Back sleeping has a good reputation. The old version of this page called it “the optimal choice” and credited it with spinal alignment, less pain, less inflammation, clearer sinuses and better skin. That is a long list for one position, so I went looking for the studies behind it. Most of the list has none. What does exist is more useful: motion-sensor data on who sleeps on their back and for how long, a small lab study that points the wrong way for the position’s fans, and two clear cases where your back is the place to leave.
This post is for people who sleep on their back, or are thinking of training themselves to. If you want the wider comparison of every position, our post on whether there is a best sleep position for your health covers it.
The short version
- You probably spend about a third of the night on your back already. In 664 Danish workers wearing motion sensors, it was 37.5% of time in bed, falling from 41.2% in people aged 20 to 34 to 32.8% at 55 to 65.
- The “better skin” claim has no outcome data behind it. The paper usually cited is a 2016 review that proposes a mechanism; nobody has measured wrinkles in back sleepers against side sleepers.
- Back sleeping is not linked to better sleep. In the one small lab study that compared them, 8 poor sleepers spent more time on their backs than 8 good sleepers.
- If you snore, stop breathing at night, or get sleep paralysis, get off your back. 55.9% of 574 apnea patients in one lab had apnea at least twice as bad on their back, and people were 3 to 4 times more likely to be on their back during sleep paralysis than when falling asleep normally.
- Position can be trained, but only the other way has been tested. A vibrating chest strap cut back sleeping from a median 49.9% of the night to 0.0% in a month; no study has trained people onto their back.
Who sleeps on their back, measured
Ask people how they sleep and most give one answer. Measure them and the answer falls apart, because everyone moves. The best data on this comes from a 2017 study in Nature and Science of Sleep by Skarpsno and colleagues, who strapped small motion sensors to the thigh, upper back and upper arm of 664 Danish workers (363 men and 301 women, aged 18 to 65) for up to six days at home. Most had at least two usable nights.
On average they spent 54.1% of their time in bed on their side, 37.5% on their back and 7.3% face down, and they changed position about 1.6 times an hour. Our guide to choosing a pillow for your sleep position gave rounded versions of those headline numbers. The breakdown underneath them is the part back sleepers should see:
| Group | Share of time in bed on the back |
|---|---|
| Aged 20 to 34 | 41.2% |
| Aged 35 to 44 | 39.3% |
| Aged 45 to 54 | 36.2% |
| Aged 55 to 65 | 32.8% |
| Women | 40.5% |
| Men | 35.1% |
| Normal weight | 42% |
| Overweight | 36.6% |
| Obese | 32% |
Two things stand out. Nobody in this data is a “back sleeper” in the sense of spending the night that way: even the youngest, leanest group spent well over half the night somewhere else. And back time drops as people get older and heavier, and the authors note side lying rises to fill the gap. They did not test why. One possible reason is breathing, since the back is where snoring and apnea get worse, and both become more common with age and weight. That is a guess on my part, and the paper does not make it.
The limits: these were mostly blue-collar workers in Denmark, and the authors say they cannot rule out that wearing three sensors changed how people slept. Still, it is home data from hundreds of people, which is more than almost any claim about sleep position can say.
The skin claim, traced
“Sleep on your back to prevent wrinkles” is the most repeated reason for the position, and the logic sounds fine: if your face is not pressed into a pillow, it is not being creased. So what has been measured?
The paper nearly every article leans on is “Sleep Wrinkles: Facial Aging and Facial Distortion During Sleep” by Anson, Kane and Lambros, published in the Aesthetic Surgery Journal in 2016. It is a review. Its own abstract says the authors “review the literature” and “explore the possibility” that pressure during sleep causes wrinkles. It argues that squeezing and dragging forces act on the face when you lie on your side or front. It reports no group of back sleepers and no wrinkle counts.
An earlier 2012 study had 15 volunteers press their faces against a clear pillow and a sheet of glass to watch the skin fold. It showed creasing. It did not follow anyone’s skin over time.
The closest thing to an outcome I could find is a 2022 study by Tran and colleagues at an eye clinic. They photographed 71 patients and compared the photos with the side each person said they slept on. People who favored one side had a lower upper eyelid on that side. There was no difference in brow height, lower lids or loose eyelid skin. Only 6 of the 71 were back sleepers, far too few to compare, and the sleep position was self-reported.
The pressure idea is reasonable, and one small study found an eyelid difference on the pillow side. Whether years of back sleeping leaves you with fewer wrinkles has never been tested, and given that even dedicated back sleepers spend most of the night elsewhere, it would be a hard study to run.
Do back sleepers sleep better?
Nothing I found says so, and one study says the opposite. In 1983, De Koninck, Gagnon and Lallier filmed 8 good sleepers and 8 poor sleepers in a sleep lab for two nights, after two nights to get used to the place. The poor sleepers were awake longer and woke more often, as you would expect. They also “spent more time on their backs with their heads straight.”
That is 16 young adults, and it cannot tell you which came first. Lying still on your back may simply be what wakeful people do. It is still the only direct comparison, and it points the wrong way.
The spine claim fares no better. A 2021 study by Cary and colleagues filmed 53 adults at home for two nights: 20 with no pain, 13 who woke with neck symptoms and 20 who woke with low back symptoms. Time on the back barely differed between groups (39.2%, 32.8% and 34.5% of time in bed). What set the neck group apart was time face down or in a twisted half-side position: a median 36.0% of the night against 17.8% for people with no pain. Our post on sleeping with SI joint pain goes through the wider spine research.
Two good reasons to leave your back
Snoring and sleep apnea
Lying face up lets the jaw and tongue fall back toward the throat, which is when snoring and breathing pauses tend to get worse. In a 1997 study in Chest, Oksenberg and colleagues looked back at 574 patients with sleep apnea tested in their sleep unit. In 55.9% of them, breathing problems were at least twice as frequent on the back as on the side. Those patients tended to be a little younger and lighter than the rest.
If someone tells you that you snore loudly, gasp, or stop breathing, the move is a proper sleep test, not a new pillow. Whether rolling onto your side is enough treatment for you is a decision for a sleep doctor. Our post on which snoring fixes sleep labs actually measured covers the at-home side.
Sleep paralysis
Sleep paralysis is waking up unable to move, sometimes with a strong sense that someone is in the room. Cheyne, a psychologist at the University of Waterloo, surveyed 6,730 people, 4,699 of whom had had it, and asked what position they were in. More people reported it on their back than in all other positions combined, and the back was 3 to 4 times more common during an episode than when people normally fell asleep. This was a survey based on memory, so treat it as a strong hint rather than a measurement. If you get sleep paralysis and you sleep on your back, it is a free thing to change.
If you want to sleep on your back anyway
Here the evidence runs out. Can sleep position be trained at all? Yes, in one direction. In a 2013 study by van Maanen and colleagues, 31 people with mild to moderate positional apnea wore a small chest strap for about 29 nights that buzzed whenever they rolled onto their back. Their median time on the back fell from 49.9% of the night to 0.0%, and they wore it on 92.7% of nights. A larger follow-up of 106 patients found back sleeping fell from 21% to 3% over six months, though only about two thirds were still using the device by then, and there was no placebo group.
Every one of those studies trains people off their back. I found no study that trained healthy people onto it, and no trial of the usual advice (a pillow under the knees, a rolled towel under the low back, pillows wedged at the hips). Those tips may make the position more comfortable for you. Nobody has measured whether they keep you there or change how you sleep.
If you try it, here is a fair way to judge it:
- Judge it by how you feel in the morning, not by how long you stayed on your back. Even young, lean people spent most of the night elsewhere in the Danish data.
- Ask a bed partner whether your snoring changed. If it got louder, that answers the question.
- Watch your pillow height, since a tall pillow pushes your chin toward your chest.
- Stop if you start waking with neck pain or sleep paralysis.
What this post does not know
It does not know whether back sleeping changes your skin over years, because that study has not been done. It does not know whether back sleepers who switch to their side sleep better, or the other way round. And it does not cover pregnancy, where advice about lying on the back in later months is a question for your midwife or obstetrician, not a sleep blog. For back pain that wakes you, reflux, or any breathing problem at night, ask the doctor who treats it, and tell them which position makes it worse.
This article is for general information only and isn't medical advice. If you have a sleep disorder or a health concern, talk to a qualified professional. Full disclaimer.