Sleep Posture

We spend a third of our lives asleep. Yes, one third! During which time, our subconscious dictates the array of awkward positions our body is contorted to. The more cases I come across where injuries could have been prevented by early posture correction sparked an interest into the significance of our sleep posture to our “awake posture.”

Sleep Posture

Bureau of Labor Statistics, American Time Use Survey

Since, for most of us, what happens after our head hits the pillow is an unconscious blur, I’ve wondered how many of the bad habits, weak postural muscles and awkward positions I see in clients are initially formed by what happens in their sleep.

Sleep Posture

Imagine for a second that each bed was a custom mould of your perfect posture. Sleeping tall, head aligned with the spine, chest out – all the hallmarks of “good posture.” It also has sides so you can’t turn and you have to spend those 8 hours per night in a coffin-like bed. Sure it doesn’t sound all that pleasant, but once you get used to it I would speculate that awake posture would better reflect the sleep posture.

I have yet to find credible research articles on this subject. In my own practice, I have taught myself to fall asleep on my back rather than curled up. It took a while to wake up in that same position but I feel that with a little bit of intent I was able to improve what was happening on an unconscious level. Additionally, I have also reduced the amount of pillows that I sleep on, although it was uncomfortable at first, setting the new normal has paid dividends to my posture.

Common Postural Issues

Postural issues are plentiful. There is such a wide array of potential comorbidities if posture correction is neglected. Here are some of the main concerns of poor posture:

1. Anterior domination

The musculature on the front of our body is much more active than the posterior. There are many reasons that might lead to such an issue: the tendency to sit for prolonged periods being the main one. Humans have mastered negating the work these muscles do from a young age – think how many hours are spent sitting in a classroom during your body’s formative years.

Anterior domination results in anteriorly rounded shoulders, kyphosis, anterior head protrusion, weak gluteals, tight hip flexiors. Many postural injuries and ailments stem from anterior domination.

2. Poor muscular endurance

Sure, when we are prompted we can all jump into good posture. It doesn’t last long though. Usually coming down to prolonged sitting once again, our postural muscles have adapted to be sprinters rather than marathon runners. If our society hadn’t evolved to have such comfortable furniture we would be required to stand on our feet longer, walk further and generally train our postural muscles to have great endurance.

3. Asymmetry – Left/Right Imbalance

Being asymmetrical is one of the most pressing postural issues. Our musculoskeletal system is made up of two virtually identical halves, if one side is stronger or more active than the other then the whole system is put under immense pressure.

For example, a right handed carpenter continually uses his right arm to hammer, saw etc. This results in the muscles connected to the right arm to over develop compared to the left. Since these muscles are connected to bones in the trunk (sternum, spine, scapula) then they will have a stronger pull to the right than to the left causing the system to be inefficient.

Sleep Posture

Since we spend one third of our time sleeping, it is reasonable to ensure that the common postural issues are not being magnified or initiated during our sleep. Although it may seem futile to worry about your sleep posture, it is just like any postive habit creation – tricky at first but worthwhile in the long run. Below are some practical tips for creating better sleep posture habits, everyone is different, so analyse your own habits and ensure they aren’t contributing to any postural deficiencies.

1. Head Position


  • Cervical spine aligned with spine
  • Head facing the same way as body
  • Avoid lateral flexion (ear to shoulder)


  • Adjust pillow height accoridingly
  • Avoid sleeping on stomach with head twisted


Sleep Posture

Avoid neck flexion

2. Trunk Position


  • Avoid trunk flexion
  • Avoid lateral trunk flexion
  • Avoid lumbar rotation


  • Sleep on back/side
  • Stay spread out as if you were standing – avoid curling up/foetal position
Sleep Posture

Avoid unnatural trunk positions


3. Upper Limb Position


  • Avoid shrugging
  • Avoid hands above shoulder level
  • Avoid sleeping on hands


  • Habit creation – learn to be comfortable with your hands/shoulders in a better position
Sleep Posture

Avoid awkward upper limb positions

4. Lower limb position


  • Avoid Hip flexion


  • Avoid curling up when possible.

Sleep posture

5. Sleeping Aids

There seems to be a low emphasis on sleeping aids. We work hard to choose ergonomic chairs for work but sleeping aids are tough to find. You might have to get creative in the way that you correct your poor habits. Ergonomic pillows can be a great tool to improve neck posture specifically.

Ergonomic pillows


Posture correction should be an area of prime priority for the everyday person. There is a high prevalence of posture related injury that can be prevented by some positive habit creation. Since we spend roughly a third of our lives asleep, I believe that sleep posture holds a great influence on everyday posture. If we are intentional about creating positive sleep habits, improvements in sleep posture should result in improvement in awake posture and in turn reduce the risk of musculoskeletal injury occurring.

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