How Does Supine Position Affect Health?

Supine position in exercise practices

It’s common to be in the supine position when doing exercises for yoga and Pilates or various breathing and relaxation exercises.

Dr. Monisha Bhanote, MD, FASCP, FCAP, triple board-certified physician and Yoga Medicine® instructor, says there are a number of yoga poses that may include the supine position, including but not limited to:

• Bridge Pose (Setu Bandha Sarvangasana)
• Reclined Twist (Supta Matsyendrasana)
• Fish Pose
• Reclined Butterfly (Supta Baddha Konasana)
• Reclined Pigeon
• Happy Baby
• Supine Extended Mountain Pose (Supta Utthita Tadasana)
• Savasana

When practicing these positions, you can always modify by using blocks, bolsters, or blankets for comfort.

Additionally, many Pilates classes do exercises in the supine position. The starting pose in many Pilates floor exercises involves finding a neutral spine. When your body is in this position, your core and hips need to be strong and steady.

Finding neutral spine

1. To find neutral spine, start by lying on your back in the supine position. With your knees bent, keep your feet flat on the floor.
2. Take a deep breath in and let your body relax or press into the floor.
3. As you exhale, use your abs to press your lower spine into the floor.
4. Inhale to release. When your back raises off the floor, you will feel a gap or natural curve in your lower back. This is the neutral spine position.

Supine position and sleep

How you sleep can exacerbate existing health issues as well as increase neck and back pain. If you have no specific health issues related to sleep, then sleeping in the supine position shouldn’t be a problem. But there are some health and medical issues that can get worse if you sleep on your back.

Here are some of the more common issues associated with sleeping in the supine position.

Obstructive sleep apnea

According to a 2014 study, more than half of all people with obstructive sleep apnea (OSA) are classified as supine-related OSA. That’s because for people with OSA being in the supine position may lead to sleep-related breathing problems as their ability to increase lung volume and expand the chest may be compromised.

“This occurs as the diaphragm and abdominal organs may compress the adjacent lung as one shifts from standing to supine. Due to difficulty with sleep, this decreases the overall quality,” explains Bhanote.

Pregnancy

After about 24 weeks of pregnancy, Bhanote says sleeping in the supine position may cause some dizziness with breathing difficulty. You can get relief from this by lying on your left side or sitting in an upright position.

Gastroesophageal reflux disease (GERD)

GERD affects up to 20 percent of the American population. With this disorder, stomach acid flows back into the esophagus.

The supine sleeping position is not recommended for people with reflux, as the supine position allows for more acid to travel up the esophagus and remain there for longer times. This results in heartburn, and even coughing or choking, while trying to sleep.

Longstanding GERD can eventually lead to more severe conditions including bleeding ulcers and Barrett’s esophagus. Keeping the head of your bed elevated may relieve some discomfort.

Risks of the supine position

Many of the risks associated with being in the supine position are also associated with other conditions.

During pregnancy

If you’re pregnant and spend a lot of time lying on your back, there is a risk that the uterus can compress the inferior vena cava, a large vein that carries de-oxygenated blood from the lower body to the heart. If this happens during pregnancy, it can result in hypotension for the person who is pregnant and reduced blood flow to the fetus.

Being in the supine position while exercising during pregnancy is another concern. According to the American College of Obstetricians and Gynecologists, you should avoid being on your back as much as possible. When doing Pilates or yoga moves, modify the poses to accommodate less time on your back.

With a heart condition

Additionally, Dr. Jessalynn Adam, MD, a board-certified physician specializing in primary care sports medicine with Orthopedics and Joint Replacement at Mercy, says that individuals with congestive heart failure can have trouble breathing in the supine position, and therefore, should not lie flat.

With acid reflux or GERD

Just like GERD can affect your sleep, it can also trigger symptoms after you eat. “Lying flat after a large meal can contribute to acid reflux as it allows the stomach contents to reflux into the esophagus,” explains Adam.

If you have GERD, she recommends eating smaller meals and remain sitting upright for at least 30 minutes after eating. If you are planning on sleeping in the supine position, Adam suggests eating no closer than two hours before bed to avoid reflux when lying supine.

The takeaway

The supine position is one of the most common ways to rest and sleep. It’s also a popular position when performing certain exercises during a yoga or Pilates class.

If you have a health condition that worsens when in this position, it’s best to avoid it or minimize the amount of time you spend on your back.