For most people with neck pain, sleeping on the back or the side is easier on the neck than sleeping on the stomach. The aim is to keep the head in line with the rest of the spine, not tipped up, down or twisted. On your back, a fairly low pillow plus a small roll under the neck often works. On your side, the pillow should fill the gap between your ear and the mattress. No single position suits everyone.
What I’d go by most is how your neck feels in the morning. If you wake stiffer than you went to bed, the position, the pillow or both may need changing.
Key takeaways
- Back and side sleeping: both are usually easier on a sore neck than stomach sleeping.
- The goal: the head stays level with the spine, with the nose pointing roughly in line with the breastbone.
- On your back: a lower pillow that supports the curve of the neck, with the chin neither tucked nor tipped up.
- On your side: a pillow thick enough to keep the head level, with a pillow between the knees to stop the body rolling.
- On your stomach: the head is turned to one side for hours, which strains the neck for many people.
- Changing position: most people need 1 to 3 weeks to get used to a new one.
How to set up each position
Back sleeping
- Pillow: low enough that your chin is not pushed toward your chest. For many adults that means a compressed pillow height of roughly 2 to 4 inches (5 to 10 cm).
- Neck support: a small rolled towel, about the thickness of your wrist, placed inside the pillowcase along the bottom edge, fills the curve behind your neck.
- Arms: rest them by your sides or on your stomach. Sleeping with the arms above the head can irritate the neck and shoulders.
- Knees: a pillow under the knees can make the position more comfortable for the lower back.
Side sleeping
- Pillow: thick enough to fill the space from your ear to the mattress, so your head does not tilt down toward the bed or up toward the ceiling. This is often about 4 to 6 inches (10 to 15 cm), more with broad shoulders.
- Pillow position: pull it down so it supports the neck as well as the head, with the shoulder in front of the pillow, not on it.
- Knees: a pillow between the knees keeps the hips and spine level.
- Arms: a pillow to hug in front of your chest stops the top shoulder rolling forward and pulling on the neck.
Stomach sleeping
If you cannot fall asleep any other way, this is how I’d reduce the strain:
- Pillow: use a very thin pillow, or none, under the head.
- Half-turn: bend the knee on the side your face points to and put a pillow under that hip and chest, so you lie partly on your side and the neck turns less.
- Switch sides: change which way your head faces from night to night.
The right sleeping position is the one where your neck feels no worse in the morning.
Common mistakes
- Stacked pillows: two or three pillows on your back push the chin toward the chest.
- Pillow under the shoulder: on your side, the shoulder ends up on the pillow and the neck bends sideways.
- Reading or scrolling in bed: propped on one elbow or with the head flexed for long periods before sleep.
- Sofa sleeping: falling asleep with the head on an armrest.
- Changing everything at once: a new pillow, new mattress and new position on the same night makes it hard to tell what helped. I suggest changing one thing at a time.
How long changes take to help
A new position often feels strange for the first week, and you may wake having rolled back into your old one. That is common. Most people settle into a new position over 1 to 3 weeks. If neck pain comes from a recent strain, it often settles over 3 to 6 weeks whatever the position, and a better position mainly makes nights more comfortable in the meantime. If you are sleeping well in a new position and still waking stiff every day after about 6 weeks, I’d look for the cause elsewhere.
Where else this could be coming from
- Neck joint stiffness or arthritis: stiffness worst on waking that eases within 30 to 60 minutes of moving, often in people over 50.
- A pinched nerve in the neck: pain or tingling running down one arm, sometimes worse lying down and eased by resting the hand on top of the head.
- Shoulder problems: pain at the outer upper arm when lying on that side can come from the rotator cuff or bursa rather than the neck.
- Upper back and rib joints: a sharp spot between the shoulder blades on rolling over or taking a deep breath.
- Jaw clenching or grinding at night: aching at the jaw and the side of the head and neck on waking.
Get it checked if
- Emergency: call your local emergency number if neck pain comes with a severe sudden headache, fever with a stiff neck and a rash or confusion, or chest pain and breathlessness.
- Today: see a doctor today if you have arm weakness that is getting worse, clumsy hands, unsteady walking, or loss of bladder or bowel control.
- Soon: get it checked if night pain wakes you most nights and no position helps, if you have unexplained weight loss or night sweats, or if the neck is not clearly easing after 2 to 4 weeks.
More on this area: desk and sleep guides.
Aim for a level head and a neck that feels no worse when you wake.
Written and reviewed by Louise Yow, Neck & Shoulder Physio. More about me. These pages explain; they don’t examine you, and your doctor’s or surgeon’s plan comes first.