What’s the Best Position to Sleep in? Do we even need a Pillow?

What’s the Best Position to Sleep in? Do we even need a Pillow?


Will the real Randy Gardner please stand up? In 1964, high school student Randy Gardner
successfully stayed awake for 11 days and 24 minutes, setting the world record for the
longest a human has gone without sleep. Over the several days awake, Gardner experienced
everything from mood changes, memory lapses, random hallucinations to temporarily losing
the ability to identify objects and recall words. But you don’t have to stay awake for multiple
days to experience detriments from sleep, as Neuroscientist Matthew Walker will tell
you. “I would like to start with testicles. Men who sleep 5 hours a night, have significantly
smaller testicles than those who sleep 7 or more.” In his book “Why we Sleep,” Walker explains
the ins and outs of just how bad too little sleep is not only for your reproductive, cardiovascular,
and immune health, but learning and cognition as well. Interestingly, lacking sleep even affects
you socially. -“…so we just published a study demonstrating
that sleep loss will trigger viral loneliness.” As Walker is explaining here in this interview
with Rhonda Patrick, this paper he authored demonstrated that people are much less comfortable
with people being close to them after they’ve been sleep deprived. They even put people in an MRI scanner and
found that the brain is lighting up in a way that makes you more suspicious of people and
less able to understand their intentions. Now, one of the things that was striking to
me that Matthew Walker said was that you cannot recover a sleep debt. You can’t just “catch up on sleep” by
sleeping for 12 hours on a Saturday after 3 nights of sleeping poorly. So, if we only have one chance at sleep, then
sleep quality or the efficiency of sleep must be very important even if you’re getting
the recommended 8 hours a night. There are many things you can do to improve
sleep quality and I’ve discussed this in another video, but what I’ve been curious
about lately is sleeping posture. What is the best position to sleep in and,
what is the best kind of pillow? Or should we even use a pillow? This question has bugged me for a while because
I’ve tried all kinds of pillows including this thing that’s supposed to keep your
head from rolling to one side but I’ve never been 100% satisfied. “Oh, man. You want a bad night? Try sleeping on one of these.” The first thing I thought might be worth looking
at is how other primates sleep. A quick google image search of “sleeping
primates” – shows a lot of them sleeping on their side. As Charles Nunn explains, what the great apes
have in common with humans is that they all build some sort of comfortable nest or sleeping
platform each night. Humans have different bone structures from
apes of course, but I thought it would still be interesting to consider the position they
sleep in most often. This 2015 study, monitored the sleeping patterns
of 5 Orangutans for two years. They found that orangutans spent 3 times more
of their sleeping time on their sides than they did on their backs. Now While digging into human research, I had
trouble finding papers that specifically looked at how sleep position affected sleep quality. And, I couldn’t find any papers comparing
sleep quality when people used a pillow versus when they didn’t use a pillow. But we can of course use a bit of logic and
make some inferences based off the data that we do have. So I figure a sleep posture that promotes
good sleep quality would have to (1) Prevent snoring and (2) at least not impede the glymphatic
system. For now, let’s look at snoring. What’s happening during snoring is that
air flow is being partially blocked by tissues in the airway, as evidenced by a… snoring
sound. I think more often than not, people would
assume that snoring is mostly a nuisance to one’s sleeping partner and the effect on
sleep quality is not enough to cause alarm. However, A study from 2003 looking at 1,144
school children separated the kids into either “always,” “frequently,” “occasionally”
and “never” snoring. What they found was that in the kids, snoring
“always” was significantly associated with poor academic performance in mathematics,
science , and spelling. And snoring “frequently” was also significantly
associated with poor academic performance in mathematics and spelling . Another study from 2001 found that children
with lower academic performance in middle school are more likely to have snored during
early childhood. Another study from 1994 showed that between
age 4 and 7, “Daytime sleepiness, hyperactivity, and restless sleep were all significantly
more common in the habitual snorers than in those who never snored.” And Yet another study from 2005 titled “Snoring
predicts hyperactivity four years later” shows that “snoring and other symptoms of
sleep-disordered breathing are strong risk factors for future emergence or exacerbation
of hyperactive behavior.” I could go on with several more studies showing
children who snore secrete less growth hormone, how snoring is associated with headache and
daytime sleepiness as well as high blood pressure, heart attack and stroke but we can get into
the full details in another video. For now, Here’s two recent nights from just the other
week tracking my sleep with the app “snore lab.” Here’s a night where I snored a lot… and
slept about seven hours, and here’s a night where I slept less about 6 and a half hours
barely snored at all – most of what the app picked up was me rustling around and my air
conditioner turning on and off. As indicated by the orange frowny face, I
distinctly remember being very groggy this particular morning when I snored alot, but
quite refreshed this morning when I didn’t snore that much. One pretty clear example of snoring being
disruptive to sleep quality is the fact that it seems to wake me up – On the nights that
I do snore, the recording will show that the snoring sometimes wakes me up enough to rustle
around or change positions. This 2013 review on “positional therapy
in position-dependent snoring” explains that it’s often observed that snoring is
usually worse when sleeping on the back and better when sleeping on their side. And, several papers have shown that sleep
apnea gets worse when people sleep on their backs. During the American War of Independence and
later during World War I , soldiers were advised to wear their rucksacks on their backs while
sleeping to keep them on their side and avoid sleeping on their backs. This would prevent snoring and making their
position known to the enemy. Papers from 1984 and 1996 found that people
snore worse on their back, and this one 2003 study found that snorers snore less on
their side So far, it looks like sleeping on one’s
side or at least avoiding sleeping on your back would be good for sleep quality. This study from 1983 found that ”Consistently,
poor sleepers spent more time on their backs with their heads straight.” Now what about pillows? There are several types of pillows and most
of the ones advertised to improve sleep quality aim to support the neck. There is a natural curvature in the neck,
a lordosis, and you can lose that and develop something called flat neck syndrome. This is developed presumably from looking
down all the time, probably at your smart phone or using a pillow that is too high. But if we want to sleep on our sides, we shouldn’t
need to worry about having the perfectly shaped pillow and just get one that keeps your neck
from bending too much while you sleep on your side. Moving on, to further evaluate sleep positions
that promote good sleep quality, the position should be good for glymphatic transport. In the body, we have something called the
lymphatic system that helps with each organ’s problem of waste clearance – this network
of vessels extends through the body and collects cellular debris, proteins and other waste
from the spaces between the cells so it can be disposed of. The brain however, does not have lymphatic
vessels that it can use for waste clearance. As Neuroscientist Jeff Iliff explains in his
TED talk, this doesn’t make much sense considering the adult brain uses about 25% of the body’s
energy budget and generates a considerable amount of metabolic waste. “So how then does the brain solve its waste
clearance problem? The brain’s solution to the problem of waste
clearance, it was really unexpected, it was ingenious.” “So the brain has this large pool of clean,
clear fluid called cerebrospinal fluid. We call it the CSF.” The CSF fills the space that surrounds the
brain and wastes from inside their brain make their way out to the CSF which gets dumped
along with the waste into the blood.” In the brain, there is a specialized network
of plumbing that organizes and facilitates the cleanup process. You can see that in these videos… The frame on your left shows what’s happening
at the brain’s surface and the frame on your right shows what’s happening down below
the surface of the brain within the tissue itself. The blood vessels are labeled in red and the
cerebrospinal fluid that’s surrounding the brain in green. “…and as it flushed down into the brain
along the outsides of these vessels, it was actually helping to clear away, to clean the
waste from the spaces between the brain’s cells.” What’s interesting is that all this is happening
when you’re asleep – the video on the left shows how much of the cerebrospinal fluid
is moving through the brain of a mouse while its awake – barely anything. But when the animal goes to sleep, the CSF
rushes into the brain to rinse and clean it out. Alzheimer’s disease is an example of how
important this sleeping brain cleanup procedure is. A hallmark of Alzheimer’s disease is the
build up of a peptide called amyloid beta, and the glymphatic system helps clear this
stuff out of the brain. The research on sleeping position affecting
glymphatic transport is very limited, but this 2015 study had rodents sleep on either
their side, back or stomach and were monitored via magnetic resonance imaging. They found that “glymphatic transport was
most efficient in the lateral position” – on their side. Dr. Maiken Nedergaard said: “It is interesting
that the lateral sleep position is already the most popular in humans and most animals
— even in the wild — and it appears that we have adapted the lateral sleep position
to most efficiently clear our brain of the metabolic waste products that built up while
we are awake.” One interesting thing about this study is
that it specifically looked at clearance of the Alzheimer’s protein Amyloid beta and
found that removal of it was most efficient in the side sleeping position. Now This is just in rodents, but this study
was looking at how sleep position could affect neurodegenerative disease in humans. This study strapped a small device with an
accelerometer to the participant’s heads to monitor what sleeping positions they were
in and for how long. They found that those people spending more
than two hours sleeping on their back a night was significantly more frequent in those with
neurodegenerative disease. Those with neurodegenerative disease spent
nearly twice as much time on their backs while sleeping – controls spent around 30% of their
sleep on their backs, those with NDD spent around 50% of their sleep on their backs. The Hadza of Tanzania are often interesting
to look at as their lifestyle is thought to be similar to that of prehistoric humans. I couldn’t find studies specifically on
their sleeping position, but this brief video talking about a study on the Hadza’s sleep
patterns shows most of them sleeping …on their side. So, the data is limited but it’s enough
at least for me to want to try and sleep on my side more. However… the problem is that you can’t
just say “OK time to sleep on my side because Ulysses McGill said so.” “How’s my hair?” People unconsciously change their sleeping
position multiple times throughout the night. One study found that over the course of 1
night, subjects changes positions as many as 20 to 40 times per night. So how can we get ourselves to stay on our
sides, or at least bias ourselves to select that position more often as we rustle around
at night? In 1984, the journal CHEST published a letter
written by a patient’s wife. She had cured her husband’s snoring problem
by inserting a plastic ball into a pocket sewn on the back of a T-shirt to prevent her
husband from sleeping on his back. In fact, there’s a type of therapy called
“positional therapy” designed to keep patients off of their back – all kinds of
things from a backpack with a softball inside to a ball in a sock on the back to a shark
fin type thing to alarms that ring when you roll on your back. So … what if pillows are making sleeping
on our backs artificially too comfortable? That is, let’s say you lay down to sleep,
but you simply don’t use a pillow. Laying on your back might become a little
less comfortable now that your neck and head aren’t cradled in a cushy comfortable cushion. What’s going to be the more comfortable
position? Probably sleeping on your side because you
can support your neck with your shoulder or a pillow made out of your arm and hands. Surprisingly, there was one paper that addresses
this directly. In this paper by Michael Tetley titled “Instinctive
sleeping and resting postures: an anthropological and zoological approach to treatment of low
back and joint pain,” he argues that forest dwellers, nomads and tribal peoples suffer
from few muscoskeletal problems because they sleep in a “natural” posture without a
pillow at night. According to Tetley, he has “organised over
14 expeditions all over the world to meet native peoples and study their sleeping and
resting postures. They all adopted similar postures and exhibited
few musculoskeletal problems.” He says tribespeople often do not like having
their photographs taken so he demonstrates most of the postures himself. What was interesting about this paper is that
none of the positions he’s presented show people sleeping on their backs. So the data on this topic is limited, but
based on what I did find, so far it seems that the side position is the better position
for cleaning out your brain and preventing snoring from impeding your sleep, and ditching
the pillow might be the way to get yourself to spend more time in that side position. That’s the idea anyway. It’ll probably take some time to adjust
to sleeping without a pillow and I’m not saying this is realistic for everyone – if
you don’t snore, and you wake up feeling refreshed and are without back or neck pain
in the morning there’s probably no need to change your routine. Also maybe you could figure out some other
way to keep yourself on your side during the night without ditching your pillow. Actually I’ve been sleeping without a pillow
for about a week now and I can’t say I’m waking up drastically more refreshed, but
I haven’t woken up with a stiff neck or back yet – something that would usually happen
every other day. But I don’t really know if this way of sleeping
is keeping me on my side like I was thinking, so I’m planning to track a couple weeks
of sleeping like this with a wearable device and hopefully one of those baby monitor type
see in the dark cameras. I’m planning to post updates on my instagram
every now and then, and at the end of the experiment, I’ll post a thorough video on
youtube letting you know how it all went. And, If any of you would like to join me in
the sleep experiment, I’ll post in the description how I plan to do it. Also, if any of you have done a sleep tracking
experiment yourself in the past, please let me know in the comments or on instagram what
you used to track your sleep. This video was sponsored by Kenhub – which
is where most all the anatomical images used in this video came from. If you’re a medicine, nursing, or physiotherapy
student and want a way to drastically reduce the frustration involved with packing ridiculous
amounts of anatomy information into the thing between your two auditory ossicles, you should
definitely check out Kenhub. With hundreds of engaging videos, interactive
quizzes, complete articles and a full atlas with stunning images, Kenhub is the best tool
for learning anatomy I’ve come across and it actually makes the process fun. Check out Kenhub at kenhub.com

100 Replies to “What’s the Best Position to Sleep in? Do we even need a Pillow?”

  1. Hey everyone, still haven't officially started the sleep tracking experiment – particularly because I haven't found my Garmin (tucked away in a box somewhere – moved recently). Also looking for a good way to monitor sleeping position. Will update on my instagram – @jeverett.whativelearned

  2. Hmm and all my friends think it’s weird that I don’t sleep with a pillow or at most the flattest pillow available

  3. So, at 12:15, once again, we are being sold the black man/white girl.
    Black man white girl can happen of course, but when you see it in an ad, it didn't just happen.
    They were chosen/selected and put together for a purpose, which is to push the diversity narrative.
    But what are Tiger Woods and etc going to do about their addictions to white girls once they've bred all the white out of them?

  4. The topic of sleep is mentioned quite often is Islamic literature as well. For example, we are advised to sleep on our right side and take a midday nap

  5. As an avid left-side sleeper its nice to know there are major benefits but my crushed left arm and lower back pain tell me there's more to the puzzle

  6. I wonder what effect pediatricians urging the “back to sleep” position for infants sets a pattern of back sleeping later on. My kids all had reflux so “back to sleep “ was not possible for them but so many kids do even to the point of having a flat head.

  7. I used to sleep on my side with pillow but after I got tube thoracostomy on my left, I usually sleep on my back without pillows while raised arms. Sometimes I sleep with my side but still raised arms without pillows. But i have pillows on my side to hug tho

  8. I use a pillow between my knees to keep me at a side position. Been doing that for years now, started because of back pain.

  9. Hi Joseph,
    at first: Your videos are really amazing, very high quality editing combined with incredibly enlightening and valuable content, so thank you very much.
    Could you maybe make a video talking a bit about starch? Just as an idea, I'd highly appreciate it
    Nothing but the best to you
    greetz

  10. Stop looking at the comments and watching this video you don’t need it you dont sleep anyways stop lying to yourself

  11. sleeping on your front, on your stomach is the most common way to sleep, and this is left out what's the point of this vid??!

  12. It's not just the position thats important, but the mattress. I have a squishy soft mattress and it is hurting my back and making it difficult to get comfortable. I'm going to switch to a firm mattress again.

  13. I try to sleep on my back bcs i heard sleeping on the sides of your face really ages you faster, thoight i really love sleeping on my side. Funny i watch this after being awake for more then 24 hours lol

  14. pregnant woman are often told to sleep on their lefthand side so that their stomachs are more easily drain into their intestine instead of back into their esophagus

  15. I was going to suggest the tennis ball trick for keeping you from sleeping on your back or stomach. My chiropractor suggested it to me.

  16. Finally, the west realised sleeping on the side is the most beneficial which was concluded by Chinese traditional medicine thousands of years ago.

  17. Hey WIL, could you make a follow-up on if you still eat only one meal a day?
    I love fasting and all that but I cannot keep up this one-meal-a-day thing for very long because of just how deeply three-meals-a-day is ingrained in our culture.
    Just found vid from 3 years ago and wondered if anything made you change since then.

  18. I have such specific sleeping posture that its almost impossible to sleep without curling up with a pillow in my arms.

  19. Were the studies on snoring and sleep apnea conducted on people who sleep on the back with or without pillow though? I sleep on my back without a pillow and find this to be the best position for my neck, spine , shoulders and elbows.

  20. 8:18 – Correction, brain is connected to lymphatic system. There are meningeal lymphatic vessels, they were discovered in 2014.

  21. For over 1400 years, there is a teaching in Islam about sleeping on the right side for many reasons that befits the body.

  22. "they even put people in an MRI scanner…"

    Shows a CT scanner.

    Sorry, apparently I've worked too much with radiology. 🙂

  23. I used an app that records my teeth grinding. I was told that I grind my teeth but after actually hearing how horrible the sound was when I decided to by a mouthpiece for my bruxism. I'm not sure if the mouth piece improved my sleep quality, but it definitely saves my teeth. I wear down my mouthpieces in an alarmingly fast rate!

  24. Nice! I expected that you also recommend us to sleep on left side if we have stomach problems, like during the sickness, but that's fine 🙂

  25. thanks for the video you did a great job analyzing and gathering information.
    I hope you continue to make great content and get the recognition for your work.

  26. Something I would like to bring up for sleep tracking, as well as heart rate, can be a fit bit! Plus it tells you how often you’re actually sleeping and how often you’re restless and moving around. I would get a Fitbit and do a control week, than do a week without pillow, a week on padding with pillow, a week on padding without a pillow, and then another normal week and see what helps you sleep better, how your heart rate could be affected and how often you’re restless.

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