Dear Dr. Steve: What is the rule for pillows? How many should you sleep on? Will using more or less affect your posture? What is the best sleeping posture: stomach, back or side? A.B. St. Clair Beach

Dr. Steve: Sleeping with one pillow that adequately supports the neck is the general rule. Notice I said supports the neck, not the head. While sleeping, the head and neck should be maintained in the neutral position. The head should not be tilted to one side or the other nor flexed or extended. When sleeping on your side, the pillow should offer support from the mattress to the side of your head. It is also a good idea to keep the legs bent and have a pillow between the knees to keep the hips in a neutral position. When sleeping on your back, the pillow should support the natural curve of the neck without letting the head go back into extension or flex forward. It is possible to do this with a high quality off the shelf pillow, however good orthopedic pillows are designed to provide more support for the neck. The cervical pillows also come n a broader range of shapes and sizes to custom fit one’s head and neck.

You may be wondering if this is beneficial when sleeping on your stomach? The answer of course is no. This brings us to the second part of the question, which asks about optimal sleeping posture. Laying flat on your back during sleep is the best way to support and relieve stress in the natural curves of the spine. This is the best way, provided you don’t have some other medical conditions such as sleep apnea, severe obesity or congestive heart failure which prevents you from doing so.

Almost as good, is side sleeping in the fetal position with legs bent and knees together. Keeping the arms down and in front (not overhead) and again, placing a pillow between your knees will optimize this position.

Stomach sleeping should be avoided as it places undue stress on the low back, by accentuating the lumbar spinal curve, which can create inflammation around the posterior joints. In addition, stomach sleeping forces you to turn your head left or right which also places undue torque on the joints of the neck. Over time, sleeping on your stomach, on an improper mattress or the wrong pillow can cause long term postural problems. These issues can progress into further biomechanical problems, which in turn promote degeneration and arthritis.

See your chiropractor for more information on this subject and for a postural, spinal analysis. Maintaining your spinal health is the key to an optimally functioning nervous system and an optimally functioning you.