Instinctive Sleeping and Resting Postures (2000) | Hacker News Reader

Instinctive Sleeping and Resting Postures (2000)

ncbi.nlm.nih.gov

369 pointsalecst175 comments

I find this article quite insubstantial. He lists alternative sleeping positions, but no sources backing up the claim that "western sleeping positions" (whatever that is) are worse.

Also only one citation, and that is to back up the claim that there are 200 primates.

Nice pictures though - I feel happy that I can sit (relatively) comfortably in the squatting position (as an European).

It's a pity that not more published research is available on this.

I think this clause near the end was what made the article make sense to me:

> This observation must be recorded to allow further research in this direction

This is just one person noting in public what could be a correlation, and then all the rest (confirming correlation, establishing causation) is up to someone else!

This appears to be a journal article. Why should it have citations? This is an arena where people are supposed to be doing primary research. "I have a PhD and this is my opinion" is probably at least 20% of academics.

I can't possibly imagine sleeping posture being such a a pristine research area that there is no prior work on the topic

There is a search bar right above this article if you want to look that research up. This is some physiotherapist recording his opinion; based on field experience. I'm going out on a limb and saying none of the other researchers in the field have been writing about his experience so there isn't anything to cite.

Primary research does not include simply stating “this is my opinion” - and this article also does not consist of someone stating their opinion, it is someone claiming to describe widespread behaviors and explanations for them.

Journals publish articles beyond primary research: https://www.bmj.com/about-bmj/resources-authors/article-type...

It also feels a little strange in writing. Examples:

"Figure Figure11 shows a mountain gorilla lying on the ground on his side without a pillow" - Of course it is without a pillow, it's a mountain gorilla! What is this clarification?

"To start with, some Westerners have to hold on to a doorframe." - Would it not be better to say "you may have to hold on" or "newbies"? It is not like Westerners have some special physiological feature that makes them do it, it's about lack of practice.

A pillow doesn't need to be a factory-made product that you buy at a store. Plenty of humans make pillows out of natural objects when sleeping outdoors. I can totally imagine a mountain gorilla using a chunk of wood, or even a body part of another gorilla, as a "pillow" if it makes them feel more comfortable.

Yeah im sure there are many tribespeople with pillows. It feels wierdly racist that this guy is acting like people in societies like this just live instinctually like gorillas and don't actually have the universal human trait of creating and relying on manmade tools.

He's viewing humans and gorillas as primates, not viewing tribespeople as gorillas.

Tribes people don't live instinctually. They have culture, like us. The critique here is our culture could benefit from observing how their culture does it.

The thing that makes it not racist for me is that he's clearly trying to point out that, as primates, in non-Western surroundings and when not socialized to prefer soft beds with fluffy pillows we tend to adopt similar sleeping positions as other primates do. It would be very racist if he had adopted a sneering "look at the lowly primitives" tone, but he's trying to show that these sleeping positions have helped him immensely and he's suggesting that we might research sleep positioning more as there seem to be differences in the two populations under comparison.

You can look at the COVID pandemic for an example of how body positioning has helped change how well people can breathe. Proning of severely sick patients substantially improved outcomes. That's literally just rolling the patient from their back to their stomach. So there might be something interesting there that we can learn if we pay attention. And he's trying to say "we can learn something from these people if only we pay attention."

My dog loves pillows. But he doesn't move them. If he's laying down, and a pillow-like object is near, he'll use it. But if the sun moves, he'll move, without the pillow.

Humans are environment-changers. That’s why dogs teamed up with humans. Humans seem to spend a lot of time doing strange and seemingly useless things, like banging rocks together and looking at shiny boxes, but at the end of the day there is always extra food and the environment around humans is full of mysteriously comfortable objects.

If our dog wants to rest and a fleece or wool blanket happens to be in reach, it will pull it in position (and sometimes even fold it) in order to rest its snout on it. But admittedly it does not move the blanket substantially. I have yet to understand how it decides where to rest though. There is a lot of places and none seems to really dominate the other ones.

I have been paying more attention and ours loves head rests. So maybe they don't understand how to make or move them, he definitely prefers them. Disputing the original claim, or dogs differ too much from primates.

For what it's worth, my dog does carry big fluffy toys around, often putting her chin on them.

I have read your comment before reading the article, and at that time I have thought that you must be right.

Nevertheless, after reading the article I have seen that the clarification about the gorilla sleeping without a pillow made perfect sense in its context, because it has not been added to provide any additional information, but it was added for emphasis, in a context where the sleeping positions in modern environments were contrasted with their correspondents that are common both in non-modernized environments and for similar primates.

Moreover, I interpret his phrase "To start with" as having the same meaning as your suggestion "newbies".

Using a door frame in the beginning is indeed good practical advice for achieving the full squat position for those who are not used to it.

It did not made sense to me, because I am not a gorilla. They have different bodies. They look kinda similar in body shape, but they climb treat the way I will never be able to no matter how much I train.

So, gorila sleeping position implies exactly nothing for my sleeping position.

Funnily, as a brit, I have always had the ability to sit in a deep squat comfortably and it's not even from tons of practice. I only even realised that its unusual to be able to do and that it may be good for you when I was about 21. By which point there were many people who couldn't do it already. I certainly hadn't been practicing it throughout my teenage years.

I'm a Brit who can squat too, and I think it has quite a bit to do with not weather shoes at home and wearing "barefoot" shoes / zero-drop trainers outside. I have a hunch that it's lengthened my calf muscles and achilles tendons, which makes squatting much more comfortable. I couldn't really do it before switching to barefoot shoes.

Having lived in Asia for 10 years I observed that I had gained the ability to squat, quite comfortably too, that I never had on arrival.

Funny old world.

I have never worn shoes at home, that's for sure. Not into barefoot shoes though. I'm not really sure why it is for me. If it's to do with calf muscles, I guess we could attribute it that my mother never learned how to drive and so we used to walk EVERYWHERE. And we lived in a tiny town.

> Of course it is without a pillow, it's a mountain gorilla!

That doesn't follow at all. Gorillas are well known for their habit of making nests. Making pillows isn't difficult.

Indeed. Many animals build nests. It's not a skill unique to humans at all. Finding something comfortable to rest on isn't a particularly difficult skill to master.

I'm a human and I don't think I'd be able to make a (comfortable) pillow...

Go pull a bunch of grass, and put it in a pile. You now have a working pillow.

That doesn't sound comfortable. I'd probably rather sleep on my arm than a pile of grass...

Im sure if you spent your whole life sleeping on the ground youd work something out to make it more comfortable

But that was the point... why don't gorillas make pillows then? My contention was that making a pillow is actually difficult. I wouldn't be surprised if pillows were seldom used by early humans.

It can be actually comfortable.

This is a failure of your imagination, not the grass.

You (most likely) have two comfortable potential pillows distal to your elbows...

(I don't use any of these positions, but I most commonly nap on a heated wooden floor in an insect-free environment. Oddly enough, I also support my temple on the dorsal surface of a wrist; it had never occurred to me that in addition to comfort, it keeps both ears free?)

> It is not like Westerners have some special physiological feature that makes them do it, it's about lack of practice.

Lack of practice causes a "special physiological feature": ankle inflexibility. For some people it would take a significant amount of time stretching the ankles every day to recover enough ankle flexibility to squat, and that could perhaps still be insufficient, as joint mobility is established based on the range of motion used in childhood.

All the babies/toddlers I've seen (my own kids included) naturally do that "asian/slav squat" - for example to pick up toys from the ground, or when they want to rest a bit without completely sitting, right?

So at which point/age do some of us stop doing that type of squat before "use it or lose it" kicks in?

I don't think it's fair to outright dismiss it because it is not a systematic/empirical study (and the author explicitly mention that). In the case of posture, stretching & training I think there's several exercises out there that doesn't have a rigorous empirical study to back it up, yet can be explained to be good/bad from our anatomical understanding of the human body.

Well, unfortunately in this article there are claims that can be explained to be completely false from our anatomical understanding of the human body - such as the idea that it is impossible to snore with your mouth closed.

I thought the 'impossible to snore' note was because of the downwards spine position, where the soft palate cannot collapse. Not because the mouth is closed.

> I don't think it's fair to outright dismiss it because it is not a systematic/empirical study

That's how science works. Show sources/data/experiments or gtfo

Science requires a level of common sense and intuition. Famously: https://www.bmj.com/content/363/bmj.k5094

It is fine, indeed should be encouraged, to put some papers in the system that don't have formal data but do record common-sense observations. If people don't like them, then they can trump opinion with data in the scientific process.

Don't forget the "repeat" part. Sources and data are great, but if they can't be replicated by others, the it's not verifiable.

That's how some steps of the science work, specifically the empirical studies. Empirical validation, falsifiability, and repeatability is all in that ball-park. But it's a part of the process and not all of it.

If that's the only thing you want to consider, sure. As a layman it's probably a good principle, and more so in engineering. But you'll have to shave off some significant works of science from history if you do that.

You can read more about those steps at https://en.wikipedia.org/wiki/Scientific_method

Einstein and Higgs predicted phenomena that were tested years resp. decades after their publication.

A theory is also a contribution to a field as long as it tested (not necessarily in the same publication).

Even an observation to a field can be a contribution if it helps people generate new theories and then test them.

In their defence: building a particle accelerator is a harder and more costly task than watching people sleep.

Experiments are the part people fixate on. Science begins with observation.

Yes. But just publishing your observations is not enough. And this seems to be a published paper, which I find very weird.

First, you might want to refresh your understanding of the scientific process. Its first step is "Observation/question." https://en.wikipedia.org/wiki/Scientific_method

Next, the acceptability of journal papers without conclusive experiments varies across fields. In some fields, such as observational sciences (e.g., astronomy, ecology, sociology), observational studies are common and valuable contributions to the literature. These studies often involve collecting and analyzing data from real-world observations, surveys, or existing datasets without the need for controlled experiments. In such cases, it is perfectly acceptable to publish papers based solely on observational data.

When you say, "is not enough," the question I respond with is "enough for what?" It's fully acceptable to publish a paper with observations in order to stimulate interest and encourage further research in the area. It's not necessary for a journal to require final results.

Finally, consider some of these famous and important papers which were published as observations without conclusive results. Should they have held back and waited until conclusive results were available?

1. Edwin Hubble's "A Relation between Distance and Radial Velocity among Extra-Galactic Nebulae"

2. Albert Einstein's "The Foundation of the General Theory of Relativity"

3. Charles Darwin's "On the Origin of Species"

And how old are these publications? And did you have a look at the paper that we're talking about?

As a North African, I instinctively understand and firmly believe everything mentioned in this article about sleeping is true.

From my perspective, the way I see your comment is this: give me scientific evidence that walking is beneficial to my health.

We lose our identity when we disconnect from Nature. I even read a post recently here in HN where it was said that "Urban humans have lost much of their ability to digest plants": https://arstechnica.com/science/2024/03/human-gut-bacteria-t...

That's where we are.

> I instinctively understand and firmly believe everything mentioned in this article about sleeping is true.

Well, yes, but that's a standard quality of B.S. It's plausible, and intuitive. When you actually start trying to prove it out, though, you discover it's wrong.

True, there is a category of "no duh" scientific findings, like walking is beneficial to one's health, that do align with our intuition. But where science really shines is when the evidence points to something counterintuitive.

Even the "walking is beneficial" part is not just "duh".

I mean, what is "walking". What distance? What pace? There are negative health effects from walking too much. The general idea is that moderate exercise is the best, too little is bad, too much is also bad. But where is the peak? It seems that walking is beneficial to the average city dweller, which aligns with our intuition, but what about foot soldiers?

And where does the intuition that walking is beneficial comes from? Walking is tiring, it is not something we do naturally if we can avoid it, not very "intuitive". That's the problem by the way, because we can avoid it in modern society. I think the intuition comes from the fact that we get told over and over than walking is beneficial, so much that we made these thought our own, i.e. that's conditioning. And the reason we are told that is because it is backed by observation and science.

Freakonomics!

> I even read a post recently here in HN where it was said that "Urban humans have lost much of their ability to digest plants"

This story is interesting, but doesn't shock me a whole lot from the perspective of losing our touch with nature, because we now have an understanding that our ancestors fluctuated between carnivory and herbivory quite a lot. If these population changes in gut bacteria can be caused in such a short span of time, it seems likely that it can also be reversed.

The poor people in my country squat when they're resting. I was taught early on as a kid that I shouldn't sit like that because that's what "poor people do".

I really regret listening to that piece of advice. As I observe my baby daughter, I realize how natural that squatting position is, and how much knee and hip mobility we really have.

Often the limiting factor is ankle mobility, as not being able to drive the knee in front of the toes means falling backwards as the center of mass never reaches mid foot.

It's why weightlifters have elevated heels, and why great squatters tend to have short femurs (and/or be short in general).

A lot of it also depends on getting the knees spread out and letting your stomach come forward in between. This keeps your center of gravity forward.

Same with walking barefeet. Now it is somewhat hip again in some areas, but not where I live. "Mum, why does this man wear no shoes?" I hear so often.

Now walking barefeet in the city is not recommended because of glass and dogshit everywhere, but through a path in the forest and over rocks it is much more fun (and healthy for my joints) without shoes. That is, if you relearned how to do it. You cannot walk barefeet, like you do with shoes. Also, if you started walking barefeet over 20, your skeleton and muscles in the feet will never really adopt again, like they would if you do it as a child. So if you have childs, let them go barefeet wherever and whenever possible (also in the snow for a short time).

Yeah I had the same response. He makes lots of anecdotal claims about tribespeople's back trouble but where's the data? It's mildly interesting nonetheless.

There's also so much talk about penis protection, I would love to know if women use different sleeping positions at different rates than men

I'm not saying it's an either/or choice, but I'd rather trust articles written by obsessed old dude experts rather than articles written by "publish or perish" academics citing 100 other p-hacked "publish or perish" articles.

This is so fascinating.

I slept (on my back) on the floor for a while. It was at times amazing—I would wake up and feel ready to go. Not like my muscles were weak or temporarily atrophied. Like, I didn’t know that was possible after a full nights sleep.

There seems to be so much potential in just reflecting on an considering what a “paleo” approach to something would be. And then you can just do that. You don’t even need to buy hundreds of dollars worth of supposedly ergonomic equipment. Just sleep in a funny-looking position. Just squat instead of sitting on a chair… if you can bare the social awkwardness or ridicule.

It’s so simple. Why do we make things complicated?

Well in part because “modern humans” cannot just do these things without becoming regarded as merely a modern human with eccentric hobbies. Because that’s what you get pegged as!—not as a modern human who rediscovered (through YouTube/the Web) some ancient wisdom but as a paleo-hipster, just another quirky modern human subculture.

And in part that is correct. You cannot be, say, a Western Buddhist who has all the know-how and experience of a born-in-the-culture (Asian) Buddhist. And in that same way you cannot become a non-modern… human.

But wait. Why would you want to? You are who you are. You may be a Buddhist from Scranton, PA who has no relation to Asian culture. Or an office worker who squats at the office. But why is that weird? Yeah you’re not a “real Buddhist” in that terribly essentialist sense, and you’re not a born-in-the-culture kind of human who has never used a chair. But why do you have to be that in order to make these (eccentric) choices for yourself? If it works for you, just go for it you paleo-hipster.

I also slept on my floor for about 5 months - until I saw a huge cockroach (common in Sydney) run across my floor and hide under my pillow.

I agree, it felt great.

When I moved into my new, almost cockroach free apartment, I built my own shikibuton by taking a futon cover and stuffing it with a comforter and a thin foam mattress topper. The whole thing is about 7cm (2.7 inches) thick. I roll it up each morning and have been sleeping like this for the last 8 months.

I also use only 1 thin pillow, and for a while was placing it lengthwise along my spine, which is apparently good for fixing the hunchback posture of modern humans.

> Why do we make things complicated?

Because we genuinely care more about how people perceive us ("am I acting normal?") than how we feel.

That's been engrained over generations, for most humans.

For my entire life I slept in one of those postures ("the lookout"). I had a bunch of problems (pain in the chest, pain in the back, some problems with my knees not loaded symmetrically, my feet getting "extended" for quite a long time causing problems with Achilles). I also had a problem with restlessness -- these positions cannot be maintained for long without moving, I would be changing my position very frequently.

Couple of years ago I have injured my ACL and had to learn to sleep on my back. Now I am much happier sleeper. Now I generally do not move at all during night (I wake up exactly as I have fallen asleep and my sleep tracker tracks way less movement). All of the pains gone.

Pillow or no pillow? Hard mattress? No mattress?

I use a very thin pillow when sleeping on my back. I find sleeping without pillow a bit uncomfortable. Although I am sure I could get used to my head being pushed back a bit, I still dislike the head just resting on the hard mattress and trying to naturally roll left/right. The pillow helps me keep my head looking straight ahead (almost vertically).

As to mattress, I prefer a mid-to-hard latex mattress with a cover.

In the article, the lookout position involves the lack of a pillow. One can imagine that the additional height of the pillow would cause you to raise your head, lower your chest, and arch your back, potentially causing the issues you reported.

That being said, this is an article of anecdotal observations by a physiotherapist - it is not the result of any kind of study.

It is really thin pure goose down pillow. Folded, it is less than 1/4in when compressed. I don't think the height of the pillow makes a huge difference.

(This is my preferred type of pillow as well - an old, thin down one - and I can tell the difference when I sleep with or without it.)

As a back sleeper, get a pillow or cushion under your knees/legs. Otherwise the arch of your back is in constant stress when you sleep and can lead to back problems. You can guess how I know.

That doesn't sound like good advice. Your hip flexors are likely very tight/shortened, so you put a pillow underneath your knees/legs to prevent them from stretching at night and thereby make them even more shorter?

It's odd that the paper goes to great lengths to talk about protecting your penis from insects but at the same point seems to ignore women completely - all the illustrations depict men. Having met women (shocking, I know), bust size can be a significant factor in ergonomics so it would be interesting to see how that factors into it. Also anecdotally, pregnant belly-sleepers frequently rely on cushioning and people may prefer certain sleeping positions after having given birth or suffering from certain ailments. I'm also certain that waist size (esp. obesity) may alter preferences.

It's an interesting paper but given the lack of substance this feels more like a school presentation than something you'd find in an academic journal.

> Also anecdotally, pregnant belly-sleepers frequently rely on cushioning

I mean, undergoing pregnancy is in and of itself not great for one's health (especially without modern healthcare), so I don't know how much that specific thing should be factored into healthy lifestyle choices.

In particular, pregnancy puts a lot of pressure on internal organs in a way that means one should not be surprised to have only one working sleeping position by the third trimester. At that point it's governed by Newton and another growing human, not choice.

(To be clear, I'm not saying pregnancy is a bad lifestyle choice, just that pregnancy is not kind to the human body.)

> I don't know how much that specific thing should be factored into healthy lifestyle choices.

I'm pretty sure the average human is not healthy, even in the societies analysed, especially if you factor in injuries, disabilities or pregnancy. If anything the perfectly "healthy" able body is the exception to the human experience.

So yes, if we want meaningful advice on healthier sleeping postures we should take various illnesses, disabilities, ailments and conditions into account.

At least this seems like a fair consideration if we already dedicate this much text to reducing the risk of insect bites on your penis.

Yes, I wondered about this as well. I understand why the author might not have observed women sleeping, and certainly wouldn't have photos, but one might at least mention it (especially given all the attention to the penis). Bust size & placement for sure has a significant effect on where arms can be placed, among other things.

It seems that the author's observations are primarily from various camping-equivalents, more so than home life.

To my sibling commenter, whether pregnancy is or isn't "healthy" isn't quite the point, IMO. Various stages of pregnancy do occupy a non-trivial part of many people's lifespan and significantly change the ergonomics of sleep. Given that humans have been getting pregnant for a long time, it is a big miss to not even mention that it hasn't been considered. Academic training tries to impress on most authors that they should mention what they're ignoring and why, not least to set up the citation train for the future and support grant applications.

I’m sure there are some great points in this paper but this bit of un-evidenced bit of speculation turned me off:

> It has been noted that guide dogs working in towns breathe the same pollutants as humans yet do not have asthma. Could this be because when they lie on their chests the kickback from the upper ribs keeps the corresponding vertebrae mobile, allowing the sympathetic system to work efficiently?

Or could it be one of the many other physiological differences between humans and dogs ?

I think the author notes that this is mostly a collection of anecdotal observations, but linking a primarily inflammatory disorder like asthma with musculoskeletal problems is a bit far fetched in my layman’s opinion. Sounds a bit like chiropractic quackery to me.

He lists his profession as a physiotherapist so probably crossed into the chiropractic side a bit, some of his personal photos are a little hippy-ish.

The article is also premised on one large appeal to nature (tribal people untainted by modern society do it therefore it is natural and therefore good). https://en.wikipedia.org/wiki/Appeal_to_nature

Appeal to nature is bad as a source of ultimate truth, "nature does it this way therefore it must be better." But it's good as a source of hypotheses, "nature does it this way, perhaps we should try it?" This paper seems more like the second.

I don't see the difference between those two statements absent scientific data. That's merely a useful seed of an idea, not a sufficient premise for an argument.

Hypotheses are not for arguments. They are indeed a seed for discovery.

What are you talking about, Willis?

Also notable: some dogs do get asthma, and cats have asthma commonly

https://www.webmd.com/pets/cats/asthma-symptoms-cats

It’s crazy to think about how little we actually know about how the human body functions- not even to say what an “optimal” sleep position might be, but even a high quality study on how different sleep positions might affect the physiology of the body. I have yet to find any real serious scientific analysis of this.

The Soviets tried, but we didn't want to hear what they had to say:

https://bldgblog.com/2007/02/sleep-labs-of-the-soviet-empire...

"not even to say what an “optimal” sleep position might be"

As with most things, maybe there isn't one optimal solution,as otherwise we all would have found out about it, by now and all use it?

Human bodies and minds are quite different.

So what is comfortable to one person might not work for the next person. Maybe people have pain in the back or in the neck, forcing them into other positions. People with stomach problems rather lie on their stomach. Some people people sleep alone, others together.

I know my sleeping position varies a lot and there is no single best one for me.

"Optimal" depends on how deep down the rabbit hole you want to go.

"Slept well and wake refreshed" might be one version of it, but "slept like an infant in the womb and awoke younger and healthier" would be more optimal, if currently in the realm of science fiction.

I never focussed much on sleeping postures, but one day I read this article about how acid reflux goes away if you side-sleep on your left hand side i.e stomach is at a lower height than when you sleep on your right hand side

that really changed my life, it was like, how did I waste 28 years of my life without finding this trick :D

I actually noticed when I sleep on my left side, I start to feel out of breath. Like ,I can breathe normally but something makes me feel I need to take deeper breathes almost as if some blood flow is getting cut off.

IMO it would be better for the government to keep this sort of general library content on a url that doesn’t contain NIH. They have the disclaimer,

> As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health.

Anyway, it seems like an interesting collection of anecdotes that would be a good place to start searching. I don’t see as much value in some of his speculations. The bit about dogs not getting asthma seems a little out of scope.

Actually, do dogs get asthma? Quick googling seems to provide contradictory answers, with the general trend that apparently cats get it more often, and apparently dogs get some sort of allergic reaction thing that is technically not asthma, but is very similar?

> keep this sort of general library content on a url that doesn’t contain NIH.

Why? The author makes it clear its purely anecdotal. Someone might come across this and decide to do a further, more scientific study. I would argue that this is valuable content that could lead to better insights on our sleep. Not having it on the NIH website would make it less likely to be viewed.

Because inclusion on the NIH website, in the same general format as peer-reviewed articles are given, can give it the aura of being promoted or at least vetted by NIH, even with the disclaimer.

If you look through Snopes there are tons of examples of hoaxes and false gossip that end up spreading because they are found on an "official" website (or official-looking website), even if that official website is just a library where anyone can publish.

Totally agreed. I also liked some of the anecdotes in this article, but I always have to do an eye roll when I read an article that claims that "primitive" cultures don't suffer from disease X, and look they do thing Y that modern cultures don't, so of course thing Y must be the the reason for the difference! Conveniently ignoring the 6387 other stark differences in culture, behaviors and diets between the cultures.

I think the hypothesis of how sleeping positions affect back pain would be worth studying, but that's all it is, a hypothesis.

  > 6387

I like that you picked the Earth's radius in kilometres for illustration.

Also, tribespeople don't spend most of their waking time sitting in front of a computer or TV.

I notice that all of the sleep positions are either on the stomach or side. I usually go between side and stomach when sleeping, and can't really fall asleep very well on my back. But, my impression is that most people go between side and back, with stomach sleepers being a minority (I've even heard it called weird).

This study backs that up (54% side, 37% back, 7% stomach)

https://www.dovepress.com/sleep-positions-and-nocturnal-body...

I wonder if the difference is cultural, or technological: that is, do we learn to sleep a certain way, or is it that the mattress changes the equation somehow and makes people 5x more likely to sleep on their back than on their stomach?

In the past, I've hypothesized that it's cultural, and my just-so etiology for the phenomenon is that it comes from TV and movies. It's much easier to get a good shot of an actor delivering dialog while lying in bed on their back, compared to their stomach, so we see people sleeping on their back and learn to do it that way.

This is all just uninformed speculation, and of course it assumes the original, linked article is valid at all.

How do you breathe when you sleep on your stomach? My back and hips feel amazing when I try it, but my neck starts to hate me from the way I have to twist around to get air.

When you sleep on your stomach you turn your head to the side, breathing is easy.

Try putting a pillow under the shoulder that your mouth is closest to. A slight lifting of the shoulder might relieve the neck strain.

Looks a lot like figure 4 in that article, but with my arms wrapped around a pillow. The arms hold up the head, and the neck isn't rotated so much that it hurts. There's usually a little twist at the hips, and my legs are kinda jackknifed as in the second figure 2 picture (I just noticed the caption points out how "the penis is protected from insects", ha ha). Very comfortable, though my ribs will get a little sore after a while, so I rotate with a side sleeping position throughout the night.

I am very uncomfortable with this paper to be called scientific research. It certainly appears the author had extensive life experiences, but does not demonstrate any of the data he collected.

> If you are a medical professional and have been trained in a “civilised” country you probably know next to nothing about the primate Homo sapiens and how they survive in the wild.

Starting off by insulting an entire population and making assumptions about what they do or do not know is odd. The disrespect continues on how an entire medical field "do not know that nature has provided". The author continues on to further disrespect by moving medical professionals in to "so called civilised people", and makes medical conclusions of "suffer[ing] unnecessarily from musculoskeletal problems".

And, this is just in the first paragraph. The second paragraph goes into the author's background how he lived amongst tribal people, commanded a platoon of African soldiers, and organized expeditions to meet native peoples and study their sleeping and resting postures.

> I tried to carry out surveys to collect evidence but they were meaningless

The author collected evidence, and the evidence was meaningless (alternative hypothesis false?) so... he discarded it? Would it not make sense to attach it and explain why it was meaningless?

One of the conclusions is

> Forest dwellers and nomads suffer fewer musculoskeletal lesions

but then...

> Arabs in the Sahara will sit in the position shown

How is the Arabs in the Sahara backing up forest dwellers conclusion?

NIH publishing this is odd. At least it was not written by ChatGPT.

How is this not science?

He has a hypothesis - modern sleep devices are not as good for the spine as the bare ground.

He suggested a reason why - pressing against the ground during sleep acts as therapy.

He has data - life experience, pictures, and demonstrations.

Maybe it doesn't pattern match as science to you, but the raw science is all there. A few hundred years ago, this is how most science was conducted - by individuals with specific bones to pick.

Is it conclusive? No. Is it worth being part of the conversation? Absolutely!

Remember that the NIH does not publish (edit: to be clearer this is the National Library of Medicine which falls under the umbrella of the NIH, and its URL), it just organizes articles like a local library but on a much larger scale. It's a common misconception. This article was published by the British Medical Journal as an interesting anecdote from a physical therapist. The NIH makes things available for searching but does not endorse anything that they have available.

You have high expectations for something that is not a scientific paper.

Very interesting. The author of the paper is around, at least according to the internet, at 90+ years of age and still practising physiotherapy.

And is also totally blind! [1] Which must have made taking these observations much harder.

[1]https://www.csp.org.uk/frontline/article/thank-you-csp

Also thought that but the article is dated 2000.

Yes, but there is a report of him being around around 2022 also - https://web.archive.org/web/20220128114020/https://whyy.org/...

> Forest dwellers and nomads suffer fewer musculoskeletal lesions than “civilised” people

> I tried to carry out surveys to collect evidence but they were meaningless, as tribespeople give you the answer they think you want.

Could they simply have higher thresholds for complaining?

They're also incredibly active compared to any "civilised" people. There's a lot of evidence that sedentary lifestyles are bad for bodies.

Presumably they're also, on average, younger than "civilised" peoples. Life expectancy for an Amazonian Tribe was just 53 years. https://www.sbs.com.au/food/article/how-to-eat-like-an-amazo...

Muscle and joint issues are a symptom of aging. If nobody's making it to 60, then aging really isn't the same issue.

Life expectancy of 53 does not usually mean nobody makes it to 60. In the early 1900s[1], life expectancy at birth in England was 53, but at the same time, as long as you survived until you were 20, your life expectancy had increased to over 60. If you lived to 50, you could expect to become 70.

https://ourworldindata.org/images/published/Life-expectancy-...

----

[1]: Not counting the years of the Spanish flu!

To the parents point, you sort of made their point. “If you made it to x”. By having fewer older members of their population they likely had few joint problems reported overall. I would expect any reasonable study to control for this variable but a survey would not.

Life expectancy is such a consistently deceptive measurement that I often wonder why it's not been replaced. Surely there must be more useful ways of quantifying lifespans, something like a "median age of currently living people"?

Point estimates in general are deceptive. It's difficult to capture the nuance of a full distribution with a single number.

I've had some luck with upper and lower percentiles, e.g. 5 % and 95 %. These cover 9 out of 10 people, which is large enough to be meaningful, yet not so small it's difficult to estimate.

This is probably because of child mortality etc.

I.e. the conclusion that people there don't usually live past 60 seems like a fallacy.

That is part of it, but there would also be things like high mortality during childbirth, and lack of antibiotics there at that time.

At the same time you have no car crashes or other post-industrial dangers.

But you also were much more likely to farm and hunt and do manual labor. All much more dangerous than office chair

Is that true? I thought there was evidence for setrong divisions of labour as soon as agriculture came along. That brings surplus and, with it, social stratification.

A lot more people used to farm as a percentage of the population. Even in the last century, especially in communist countries where pay was low. Small subsistence farmers were much more common. You might own a small plot, and some pigs, cows an even a horse. Or if really poor work on someone else's land. Just being around animals exposes you to many more dangers, like getting kicked or even infections from cleaning waste.

Reminder that "life expectancy" is a useless metric if you don't specify the base age. Life expectancy at birth, at 5 years, at 15 years?

They sure seem to complain a lot about insects on their penises

How many times do you think somebody’s penis has to be attacked by insects before preventing that becomes the main “figure of merit” for evaluating sleeping positions? I think it is not very far from 1 time.

More than a few middle-aged westerners would find it impossible to sleep with bent knees owing to a high prevalance of artherosclerosis (I think).

Also one of the great pleasures of life is turning over in bed repeatedly during a lie-in. Don't know whether it's to do with lymph circulation and/or detoxifying the brain. More investigation needed!

I love sleeping in the "lookout posture". I get very restful sleep. However after a couple of days it leads to a lot of pain in my back. I'm guessing some tendons get overstretched. No idea how to work around it though

I should try the reverse with the elbow outward. Seems doable. The Tibetan kneel seems a big too hardcore though :)

I have actually used that Tibetan kneel once! I was exhausted and had to sit on the floor for a while and then I just fell asleep like that. It surprised me enough that I've tried to recreate it but it seems I can only do it when I'm really tired.

Maybe it's a matter of habit and I can learn to do it if I try often enough.

The interesting point of this article to me is not the positions but the sleeping surface. Due to my newborn I’ve been sleeping on the floor on a thin yoga mat for over three months and my back and joints feel great. The pressure from the hard ground is like stretching while you sleep. Took a few weeks to get used to it though.

I have a Japanese futon mat[1] under my bed that I roll out if I have muscle soreness. If it weren’t for my partner (who insists on sleeping in a bed) I would sleep on the floor 100% of the time. After getting used to floor sleeping I can never feel truly relaxed in a bed-I feel like the padding is putting pressure on my lumbar spine.

[1] https://www.futonbedsfromjapan.com/

When I was 16, I inherited a bit of money. Not a large sum at all, but enough so that I could afford a new bed, a bookshelf and some nick-nacks from my local furniture store. Being 16, I didn't exactly put much thought into how kind my new mattress would be to my back down the line, and so I managed to find the firmest mattress known to man.

At first, it was hard to sleep on, but I'm lazy, and so I kept it. That was a good decision. Today, I have a much softer mattress, and let me tell you, I'm suffering.

Whenever I go camping in the summer, where I'm not in need of any insulation, I usually opt for just a simple, thin, foam sleeping pad, and it works wonder. The first couple of nights it's usually quite rough, not uncomfortable mind you, just hard to sleep as it's not as superficially comfortable, but after the initial acclimation my back's so much better.

When I was 28 at my peak fitness days, I opted for a firm mattress believing it would strengthen me as I got used to it.

I never got used it. The slightest sound from outside would wake me. Sleeping on the side was a daily chore. I learned to sleep on my back and snore like a lion.

Switched recently a soft mattress with shoulder support. Sleep on my side like a baby.

This sounds easy to a/b test. Just sleep on the floor for a month, then your squishy mattress for a month, and document everything. (A month is just a guess, one or two weeks seems like transitional effects would dominate, hopefully after that you'd see more of the ongoing effects?)

Will do, I'll record a log and document the effects.

Is this considered unusual? I’ve used minor variations of all of these except the sleeping on the shins posture, and I’m from Europe, not some African tribe.

I very predictably have nightmares whenever I fall asleep flat on my back, sleep paralysis kind of things. In Germanic mythology the mare is a demon who sits on your chest, so my conclusion is that I'm not alone in this.

I can't understand how anyone can sleep on their back. They snore and can't breathe it's like they're dying it's pretty obviously wrong.

not everybody who sleeps on their back snores and can't breathe?

Surprise, surprise, people are different to each other. I pretty much can only sleep on my back, no other positions allow me to fall asleep. Also, I don’t snore.

But I’m also very much in shape with no excess weight, snoring is generally correlated with ill health and being overweight.

Worth pointing out the false dichotomy here. I sleep better on my side, but I fall asleep better on my back! So ideally I'd go to bed on my back and then have someone push me over to my side once I'm sleeping...

I'm an expert snorer and can snore in any position. Probably central apnea, which only activates when most comfortable; previous sleep study showed nothing, presumably because I wasn't totally comfortable. I'd self medicate with a cpap if they were sold without a prescription. B1 with dinner/before bed helps, oddly.

Also, my previous cats preferred to sleep on my chest, so they trained me to sleep without a lot of motion. Currenrly, one cat likes to sleep on my legs and overheats them, resulting in a lot of movement at night; the other cat will only briefly visit at night, but will help me stay in place for naps on the couch.

Yeah fr. The first one he showed I was like, duh... that is the most obvious way to sleep possible

I'm fairly sure the cause of back pain is sitting at desks, not the position I'm sleeping in.

I'm skeptical that there's anything especially unhealthy about sitting at a desk even for long periods of time. What's more plausible to me is that back pain comes from having a weak back and it's more about what you're not doing, which is training your back muscles. Over the course of about a year, weight lifting eliminated a range of aches and pains I'd developed throughout adulthood, including back, wrist and knee pain. For the back it's all about deadlifts. In hindsight it seems obvious, all the muscles supporting my spine are visibly larger and demonstrably more powerful, carrying my body around is a much easier job for them now. Sinking into a padded chair after a few big lifts also feels fantastic and now feels like a perk of my job lol

I dunno. I never had chronic back or neck pain until I started working office jobs. When I was at university, I spent periods sitting at desks, but was never strapped to one for 8 hour shifts. I would sit down at a desk for max 4 hours at a time apart from during extreme crunch periods, and would spend the rest of my day walking around, lounging and chilling in different positions, excercising, etc. As soon as I started working at an office it became noticably harder to reach an over-10k step count daily, and even though I continued going to the gym and doing heavy back days, my left trap has become completely hardened up, and I've occasionally had lower back pain too during stressful times. I'm totally unable to train upper traps because they are literally like bricks. When I have a weekend where I walk and lounge a lot, or am off sick, or go on holiday, my traps feel significantly better and my workouts are better. It's a lifestyle where you are unnaturally in one position for too long that causes this.

>I'm skeptical that there's anything especially unhealthy about sitting at a desk even for long periods of time. What's more plausible to me is that back pain comes from having a weak back

I figure few habits will give you a weaker back than sitting at a desk for longer periods of time.

Yeah I think it's exactly this.

A lot of people end up thinking it's about ergonomic chairs. An un-ergonomic chair will make things bad pretty quick, but supportive ergonomic chairs are part of the long term problem IMHO.

And deadlifts are not the only solution. I started out using just a backless stool and it helped a bit (can't slouch!), but what really sorted me out was using the "lumbar machine" at the gym for a couple of years. When Covid came along I couldn't go any more so I started doing "the plank" at home, that plus the "side plank" and some push ups have kept me going the last four years. And it's totally free and I can do them basically anywhere e.g. on holiday.

> A lot of people end up thinking it's about ergonomic chairs. An un-ergonomic chair will make things bad pretty quick

I'm still fairly young so I probably shouldn't be so quick to say – maybe I'll have to eat my hat in the next decade or two – but I feel like this is also one of those "it's not the thing but how you use it" type situations. I have always used un-ergonomic fairly spartan wood chairs and stools without problem.

What I do, that I don't see everyone else do, is adjust my position a lot. Since I find the chair slightly uncomfortable, I have like a million different positions I can sit in and I rotate through them naturally throughout the day. I haven't seen any science on it but it would make sense that variety helps prevent damage caused by prolonged exposure to one position.

That might help to some degree, but I bet actually exercising your back muscles regularly will have a larger effect.

I mean I'm sure of it. It seems like common sense we've forgotten. Stress the muscles, eat a generous amount of protein, they will grow and get stronger. Do stuff that doesn't stress them as much, they will stay weak and that will lead to complications.

Similar to how the discussion around obesity has become so complicated, in a country where the #1 cause of death is heart disease. It is not complicated, obesity leads to heart disease, to reduce your risk, you must become less obese. Yet we insist on complicating the topic.

I bought a very strange mattress six months ago. This isn't an advertisement -- I can't strongly recommend it -- but it's called SONU Sleep. It has a "channel" along the top that you can lower your arm into when sleeping on the side. I got it due to persistent shoulder pain from side sleeping. Gradually I've adjusted to it and am now sleeping better.

But that's an argument against my usual paleo heuristic: this sure isn't how we evolved to sleep over millions of years. I wonder if I'd sleep well in orbit.

If you're sleeping better, why cant you "strongly recommend" it?

It has been a difficult adjustment that has taken months. I've had neck and shoulder pain while learning to use it. It sure isn't for everyone. I got the firm mattress, but it is still softer than I like. And it's at a premium price that may not be worth paying if you already sleep well on a conventional bed.

There are a lot of things that we do that wild animals and wild people don't do, and a lot of things they do that we don't do. If "do what they do" were a panacea we wouldn't be living like this in the first place.

They don't have access to antiparasitic medications, for example. Another example, they don't stare at screens ever. Plenty of our habits are better for us and plenty are worse, and the same is true for them. I'm sure plenty of habits of all people have trade offs. We have a higher life expectancy. What's a better metric for healthy lifestyle than that? It doesn't mean everything is better, but it is a good yardstick for determining if we are doing more right than wrong to our health, all in all.

So just "this is how it's done in nature so we are wrong about how we do it" isn't a good heuristic. A dog will lay on something soft given the opportunity.

@dang please macro expand previous

https://news.ycombinator.com/item?id=18024260 Sept 19, 2018

https://news.ycombinator.com/item?id=32531484 Aug 20, 2022

The part about musculoskeletal issues really hits home for me.

Can anyone recommend a book or site to learn to diagnose and fix musculoskeletal issues where possible? For example, I've had one leg longer than the other for most of my life, and it has caused my a lot of back pain. I went to a physical therapist and he figured out pretty quickly that the two major pieces of my pelvis were twisted and not aligned with each other, and he had a simple move I could do to crack it back into place (essentially just squeezing a pillow between my legs). Now it's part of my morning routine, and I'm working on hip flexibility and strength as well.

But I also get other misalignments and I would like to feel empowered to free myself from pain where possible.

Consider your footwear. Most people don't realise it, but modern shoes are generally pretty terrible for the body. They make your feet weak, "disconnect" you from the ground, and the elevated heels put a lot of strain on many parts of your body and shortens your ham-strings.

My favourite is Vivo Barefoot, but there are many brands now. Make sure to look for a wide toe box, flexible sole, and zero-drop (no elevated heel).

Amazing demonstrations of casual racism in that article. It reads as if it was written in 1850 rather than 2000.

There's no plausible reason to suppose that Tibetans or "tribesmen" have more natural sleeping positions than "civilized" (i e. White) people.

> There's no plausible reason to suppose that Tibetans or "tribesmen" have more natural sleeping positions than "civilized" (i e. White) people.

So Tibetan tribal society is likely to have exposed its members to the same level of furniture and mattress adverts as the average American or European then?

Tibetans traditionally sleep on beds that are not much different from European beds.

The porters shown in the article are "camping", so to speak, i.e. not in their typical sleeping postures.

I am a subject of the species Sapiens, genus Homo. Subject is a civilized example of the species. An unfortunate side-effect of being civilized is an encouragement to collect paper, with which subject is to trade for essential goods. The method subject has devised to collect these trade papers involves sitting on a soft yet sturdy apparatus and being bent at an approximately 90-degree angle at the hip and knee joints, and looking at a glowing rectangle while subject taps on a noisy set of squares.

Of the unfortunate side-effects of civilization, one is risk of injury. Of the several injuries subject has sustained in this pursuit (including to eyes, fingers, wrists, and elbows) is injury to subject's neck. In particular, a musculoskeletal injury of the muscles supporting the head on the spine, due to repeated stress from looking at a downard angle at glowing rectangle, as opposed to looking straight ahead.

This injury did result in up to 11 months of recuperation. During this time period, finding a way to rest the neck and head was extremely difficult and painful. After completing several weeks' worth of paper collection, some attempts were made at recuperation outside in nature. Upon attempting to sleep on the ground, rest was significantly painful and uncomfortable. Thus were attempted many months of trial and error at attempting to find positions with which to rest in a comfortable manner, while allowing the neck to heal.

At the end of recuperation, the result of attempts at finding resting positions was quite unexpected. Rest for this subject no longer requires (nor benefits from) pillows when side-sleeping, and back-sleeping is easier, though still not preferable. The explanation for this change appears to be an adaptation in musculoskeletal alignment when sleeping. This subject now acquires a particular alignment of head, neck, spine, shoulder, chest, back, and hips, that keeps any one body part from receiving undue strain. Sleep quality is consistent with sleep quality before injury, with the benefit of no longer needing props to assist in sleep quality.

The linked article's conclusion appears to be supported by subject's experience. Subject additionally notes that a single ear is enough to be alerted to most dangers. When sleeping outside, or in an enclosed cabin, such things as mice, deer, and the occasional canid, do tend to wake the subject, as well as odd sounds such as socks falling off the bed onto a plastic bag, or elastic bed sheet end-corners snapping upwards. Whether non-h.sapiens species are also alerted to the latter sounds with one ear open has not been formally evaluated.

These and other anthropological elements are very well described by Esther Gokhale as the basis of her method (which has been a life changer, at least for me).

You can find more on her website or book "8 Steps to a pan-free back".

The text referencing Figure 2 seems to mistakenly swap the top and bottom images.

When the legs are in the reverse recovery position (fig (fig2,2, bottom), the penis lies on the lower thigh and is protected. In this position the Achilles tendon of the leading foot can be inserted in the gap between the big toe and the first lesser toe to help correct a bunion.

Note that the top picture in Figure 2 shows the Achilles tendon of the leading foot between the big toe and adjacent toe of the trailing foot. I would conclude then that the top position is actually the one that protects the penis.

Figure 1 also has the images the wrong way around, though it's harder to see because they're meant to be side-by-side. I think it's a problem with the HTML conversion.

I will be trying more of these suggested positions. Coincidentally, I had a 5 degree wedge under my mattress to lift my head up slightly to reduce snoring. This resulted in increased lower back pain. Removing it reduced this lower back pain substantially.

In some sense, the vertical use of our vertebrae is a design anti-pattern. We evolved from animals that walked on all fours, and vertebrae are much better suited for this horizontal position. This is why we suffer from slipped discs and other ailments that are not common in other animals.

I wish I could sleep without a pillow but my nose completely clogs if I do. And that’s after surgery to remove a very small part of the bone in my nostrils to widen the passage. The mucosa inside my nose just swells too much and clogs my nose which keeps me from breathing which translates to terrible sleep.

Is anyone planning on trying these sleeping techniques? I’d be curious to hear about your experience and if you noticed any difference at all.

To add to the anecdotes, I have been sleeping on a flat rice straw tatami matt (without anything else) for 2 months. It's pretty hard and I have bruises on my ribs, but I have way less back and neck pain than before. I usually fall asleep in position similar to Figures 4 and 5 in the paper.

The reason I started doing this is that after moving to a new house I bought an expensive memory foam mattress which made my back hurt every morning.

Really interesting post. It is also quite counterintuitive - I personally think a lot of people are injured in sleep (including myself), and some of the postures indicated look like they could be very challenging/dangerous. Maybe the injuries come from lying on soft mattresses and a hard surface would be better as it provides more immediate feedback of bodily stress..?

Soft mattresses are really not suitable for sleeping. From my experience.

It would be interesting to know how the comfort or suitability of these postures is affected by physiology.

For example, even the suitability to obtain a deep squat may be affected by things like hip joint geometry: https://www.otpbooks.com/stuart-mcgill-hip-anatomy/

The images for Figure 2 are reversed. Both the caption and the description in the paragraph below refer to the bottom image while describing the top one.

I tried some of the positions in this article while trying to get used to sleeping on the floor in an attempt to fix my back pain. These hurt like hell

This came up on HN a while ago already. I tried it out and found that quadrupedal lying (fig 5) did help my lower back pain.

Excellent read right before shuteye.

The Tibetan caraveneers sleeping on their shins is metal af.

As a bonus, in that position, the penis is protected from instects.

Did that little observation, erm, stand out to anyone else?

Penis and insects are mentioned in quite a few places in the study. Author seems very preoccupied with that.

You never think about ants crawling up your urethra until one of them tries.

Rest and vest brahs, rest and vest.

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