Sleep disruption and sleep position: Increased wake frequency in supine predicts lateral position preference

Summary Little is known about the physiological and biomechanical factors that determine individual preferences in lying posture during sleep. This study investigated relationships between position preference and position‐specific arousals, awakenings, limb movements and limb movement arousals to explore the mechanisms by which biomechanical factors influence position preference. Forty‐one mature‐aged adults underwent 2 nights of at‐home polysomnography ~2 weeks apart, on a standardised firm foam mattress, measuring nocturnal sleep architecture and position. The lateral supine ratio and restlessness indices specific to lateral and supine positions including limb movement index, limb movement arousal index, arousal index, wake index, respiratory arousal index and apnea–hypopnea index were calculated and analysed via linear mixed‐effects regression. In the supine position, all restlessness indices were significantly increased compared with the lateral position, including a 379% increase in respiratory arousals ( β = 7.0, p < 0.001), 108% increase in arousal index ( β = 10.3, p < 0.001) and 107% increase in wake index ( β = 2.5, p < 0.001). Wake index in the supine position increased significantly with more lateral sleep ( β = 1.9, p = 0.0013), and significant correlation between lateral supine ratio polysomnography 1 and lateral supine ratio polysomnography 2 ( β = 0.95, p < 0.001) indicated strong consistency in sleep preference. Overall, the findings suggest that some individuals have low tolerance to supine posture, represented by a comparatively high wake index in the supine position, and that these individuals compensate by sleeping a greater proportion in the lateral position.