A physiotherapist traveled the world studying sleep, and says most of us do it wrong

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Physiotherapist Michael Tetley demonstrates one of the sleeping positions he observed during travels. (Courtesy Michael Tetley)

Physiotherapist Michael Tetley demonstrates one of the sleeping positions he observed during travels. (Courtesy Michael Tetley)

This story is from The Pulse, a weekly health and science podcast.

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The very first line in this research paper grabbed my attention: “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.” 

Science papers don’t typically open up by saying: Not for nothing, all of you are clueless.

But that’s how Michael Tetley, a physiotherapist, opens what seems to be his first and only published paper on sleep and sleeping positions.

He goes on to tell an incredible story. He talks about growing up with tribal peoples in Africa, leading local troops into war in the ’50s and undertaking some 14 expeditions all over the world, and how all this taught him one thing: The peoples of the Western developed world, us, we’re  sleeping wrong. 

We’re sleeping in positions and on beds and pillows that cause us injury, and the answers to the myriad back and neck pains of middle and late adulthood can be found in nature — and in sleep. 

The paper makes an argument that the best all-around position for sleep is this:

On your side, with one leg over top of the other, and, instead of on a pillow, your head rests on the crook of your arm. 

The pictures in the paper are perhaps the most striking part. A gray haired man in his underwear is sleeping in different positions, some that look more like they’re in a yoga studio than in a bedroom. 

That man is Michael Tetley himself. The paper explains he’s demonstrating sleeping positions taught to him by people in pre-industrial societies, remote tribes, and such, who were averse to having their photographs taken. 

I wanted to talk to Tetley, but he looked like a grandfather in these photos, and the paper was published more than 20 years ago. I wasn’t sure he was still alive. 

Turns out he is alive and well, 91 years old, and he’s still a practicing physiotherapist. 

“Show me another animal in the world that retires,” he said, adding that he’d seen patients earlier that day. 

Tetley hasn’t slept on what most of us would consider a proper bed in decades.

“I can sleep on concrete still now,” he said.

His bed is closer to a Japanese futon, five layers of compressed cotton, no pillow. He lives in England, but he sleeps the way he was taught to during a war I hadn’t even heard of that raged back in Kenya, where he was born. 

The first surprise I got when I found Tetley was just the fact that he was still around and working. The second was that all these expeditions he mounted, all of his sleep research, he did it all completely blind. He had lost his sight to a bullet when he was 23 and a British Army officer. He said seven terrorists shot at him. 

“And then tried to come and cut me up into little pieces,” he said. 

One of his African soldiers stood over him and shot all seven.

 “If I hadn’t been with him, I’d been dead cut up to pieces by now,” he said.

The people Tetley calls terrorists, others might call freedom fighters. They were known in their day as the Mau Mau, a secretive militant group whose legacy is controversial even now in Kenya. The Mau Mau Uprising sought an end to English colonial rule in the 1950s. 

Tetley was born in Nairobi to English parents, and he spoke local languages, which made him useful to the British military. 

There were the armed human threats, then there were the non-human ones.

“When you imagine Kenya nearly a hundred years ago, it’s completely different,” Tetley said. “If you’re out in the bush and you go to sleep on the ground, the last thing you want to do is put your head in a pillow because you can’t hear the lions and the hyenas coming. At one time, there were more [hospital] beds filled with lion and hyena bites than malaria. So, if you’re out in the bush, you want all your senses slightly awake all the time. And so, if you lie on your side with a crooked arm your lower ear isn’t blocked.”

Tetley says the African soldiers slept differently than their European counterparts, perfectly comfortable on the hard ground — not a pillow in sight.

“The first time I saw them sleeping on the ground in this position, I thought, well, I can’t do that,” he said. “But by the time I’d been with them several months, I was doing exactly the same thing.” 

Sleeping this way, on your side, head in the crook of your arm seemed at first something you’d do just out of necessity. There are no beds out there, and you can’t afford to block your hearing with a pillow in case some predator comes by. But Tetley noticed eventually that it seemed to have these other benefits. 

“My African troops — I was the only white man among them — they never seem to suffer with back problems and shoulder problems like the British troops that were alongside us, and that made me start wondering what is it that they’re doing?” Tetley said.

Something about the way his troops slept stuck with Tetley for years after the Kenya campaign. After losing his sight, he had gone to England and after despairing for some while on what he’d do next, his father advised him to learn physiotherapy.

That’s what Tetley did and, complementing what he learned in his modern clinical training, he started to apply lessons from his time in the African bush to help clients heal themselves, changing the way they slept to alleviate pain. 

And as it turned out, the bullet that ended Tetley’s military career would do nothing to blunt his adventuring.

“I’ve been ever so lucky,” Tetley said. “If you’d ask me the things that I’ve done since I’ve been blind, I’d never believed you.”

Tetley has easily filled several bucket lists since losing his sight: He’s climbed Mount Everest, rowed a canoe with cannibals, pedaled a tandem bicycle some 500 miles across Kenya with a sighted partner guide — once outrunning a herd of elephants along the way. 

“Suddenly, I heard my friend say, ‘For Christ’s sake, pedal like hell!’ We were weaving in and out between the elephants, and you could hear their tummies rumbling,” Tetley said. “We were so close.” 

I’m surprised no one’s made a movie about this guy. But this wasn’t all for fun or kicks, there  was always the research. Research he funded himself through his successful practice. He liked funding his own work, because it kept him independent, able to take risks, and follow his curiosity.

He asked everyone he met: How do you sleep?  

”I’d ask them to put themselves in the position that they would normally sleep, then I’d have a quick feel what they were doing,” Tetley said. 

He used his hands to get a sense of their positions, where their legs were, their arms, their heads.

“Sometimes, you have to be very careful if you ask ladies what they call sleeping positions they put themselves in,” he said.

He met Somali people who sleep with tiny stools under their heads.

“Which is 10 inches wide and 7 inches high. I’ve tried that, but I didn’t find it particularly comfortable, but at least it kept the sand out of your face,” he said.

In China, he found some people who slept with pillows made with bits of rock-hard shining jade. 

“I thought it’s going to be very uncomfortable sleeping on jade, you know, which is a hard stone, but it’s very comfortable,” he said. 

The jade stones allowed air flow, kept you cool. In his mind, these were all sleeping practices adapted to and governed by nature as opposed to a department store mattress and pillow sets. 

“I think nature expects you to hurt every joint in your body sometime every day, and it corrects it every night when you sleep,” Tetley said. “And when you sleep on a firm mattress, you’ve got to breathe, which means the ribs have got to move. And if the  ribs can’t move, like on the forest floor, for example, it kicks back against the spine and it resets the spine every day.”

So, what was the response to all this when Tetley published his paper over 20 years ago about all these alternatives to how most of us sleep?

“The British doctors thought it was crackers,” he said. 

That’s U.K .slang for: They thought he was nuts.

“But I got emails from all over the world, from other doctors that had been trained in England but had gone around the rest of the world. They said It’s about time somebody pointed it out to them,” Tetley said. 

I wondered how researchers would react to Tetley’s paper now, in 2022? 

Science changes all the time. Old knowledge becomes new again. Ideas come in and out of fashion. I sent out some emails to medical centers, physical therapy practices, and universities.

I expected, quite honestly, not much of a response.

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Instead, it turns out the very first line of Tetley’s paper, the one that says modern Western science was clueless about this stuff, actually wasn’t that far off the mark. There was almost no research on sleeping postures.

“We found that there’s only four papers out there, and one of which was one of our ones already that actually addressed this question, which was specific to us, which is looking at the relationships between sleep posture and waking spinal symptoms,” said Australian physiotherapist Doug Carey. 

“Look at anything on Google, there’s a bunch of anecdotal information that comes back to you, don’t do this and don’t do that, and there’s even heaps of blogs saying, ‘Oh, you should be doing this and should be doing that.’ But the reality is there’s no evidence backing up any of those sort of assumptions,” Carey said.

He used an infrared camera to study how people sleep. What he found to be the position associated with the least amount of pain actually lined up pretty well with the way Tetley’s soldiers taught him to sleep all those years ago — on the side, legs on top of each other. But his subjects, of course, used pillows instead of their arms.

Carey thinks we humans kind of find our way to this position as we age.

“From a young age, say, 5 or 6, we spend about the same amount of time in each of the sleep positions: on your back, on your front, or on your side. But as people get older and they move into their 40s and 50s, they start to spend more and more time in side-lying,” he said. “As we get older, if we’re getting so-called smarter about what we do based upon feedback from our body, we do spend more time on our side.”

Learning all this has influenced how Carey treats his patients. It’s led to a kind of less-is-more attitude. 

“As a physio, you had this urge to help people. And part of that urge is to put your hands on them,” he said. “To do some sort of intervention is going to make that pain go away.”

Instead of pushing and pulling on his patients, he gives them a simple sleep instruction: ‘Try lying on your side’. And then, he just waits for his advice to work. To his patients’ astonishment, it often does. 

“They almost look at you and go, ‘Are you kidding me? Is it that easy?’” he said. “They’re just over the moon because, for the first time, they’ve actually realized what’s the cause of the problem.”

I also sent Tetley’s paper on sleep positions and beds and pillows to a big-shot spinal surgeon in Philadelphia, thinking, well, if anyone is going to be skeptical of this, it’s going to be a medical doctor who actually repairs human spines using the most cutting-edge surgical techniques.

Jim Harrop is a spinal surgeon at Jefferson University Hospitals. 

“It’s funny, I got this email, and I was like, that is the coolest thing in the world,” he said. 

Harrop was more blown away by Tetley’s research paper than even I was. He asked for Tetley’s email and sent off a flurry of questions, even a picture of his dog sleeping in a curiously human way, trying to pick his brain. 

Harrop had been trying to figure out pillows, whether they have some kind of effect on neck pain, and he hadn’t been finding much. In fact, just like Carey, he told me there really isn’t that much out there. 

“We don’t totally understand the cervical spine. We don’t understand the pain developed from [the] spine,” he said. 

Harrop was trying to figure which pillow might alleviate pain, and here Tetley was saying, well, don’t use one at all. Harrop doesn’t know if that’s correct or not, but when we know so little, he said, we cant shut down ideas.

“Why do people have that pain? Is the structure of their spine different?” he asked. “I mean, we don’t have the basic understanding of anything right now.”

It’s worth keeping an open mind about the possibility of a different way of sleeping correcting spine issues, because the alternative — surgery — is kind of a devil’s bargain. 

Fix something in one part of the spine, it creates a problem in another part. Straighten it with a rod along one axis, as with scoliosis treatment, and you lose the natural curve of another axis. 

“What we found is your spine, and your posture is extremely more complex than you would believe,” Harrop said 

The main issue is the spine is a moving organ: It twists and bends and turns constantly in three dimensions. What you repair one day could lead to another problem in a different part of the spine.

Harrop is a surgeon who absolutely, positively wants to avoid doing surgery. The idea of fixing a spine without going under the knife, of literally doing it in your sleep — that’s an idea worth exploring.

Harrop has reached out to Tetley and told me that the two of them will talk shop. Harrop is going to continue his pillow research, and he said it’s already being informed by what he’s learned from Tetley. 

“I’m going to make up this survey, and I’ve been doing it and I added a couple of questions, Harrop said. “Do you sleep with a pillow? Do you sleep on which side?” 

So perhaps Tetley’s first sleep study paper published some 20 years ago won’t be the last one published with his name on it.

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