have tight hip flexors or weak core muscles. PT can help address these issues with targeted stretches and stability work. A physical therapist might also assess pelvic tilt and recommend postural changes to reduce stress on the lumbar spine.
Sleeping on Your Side
Pros:
- May reduce snoring
- Good for people with sleep apnea
- Helps reduce acid reflux (especially left side)
- Can ease lower back pain if supported well
Cons:
- Puts pressure on shoulder and hip
- Can lead to neck pain if pillow is too low or too high
- May cause jaw compression or misalignment
Tips:
- Use a firm pillow between the knees to keep hips aligned
- Hug a pillow to support the top arm
- Choose a pillow that fills the space between neck and shoulder
- Switch sides regularly to avoid creating muscle imbalances
PT Insight:
Side sleepers often show signs of shoulder impingement or greater trochanteric pain syndrome due to compression of soft tissues. PTs can use joint mobilization, soft tissue work, and exercise to correct shoulder and hip mechanics. They can also teach proper pillow placement for side-lying support.
Sleeping on Your Stomach
Pros:
- May reduce snoring (but not ideal for sleep apnea)
Cons:
- Puts the neck in prolonged rotation
- Flattens the natural curve of the spine
- Can strain the lower back and shoulders
- May aggravate thoracic outlet syndrome or nerve compression
Tips:
- If you must sleep this way, place a pillow under the stomach to support the spine
- Use a very thin pillow or no pillow under the head
- Consider transitioning to a modified side position over time
PT Insight:
Stomach sleepers frequently present with cervical facet joint irritation and lumbar disc stress. A PT can perform assessments of spinal mobility and suggest techniques to improve sleeping posture gradually. Manual therapy, postural correction, and core strengthening can support long-term changes. This position is by far one of the worst for the body over time. However, it can be corrected.
Combination Sleepers (Toss and Turn)
Many people change positions during the night. This is normal and can actually be protective for circulation and pressure relief. However, inconsistent support from pillows or mattresses can lead to disrupted sleep or positional discomfort. Additionally, you can easily roll into a bad position and wake up with that really annoying neck pain which affects your entire day.
PT Insight:
A PT can assess your movement patterns, sleeping habits, and postural control. They can recommend changes to sleep setup and prescribe exercises to ease pain caused by sleep position. In some cases, instability or asymmetry in the body (e.g., leg length differences or scoliosis) may cause frequent position changes. PTs help identify and address these issues.
Mattresses and Pillows
Choosing the right sleep surface is key:
- Too soft: May cause spine to sink and twist, leading to joint stress
- Too firm: May create pressure points on shoulders, hips, or knees
PTs recommend medium-firm mattresses for most people, and memory foam toppers for added pressure relief. Pillow choice depends on sleep position, neck length, and shoulder width. Our physical therapists can help patients trial different pillow heights and densities. We can even give you a more tailored recommendation based on what your pain points are.
What Else Affects Sleep-Related Pain?
- Stress and tension: Clenching, muscle guarding, and shallow breathing can worsen pain during sleep
- Temperature regulation: Too much heat or cold can cause you to curl into positions that strain the body
- Sleep hygiene: Inconsistent sleep schedules or excessive screen time can lead to restlessness and poor posture in bed
- Sleep apnea or breathing issues: May cause altered positioning or awakenings that affect comfort
It’s important to understand that sleep is one piece of the puzzle. Your sleep posture and daily posture can affect each other. For example if you sit at a desk all day and look down, this can affect the curve of your spine which can then lead to sleeping in certain positions to avoid pain. The opposite is true too where you might sleep in a weird position and then your body holds itself in a strange, uncomfortable posture to try and avoid pain…which unfortunately normally leads to more pain.
How Physical Therapy Helps
Physical therapy doesn’t stop when you go to bed. Here’s how PT supports better sleep health:
- Postural training: Teaching spinal alignment and joint positioning that carries over into sleep
- Breathing and relaxation work: Helping reduce nighttime tension that worsens pain
- Mobility and strength: Addressing the root cause of pain that makes certain positions harder to tolerate
- Mattress and pillow education: Helping patients choose sleep supports that match their needs
- Pain reduction: Manual therapy and movement can ease the discomfort that disrupts rest
- Sleep routine coaching: Creating movement routines that help wind down the nervous system
That’s right, we can help you work on your sleep position too! Certain exercises and supports can make all the difference. We assess where your pain is coming from, and then we create a custom plan to address the issue for you which may include better ways to sleep.
What to Do if You Wake Up in Pain
- Neck pain? Check pillow height and sleeping position. Use cervical support and avoid side sleeping on the affected side.
- Shoulder pain? Avoid lying directly on the painful side, and support the top arm with a pillow.
- Back pain? Add support under the knees (back sleepers) or between them (side sleepers) and check mattress firmness.
- Hip pain? Use a firmer mattress topper or position pillows to reduce direct pressure. Stretch hip flexors and strengthen glutes.
- Jaw pain or clenching? Consider jaw support pillows and relaxation exercises before bed.
If you try out these tips and find you still wake up in pain, then it’s time to reach out to a physical therapist in Austin.
When to See a Physical Therapist
If sleep pain doesn’t improve after changing pillows or positions, or if it’s affecting your daily life, a PT can:
- Perform a full postural and movement assessment
- Identify asymmetries or mobility restrictions
- Teach positioning strategies specific to your anatomy
- Reduce joint or nerve irritation through manual therapy
- Design a home program to reduce nighttime and morning stiffness
Sleep isn’t just about how long you rest, it’s about how well you recover. Your sleeping position plays a big role in how you feel each morning.
If you’re waking up sore, stiff, or tired, don’t ignore it. Small changes in sleep posture combined with physical therapy can make a big difference in pain, posture, and performance.
Better sleep starts with better support. A PT can help you find the right position, pillow, and plan for pain-free rest. A few smart changes today can lead to better nights and brighter mornings. Reach out to Move Empower Concierge Physical Therapy today to schedule a FREE discovery session to see how we can help you sleep better and wake up refreshed.