Yeah, I've my 14cm case fans at the top of my case so I have the heat sink configured to blow the air straight up into them. Likewise, when not gaming my case fans a turned completely off so things are nice and quiet. This configuration helps.
Doing this you do need to install RAM prior to installing the heatsink. It's great to have the abillity to mount the heatsink in any direction you like. Many heatsinks aren't so flexable on orientation.
Heatspreaders aren't an issue for me as I tend to rip them off. Last I heard heatspreaders tend to hinder cooling rather than actually improve it.