What two positions are not recommended for the elderly while in bed?

As we age, our bodies go through many changes that can impact our comfort and safety when sleeping. Choosing the right sleep position is important for older adults to ensure proper sleep quality and avoid pain or injury. There are two positions in particular that experts warn against for elderly individuals – sleeping on the stomach and sleeping completely flat on the back.

Why Sleeping on Stomach is Not Advised

Sleeping on the stomach, also known as the prone position, is generally not recommended for seniors for a few key reasons:

  • Can strain the neck – In the prone position, the neck is turned to the side for hours, which can put stress on the cervical spine and lead to pain or stiffness in the neck.
  • Causes back pain – With the entire front of the body pressed against the mattress, the natural curve of the spine is flattened. This can exacerbate back issues and cause discomfort.
  • Impairs breathing – When sleeping face down, the abdomen is compressed, making it more difficult to breathe deeply. This can exacerbate sleep apnea and cause oxygen deprivation.
  • Increases pressure on joints – Hips and shoulders press into the mattress, increasing pressure on these joints which are already prone to arthritis and discomfort.
  • Can aggravate acid reflux – In the prone position, digested foods and acids from the stomach can travel back up the esophagus more easily, worsening symptoms of heartburn.
  • Increases risk of wrinkles – Sleeping face down can lead to facial wrinkles and skin aging since the face is smushed against the pillow.

For those with mobility limitations or who use a wheelchair during the day, lying on the stomach may also be very difficult to get into and out of. Given the potential for pain, breathing issues, and skin irritation, stomach sleeping is generally not recommended for older adults.

Why Sleeping Flat on Back is Not Advised

Sleeping in a supine position, meaning completely flat on the back without elevating the head, can also pose problems for seniors, such as:

  • Can worsen sleep apnea – When lying fully flat, the tongue can fall to the back of the throat, obstructing breathing passageways. This exacerbates obstructive sleep apnea.
  • Triggers acid reflux – Gravity allows digested food and stomach acid to travel back up the esophagus more easily when lying flat.
  • Leads to back pain – Without any support for the natural lumbar curve, the spine can flatten and cause discomfort in back muscles and joints.
  • Increases snoring – The tendency to snore is higher when sleeping on the back as the tongue and tissues in throat relax into the airway.
  • Can contribute to glaucoma – Research indicates that fluid pressure inside the eye may rise for some individuals when resting flat on the back.

Seniors with mobility limitations may also find it difficult and strenuous trying to get in and out of a fully flat, supine position. For those dealing with respiratory issues, acid reflux, and back pain, sleeping without an elevated head would likely exacerbate these existing problems.

Recommended Sleep Positions for Seniors

Rather than stomach or flat back sleeping, the two positions most often recommended for older adults are side sleeping and elevated back sleeping.

Here are some benefits of these preferred sleep positions:

Side sleeping:

  • Alleviates pressure on the back
  • Opens up airways to improve breathing
  • Reduces acid reflux as gravity keeps stomach acids down
  • Allows spine to rest in neutral alignment
  • Can place a pillow between knees to better align hips and spine

Elevated back sleeping:

  • Elevating the head helps keep airways open to minimize apnea and snoring
  • Raising the head lessens acid reflux after meals
  • Provides support for the natural curve of the spine
  • Can make it easier to get in and out of bed if mobility is an issue
  • Can use pillows under knees to improve comfort and alignment

An incline of about 30 to 45 degrees is often recommended as optimal for back support when propped up in bed. Using pillows, a bed wedge, or adjustable bed base are ways seniors can achieve the right degree of incline for comfortable and healthy elevated back sleeping.

Tips for Improving Sleep Quality

In addition to position, here are some other tips that can help improve sleep quality for older adults:

  • Establish a regular sleep routine going to bed and waking up the same time daily.
  • Make sure the sleep environment is cool, quiet and comfortable.
  • Limit daytime naps to 30 minutes to avoid interfering with nighttime sleep.
  • Avoid large meals, alcohol, caffeine and screen time close to bed.
  • Do relaxing activities to wind down before bed like reading, meditation or light stretches.
  • Use nightlights and keep items within easy reach to minimize midnight trips or falls.
  • Talk to a doctor if experiencing chronic insomnia or sleep disruptions.

Quality sleep is critical for seniors to stay healthy and energetic. By avoiding positions that can exacerbate underlying issues, and optimizing the sleep environment, older adults can wake up each morning feeling rested and ready to take on the day.

The Importance of Proper Sleep for the Elderly

It’s clear that getting adequate, high-quality sleep is extremely important for seniors. As we age, how our bodies process and manage sleep changes. Sleep disturbances like insomnia and sleep apnea increase with age. Poor sleep can negatively impact mental abilities, exacerbate chronic conditions, and degrade quality of life. For these reasons, it becomes especially important for older adults to prioritize healthy sleep hygiene practices.

Here are some of the key reasons proper sleep is so vital for the elderly:

  • Mental Sharpness – During sleep, the brain clears out toxins and forms new pathway connections impacting memory and cognition. Disrupted sleep can cause mental fogginess and confusion.
  • Immune Function – Deep, restorative sleep is when the body produces proteins like cytokines that target infection and inflammation. Lack of sleep weakens the immune system.
  • Metabolism – Growth and appetite hormones are regulated during sleep. Insufficient sleep can negatively affect metabolism and contribute to weight gain.
  • Mood Regulation – Serotonin, dopamine and other mood-influencing hormones are impacted by sleep. Poor sleep aggravates psychological health conditions like anxiety and depression.
  • Chronic Diseases – Conditions like diabetes, high blood pressure and arthritis can all be exacerbated by poor quality and inadequate sleep.
  • Accident Prevention – Excessive daytime fatigue slows reaction time and impairs cognition, increasing the risk for accidents or falls.

Optimizing sleep and choosing comfortable, supportive sleep positions helps seniors manage these health risks more effectively. Prioritizing sleep and consulting doctors when needed can greatly benefit wellbeing in old age. Treating issues like sleep apnea can also significantly improve seniors’ sleep quality and length.

Common Sleep Disturbances in the Elderly

While sleep needs don’t necessarily decrease with age, some seniors do experience changes in sleep quality and patterns. Some common sleep disturbances for older adults include:

  • Insomnia – Difficulty falling or staying asleep affects up to 50% of seniors. Causes include medication side effects, frequent nighttime awakenings, anxiety or depression.
  • Sleep Apnea – Around 20% of older adults have breathing disruptions and snoring from this condition. Apnea increases fatigue and risk for medical problems.
  • Restless Leg Syndrome – Uncomfortable tingling or urge to move the legs when lying down affects 10-20% of people over 65.
  • REM Sleep Behavior Disorder – Around one in four seniors experience abnormal movement and dreaming during REM sleep stages.
  • Circadian Rhythm Changes – With age, the body’s sleep-wake cycles often advance, causing older adults to become tired and wake up earlier.
  • Frequent Nighttime Awakenings – Sleep fragmentation from needing to use the bathroom, pain, discomfort, noise or other issues.

Medical issues like respiratory conditions, arthritis, heart disease and stroke also commonly interfere with and disrupt sleep as people age. Dementia and Alzheimer’s affect sleep-wake cycles as well. Understanding common causes of sleep disturbances helps seniors address issues proactively.

When to Seek Medical Help for Sleep Issues

Occasional nights of poor sleep are normal, but consistently disrupted or inadequate sleep should be addressed with a doctor. Seniors and caregivers should consider seeking medical help for sleep issues when:

  • Having difficulty falling asleep or staying asleep 3 or more nights per week.
  • Feeling excessively tired or fatigued during the day on most days.
  • Waking up frequently multiple times a night.
  • Loud, frequent snoring or gasping breaths during sleep.
  • Uncomfortable sensations in legs combined with strong urge to move them.
  • Noticeable breathing pauses or choking sounds while sleeping.
  • Feeling confused, depressed or irritable consistently during the day.
  • Falling asleep unintentionally during the day.
  • Using sleep medication regularly without improvement in sleep quality.

Sleep issues that consistently interfere with feeling rested or impair daytime function should always be evaluated by a physician. They can help diagnose any underlying conditions and recommend lifestyle changes, therapies or prescription medications to help improve sleep.

Medical Solutions for Sleep Problems

If lifestyle and behavior approaches don’t resolve persistent sleep problems, doctors have many medical tools and therapies they can offer seniors to restore healthy sleep. Common medical solutions for sleep issues include:

  • Prescription sleeping pills like Lunesta or Sonata for insomnia. These should be used cautiously and only for limited periods.
  • Natural sleep aids like melatonin can help reset circadian rhythms and improve sleep onset.
  • CPAP therapy provides pressurized air through a face mask to keep airways open for sleep apnea.
  • Dental devices adjust the jaw position to open up breathing passageways and prevent apnea.
  • Medications that reduce restless legs syndrome symptoms for those with this condition.
  • Light therapy uses light exposure to adjust melatonin production and sleep cycles.
  • Cognitive behavioral therapy provides strategies to change sleep-disrupting thoughts and behaviors.

Doctors may recommend combinations of lifestyle adjustments, natural remedies, therapy approaches and medications to address sleep disorders in seniors. Consistent follow up is key to ensure treatments are working and adjusted as needed. Referral to a sleep specialist may be warranted in difficult, long-standing cases of disordered sleep.


Sleeping in certain positions like the stomach or fully flat on the back can increase pain and exacerbate many common age-related health issues like acid reflux, breathing problems, and back pain. Seniors should aim to sleep on their sides or with the head slightly elevated when on their back. Choosing comfortable sleep positions is one important way older adults can optimize sleep quality and stay healthy. With age, many experience disrupted sleep from conditions like sleep apnea and insomnia. Addressing sleep issues proactively and seeking help when needed is key, as poor sleep can significantly impact physical and mental health in the elderly.

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