Sleep in this position for better gut health

By Alpana Mohta, MD, DNB, FEADV, FIADVL, IFAAD | Fact-checked by Barbara Bekiesz
Published June 5, 2024

Key Takeaways

  • Poor sleep upregulates inflammatory cytokines, increases intestinal inflammation, and reduces mucosal healing, among other effects, which significantly increases the risk of GI disorders.

  • Left-side sleeping reduces acid exposure, nocturnal reflux, and acid clearance time better than right-side sleeping and supine positions. 

  • By advising your patients on the best sleeping positions, you can improve quality of life for those suffering from GI disorders. 

Given that we spend about a third of our lives sleeping, the effects of sleep deprivation, circadian disruptions, and untreated sleep disorders cannot be overstated.

Chronic lack of sleep is linked to increased mortality and contributes to cardiovascular disease, diabetes, obesity, and cancer. Its effect on gastrointestinal (GI) health is a topic of emerging interest in gastroenterology. 

Research has identified that sleeping position, in addition to sleep quality and duration, has a direct impact on improving symptoms for patients with GI disorders. Here's everything physicians need to know.

Sleeping positions—and why they matter

Over 60% of individuals prefer lateral decubitus sleeping, with males exhibiting a higher propensity for this position than females.[] Sleep postures are more evenly distributed during childhood, but by adulthood, side sleeping predominates. Reduced spinal flexibility with aging likely contributes to this preference in older adults. 

Left-side sleeping

Left-side sleeping, or left lateral decubitus (LLD) sleeping, is harmonious with the body's anatomical asymmetry. It promotes digestion and the natural movement of food and waste through the GI tract.

Sleeping in the LLD position situates the lower esophagus sphincter above the stomach, which helps retain stomach contents and reduces the risk of gastroesophageal reflux disease (GERD) symptoms and heartburn. However, some reflux of gas or a mix of gas and liquid may still occur.[]

A 2023 World Journal of Clinical Cases meta-analysis noted that the LLD position significantly reduced acid exposure time, nocturnal reflux, and acid clearance time more than the right lateral decubitus (RLD) and the supine position in GERD patients.[]

A randomized, sham-controlled trial compared nocturnal reflux symptoms between patients using an electronic sleep positional therapy device (which encouraged the LLD position) and those using a sham device. After 2 weeks, the intervention group experienced more reflux-free nights, fewer total reflux symptoms, and better improvement in quality of life.[]

Right-side sleeping

Conversely, right-side sleeping, or the RLD position, may exacerbate GERD symptoms. This position allows stomach acid to pool at the junction of the esophagus and stomach.[]

The report from the World Journal of Clinical Cases states, “Lying on the right side would position the esophagus inferior to the gastroesophageal junction.” This position therefore increases the likelihood of acid reflux, the duration of acid exposure, and acid clearance time in the stomach.[]

Supine position

Sleeping on the back naturally aligns the spine, reducing shoulder and neck pressure. However, this position also increases acid exposure and clearance time.[]

Stomach sleeping

Stomach sleeping can compress the abdomen, potentially disrupting digestive processes and increasing intra-abdominal pressure due to restricted abdominal movement.[]

Impacts on sleep quality

Apart from sleep positions, any disturbance in sleep can disrupt the colonic barrier and contribute to the onset of GI disease. Consider the following key research findings.

  • A Mendelian randomization study found that fluctuation in sleep-associated traits can impact the gut microbiota. The study established a causal association between sleep and the gut microbiome.[]

  • A systematic review from the journal Sleep observed that “shorter sleep duration is associated with an increase in pro-inflammatory bacteria whereas increasing sleep quality is positively associated with an increase of beneficial Verrucomicrobia and Lentisphaerae phyla.”[]

  • A pilot study of gut microbiome analysis in Clocks and Sleep found that short sleepers had lower levels of the gut-beneficial bacteria Sutterella, which metabolizes tryptophan, and higher levels of pathogenic Pseudomonas, compared with normal-duration sleepers.[]

Peptic ulcers

As stated in a review from the International Journal of Medical Sciences, disturbance in circadian rhythm—as seen in shift workers—contributes to the development of peptic ulcer disease, whereas longer sleep duration is protective against the onset of peptic ulcers.[]

Functional GI disorders

Patients with sleep disturbance have decreased melatonin and orexin signaling.

This may play a role in the pathogenesis of functional GI disorders—like functional dyspepsia, nausea, vomiting, diarrhea, constipation, IBS, anorectal pain, incontinence, and flatulence.[]

Intestinal inflammation

Sleep deprivation upregulates inflammatory cytokines, like IL-1 and TNF-α. Clinical research has demonstrated a link between sleep disturbances, disease activity, subclinical inflammation, and IBD relapse risk. Poor sleep quality correlates with a lack of mucosal healing in IBD.[]

A 2023 study found that sleep disruption resulted in reduced body weight, elevated inflammation in colitis, and heightened expression of the clock gene Cry2 in an animal model. In humans with active IBD, the mRNA levels of circadian genes Cry1, Cry2, Bmal1, and Rev-erbα were markedly lower in inflammatory tissues than in non-inflammatory tissues.[]

In the clinic

Physicians can advise their patients with GI conditions to sleep on their left side to reduce gastroesophageal reflux by positioning the esophagus above the stomach. Recommend proper pillow support for spinal alignment to alleviate back pain and improve sleep quality. 

Instruct patients to avoid right-side and prone sleeping positions, as they increase acid reflux risk. Encourage a dark, quiet, and cool sleep environment, a regular sleep schedule, and limiting large meals before bed. 

What this means for you

Sleeping positions can affect gut health just as much as the duration and quality of sleep. Emerging research highlights the bidirectional relationship between sleep disturbances and gastrointestinal health, including altered gut microbiota and an increased risk of peptic ulcers, functional GI disorders, and intestinal inflammation. Incorporating sleep assessments and interventions in routine clinical practice could improve patient outcomes in gastroenterology.

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