Do you wake up in the morning in pain and wonder why? Have you wondered how exactly you should position yourself for sleep? One pillow? Two pillows? Five pillows? Where do all of those pillows go?

While asleep, your body remains relatively still for several hours at a time. If you are holding your body in curved or twisted position while in bed you will have increased stress on joints, muscles, ligaments, and tendons. The areas of your body that might be most affected are your neck, shoulders, upper and lower back, and hips.

The goal is to keep your spine in a neutral position, or one in which the natural curves of your spine are maintained and supported.

The easiest position to achieve this in is lying on your back. However, many people prefer to sleep instead in a side lying position. With the right placement of pillows, the natural curves of your spine can be maintained and supported in this position. *If you have shoulder or arm pain, you should avoid sleeping on the affected side.

• You will need 1-2 pillows under your head, ensuring that your head is neither tilted or rotated up or down.

• To keep your trunk in a “straight line,” rather than side bent (or curved down/concave), you may need a pillow under your trunk.

• To support your hips and prevent the weight of your top leg from pulling your hips/pelvis and twisting your spine, put 1-2 pillows between your knees.

• Place a folded pillow in front of your body to rest your top arm on. This will support your shoulder and prevent your upper back from twisting.

The above position is theoretically easy to replicate. It is more difficult, however, to know if you have actually achieved the goal of a neutral spine position. Try having a friend or partner take a picture of you (without your shirt on) from the front and the back. Draw a line from the top of your head to your tailbone. If the line is crooked, try to straighten it out by adding or removing pillows. If you are unsure, or don’t know how to fix it, consult a physical therapist.

Do you instead prefer to sleep on your stomach? This is the least ideal position. Your neck is rotated to an end range position, your arms are often positioned away from your body or over your head, and the front to back curves of your spine are not maintained. If you are in the position for several minutes before falling asleep, it is not necessary to make any changes (unless you have pain while doing so). However, if you spend most of the night, or even just several hours, lying on your stomach, those hours add up over the weeks and months and years and can contribute to harmful stresses on your joints, particularly those of your neck.

We love to blame our mattresses when we start to experience pain. I recommend using a firm mattress and avoiding memory foam mattresses. Memory foam mattresses conform to whatever position you prefer to assume, rather than support your spine, like a firm mattress will. However, before throwing away your mattress, try making some changing to your preferred sleeping position and consult a physical therapist.