Chiropractic + Naturopathic Doctor

Breaking Bad Sleep Habits

By Darrin T. Milne DC   

Features Clinical Patient Care

Behaviour modification reduces front-down sleeping.

Is it really necessary to wait an hour after eating before going swimming?  Did your mother ever tell you not to go outside without a coat because you’ll catch pneumonia?  These examples of medical myths seem to have been generally accepted by the public.  They are, after all, reasonable and intuitive.  My favourite medical myth is that if you get hit on your back while your eyes are crossed, they will stay that way.  While these myths may seem silly to us, some of them may have crept into the chiropractic vernacular.

In our practices, while educating patients, we make recommendations about sleeping that are based on reasonable concepts: “a contour pillow supports the neck”; “flipping a mattress may prolong its longevity”; and “sleeping on your side or back is preferable to tummy sleeping.”  I became interested in the latter recommendation when a patient asked me if any studies had proven it.


I did a quick literature review and came back wanting.  Most of the articles on tummy sleeping relate to sudden infant death syndrome (SIDS), and plenty of articles reported that maintaining the neck posture, or cervical curvature, while sleeping is important in reducing neck pain in a symptomatic population.(1,2)  But what about the asymptomatic population?  Can a child’s sleep posture predispose spinal symptoms in the future?

It appears that there is little research on sleep posture as related to the development of spinal pain.  Yet, a general chiropractic adage remains that sleeping on the stomach can result in such discomfort.  I had always understood that this predisposition was based on the idea that stomach sleeping causes an increased lumbar extension and a prolonged, static neck rotation over the course of a night’s sleep.  Therefore, accepting this assumption as being generally true, I frequently recommend avoiding the prone sleep posture.

However, simply advising a patient to eliminate the front-down sleeping posture is often met with non-compliance.  Not that those patients consciously ignore the recommendation, it is just that when one is asleep, one tends to do what the body has grown accustomed to.

Interestingly, the patient who had asked me for proof suggested that preventing the front-down sleeping habit would require a physical reminder in addition to verbal instruction.

One day he showed me his physical reminder in the form of a unique pillow that he had designed, and he asked for my opinion on it.  Though skeptical, I decided to develop a study to test the pillow.  The objective was to determine if the provision of education related to sleeping posture along with the introduction of a specially designed pillow could reduce front-down sleeping patterns in children who demonstrated this behaviour and who were asymptomatic for spinal pain.

This before-after study ran over a three-week period.  The first week established the baseline sleeping behaviour.  During the next two weeks, parents underwent a brief education session on proper sleep posture and were asked to document their child’s sleeping positions using the test pillow.(3)

Since the pillow has a unique shape and remains with the sleeper for the entire night, it was hoped that it would be an effective tool for behaviour modification.  By reducing front-down sleeping behaviour in children, it was hypothesized that this habit would be broken before it was ingrained; therefore, lifelong neck and/or back pain could be avoided insofar as the origin relates to sleeping position.

Imagine sleeping on your back with your head comfortably resting in the centre of the experimental pillow.  While in that position, your head may lean to the left or the right with support from one of the pillow’s two wings.  If you roll to one side, the pillow will roll with you, and your head will rest comfortably on one of the two wings that are now in direct contact with the surface of the mattress.  If, however, you try to sleep on your front, the pillow will not be very comfortable because the wings bend up into the head, making the pillow not very huggable.  This discomfort is the key.  It reminds you – if only subconsciously – why you are using this particular pillow; you reject the front-down position and shift to one of the two acceptable positions.

After a few weeks on the pillow, the tummy sleeper will, hopefully, be conditioned to avoid the prone position.  After a few months, the preferred behaviour should be firmly established and the sleeper can use any pillow appropriately.

The study data was analyzed statistically using paired t-test results to assess the significance of the changes to front-down sleeping time following introduction of the pillow and postural education.  From the data collected, it was concluded that the experimental group had a statistically significant (p<0.05) incidence of change from stomach sleeping to back or side sleeping behaviour.

The study results suggest that when compared to subjects sleeping with their regular pillow, this specialized pillow facilitated the desired change in sleeping position from prone to lateral recumbent or supine sleeping after only a two-week period of use.

It was not the intent to prove experimentally that sleeping on your side or back is clinically better than sleeping on your belly. However, this study has shown that the front-down sleeping pattern can be significantly reduced through behaviour modification with this specialized pillow.  All that is required is time, an effective retraining method and a reasonable degree of willpower on the part of the patient. 

As chiropractors, we cannot always hope to affect an individual’s willpower.  But we can at least provide a pillow, effective education, and reasonable recommendations to facilitate a change from a behaviour that we believe is detrimental to our patient’s long-term spinal health.•

1. Lavin RA, Pappagallo M, Kuhlemeier KV. Cervical pain: a comparison of three pillows. Arch Phys Med Rehabil 1997; 78(2):193-8.
2. Persson L, Moristz U. Neck support pillows: a comparative study. J Manipulative Physiol Ther 1998; 21(4):237-40.
3. Re-Mind-Me™ Training Pillow information website: www.marketlaunchers.comre-mind-me.html.

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