What is the optimal lateral recumbent position for sleep?

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Dainyal Siddiqui, MD

Internal Medicine

Manuel Jimenez, MD

Cardiology

Franz Pierre-Louis, MD

Infectious Disease

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Last updated: February 16, 2025 • View editorial policy

From the Guidelines

Optimal Lateral Recumbent Position for Sleep

The optimal lateral recumbent position for sleep is not recommended for infants, as the supine position (on the back) is considered the safest position to reduce the risk of SIDS (Sudden Infant Death Syndrome) 1, 2, 3, 4, 5, 6. However, for adults, particularly those with gastroesophageal reflux disease (GERD), sleeping on the left side is generally considered preferable, as it allows for optimal positioning of the stomach and intestines, reducing pressure on the liver and improving digestion 7.

Key Considerations

Supine position: Recommended for infants to reduce the risk of SIDS, as it reduces the risk of rebreathing expired gases, overheating, and aspiration 1, 2, 3, 4, 5, 6.
Left lateral decubitus position: Recommended for adults with GERD, as it improves nocturnal esophageal acid exposure and reduces symptoms of acid reflux 7.
Avoiding prone position: The prone position (on the stomach) is not recommended for infants, as it increases the risk of SIDS, and for adults with GERD, as it can exacerbate symptoms 1, 2, 3, 4, 5, 6.
Elevating the head of the bed: Recommended for adults with GERD, as it improves nocturnal esophageal acid exposure and reduces symptoms of acid reflux 7.

Important Notes

The American Academy of Pediatrics (AAP) recommends that infants be placed on their backs to sleep, as this is the safest position to reduce the risk of SIDS 1, 2, 3, 4, 5, 6.
Adults with GERD should avoid eating close to bedtime, elevate the head of their bed, and sleep on their left side to reduce symptoms of acid reflux 7.

From the Research

Optimal Lateral Recumbent Position for Sleep

The optimal lateral recumbent position for sleep is a topic of interest, particularly for individuals with gastroesophageal reflux disease (GERD).

Studies have shown that sleeping in the left lateral decubitus (LLD) position can reduce nocturnal reflux and improve GERD-related quality of life 8, 9, 10, 11.
The LLD position is associated with shorter nocturnal esophageal acid exposure time and faster esophageal acid clearance compared to the supine and right lateral decubitus positions 8, 11.
In contrast, the right lateral decubitus position is associated with greater percent time pH <4 and longer esophageal acid clearance compared to the left, supine, and prone positions 8.
A sleep-positioning device that maintains the LLD position while elevating the head/torso has been shown to reduce recumbent esophageal acid exposure and improve GERD symptoms 9.

Key Findings

The left lateral decubitus position is preferred for patients with nocturnal GERD 8.
Sleeping in the LLD position can reduce the number of reflux episodes and improve esophageal acid exposure time 9, 10, 11.
The use of a sleep-positioning device can help maintain the LLD position and reduce GERD symptoms 9.
Non-pharmacological interventions, such as positioning infants on their left side after feeding, can reduce reflux in infants 12.

Sleeping Position and GERD

The supine position is associated with more frequent GER episodes and longer esophageal acid clearance times compared to the LLD position 8, 11.
The prone position is not commonly recommended for sleeping due to the risk of sudden infant death syndrome (SIDS) and other complications.
The LLD position is a simple and effective way to reduce GERD symptoms and improve quality of life for individuals with GERD 10.