This Is the Best Position To Sleep In For Skin and Spine Health
Could the way you sleep be affecting your skin and spine? A physical therapist explains how different sleeping positions influence wrinkles, facial asymmetry, neck pain, and overall sleep quality.
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Consumers are investing in sleep health more than ever before, with nearly 48% of US adults utilizing a sleep tracker like an Oura Ring or Eight Sleep Pod. With a third of our lives spent sleeping, finding ways to optimize for overall health is a non-negotiable. Tracking sleep metrics isn’t the only thing to think about. The right sleeping position can support everything from deeper sleep to spine and skin health.
The Optimal Sleep Position
Dr. Mark Huntsinger, PT, DPT, is a physical therapist and founder of The BodyWell Method. He has garnered 100+ million views across platforms for his sleeping position videos. His expert opinion is to sleep on your back if you can. “If I had to say one position, it would be sleeping on your back. It is the easiest position to ensure the lower back, neck, TMJ, hips, and shoulders are in an optimal position for their health. Doing this while setting yourself up with a pillow under your knees, a pillow or two under your arms, and a good pillow under your neck keeps most of the joints in the body in what is called the “loose-packed position,” which means the joint capsule and ligaments around the joints are in a lax and relaxed position.
Sleep expert Dr.
One of the simplest benefits of this is that it can lead to better sleep due to a lack of waking up from discomfort in the joints,” he explained. “More specifically, being in this position for the long hours we are not moving during sleep leads to an optimal environment inside the joint when it comes to pressure, blood flow, and cartilage health. For example, the slight amount of flexion in the lumbar spine allows for maximal height and reduced pressure in the discs, unloading of the facet joint cartilage, reduced tension in the nerves, relaxation of the large ligaments around the spine, and relaxation and improved blood flow to the muscles around the spine.”
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Dr. Ava Shamban, board-certified celebrity dermatologist and founder of AVA MD and ALTHAEA SKIN, agrees with Dr. Huntsinger, PT, DPT, on sleeping on your back from an aesthetic perspective. “If your skin could vote, it would absolutely vote for sleeping on your back. Even better is what is called the “astronaut position” — you’re on your back, your upper and lower body is supported, and your face isn’t being compressed into a pillow for six to eight hours. You’re essentially taking the mechanical stress off the face and allowing the body to rest without the face or feet bearing the brunt of any pressure all night long,” she added.
“When you sleep on your side, one side of the face is repeatedly compressed, folded, and sheared against the pillow. Over time, that mechanical distortion can contribute to what we call “sleep wrinkles.” These are different from the fine lines we associate with facial expression. They can be more deeply etched, vertically or obliquely oriented creases created by repeatedly folding and compressing the skin. Stomach sleeping is even less friendly to the face because you are essentially pressing your entire face into the pillow. So, from a purely aesthetic standpoint, back sleeping wins!”
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Dr. Shamban, MD, thinks about nighttime skin care as repair time. The skin has its own circadian biology, and processes involving barrier function, blood flow, DNA repair, and skin recovery fluctuate over the 24-hour cycle. Some aspects of skin repair are particularly active at night, which is one reason adequate, consistent sleep matters so much for the skin. “My ideal evening routine is therefore never a 14-step beauty ritual. It is about giving the skin what it needs to repair while you’re sleeping and creating a synchronized cycle so skin is not cellularly tied,” she added.
What To Avoid While Sleeping
Both experts also emphasized that adjusting to sleeping on your back may take time and practice, but if it is not appropriate for you due to a medical condition or inability to sleep, find another sleeping position to try, like side sleeping. However, sleeping on your stomach is not recommended.
“I don’t have a problem with people sleeping on their sides, particularly if they have sleep apnea, suffer from sleep paralysis, snoring, or don’t feel secure on their back. I still recommend using pillows to support your spine in this position. A pillow between the knees keeps the hip and lower back joints close to that optimal loose-packed position; a hug pillow keeps the upper shoulder and mid-back in that optimal position, as well as reducing pull from the shoulder and arm on the neck joints and musculature,” Dr. Huntsinger, PT, DPT, explained.
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“The most important pillow for sleeping on the side is a pillow tucked between the head and the shoulder, filling up the space of the neck, and the pillow needs to maintain that shape all night. If the pillow is inadequate, one side of the neck will be under excess tension in the joints, muscles, and nerves, while the other side is under excess compression in these tissues.”
He further explained that if you do not have the pillow support from side sleeping, you risk excess compression or tension on structures for hours on end overnight. The neck joints, discs, muscles, and nerves can be compressed, leading to issues like TMJ dysfunction, headaches, and shoulder and neck strain. From a skin perspective, Dr. Shamban, MD, added, focus on reducing pressure on the face.
“Sleep itself is essential for skin health. If someone simply cannot sleep on their back, I would focus on reducing pressure on the face. Think about taking a piece of fabric and pressing it into the same position for eight hours straight. Eventually, the material begins to hold the fold. Your skin is much more sophisticated than fabric, of course — but the basic mechanical principle is relevant. During side or stomach sleeping, the skin experiences compression and repeated deformation. When the face is pushed against a pillow for hours at a time, it can create temporary creasing when you wake up. Repeated mechanical stress over years contributes to more persistent sleep-related lines,” she explained.
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“We are all asymmetrical in some form or fashion naturally. But the issue here that can exacerbate the appearance of asymmetry is where the pressure is being applied. Consistently sleeping on only one side furthers more compression and distortion. This can make existing differences in volume, laxity, or contour even more noticeable. Facial aging is multifactorial — intrinsic aging, genetics, UV exposure, hormonal changes, volume loss, collagen and elastin changes, and lifestyle all contribute.”
While stomach sleeping is common for many people, the issue Dr. Huntsinger, PT, DPT has with this sleeping position is the issues it can cause for the neck and lower back. “The neck is the main one I see problems with from sleeping on your back. There is no way to sleep on your stomach without having your head turned to one side, which can compress and tense many of the spinal structures, but the worst part about it is it leads to asymmetry in the upper cervical spine.
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Besides waking up not feeling your best, this asymmetry follows the person in their whole life when they are moving throughout the day. The upper cervical spine is responsible for about 50% of all neck rotation, so when it is asymmetrical, there is increased compression and tension on the lower neck joints, muscles, ligaments, discs, and nerves.”
This upper neck asymmetry can also lead to increased compression in one or both sides of the TMJ (jaw joints) with chewing and talking. Individuals also risk having hip asymmetries, lower back compression, and mobility issues. “The impact of sleeping on your stomach is so strong that I can immediately identify my patients who do sleep on their stomach just based on the mobility asymmetries,” he shared.
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Tips For Better Sleep Health
Besides finding a sleeping position that decompresses and lubricates your spine while also avoiding intense pressure on the skin, these small changes can improve your overall sleep health.
Finding the proper mattress firmness and pillow height can make or break your sleep success, according to Dr. Huntsinger, PT, DPT. He recommends a combination of shredded memory foam and wool that can keep its shape, versus down filling, which can collapse in shape throughout the night. Correct pillow height is directly related to how firm or soft the mattress is, and the firmness or softness of the mattress can also greatly influence whether the rest of the spine can stay in neutral alignment while sleeping. It is equally important to invest in both a good mattress and pillow for your body.
Before getting out of bed in the morning, Dr. Huntsinger, PT, DPT, also recommends gentle lubricating stretches like knee rocking or a spinal twist to bring back fluid into your discs, relax muscles, and get the body ready for gravity to start pressing down on it again.
Correcting Asymmetries
Dr. Shanbam often sees her patients needing correction rather than prevention: “A topical cream alone isn’t going to magically compensate for spending eight hours with your face compressed into a pillow. If I’m seeing laxity, loss of definition or deeper lines, I want to treat the quality and structure of the skin, not just the wrinkle sitting on the surface. For tissue tightening, I love technologies such as Sofwave and EVERESSE because they work at the dermal level to stimulate collagen remodeling and improve the appearance of laxity and contour. Sofwave uses its proprietary superb ultrasound technology to target the mid-dermal layer and stimulate collagen, elastin, and hyaluronic acid production. EVERESSE uses monopolar radiofrequency to heat the deeper dermal layers and stimulate collagen generation. These are particularly interesting when someone comes in and says, “This side of my face just looks lower.”
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For deeper creases and true volume loss, dermal fillers can be used strategically to restore volume and contour. I am very much in favor of using hyaluronic-acid gels as a tool for restoring facial harmony, rather than simply filling a wrinkle,” she explained. “The goal is facial balance—restoring volume where it has diminished, lifting tissues, reducing wrinkles and bringing the two sides of the face back into better proportion. Neuromodulators can also be useful when muscle activity is contributing to asymmetry or expression lines—for example, selectively addressing the brow or periocular area.”
She shared that an individual strategy is key here, as she is not trying to make both sides of the face identical but restoring balance without erasing individuality.
For more biomechanical correction, treatments that restore equal mobility and reduce compression and tension across the joints are what you want to look for. This could include massage, physical therapy, chiropractic, stretching, Pilates, acupuncture, among many other modalities. Finding the sleep formula that works for you might be the most underrated approach to longevity, as it impacts all functions of our health.
