The right pillow for neck pain is the one that keeps your head level with your spine in the position you sleep in. Side sleepers usually need a higher, firmer pillow, roughly the distance from the side of the neck to the outer edge of the shoulder. Back sleepers usually need a lower pillow with some support under the curve of the neck. Stomach sleepers need very little height, or none. Pillow height matters more than pillow type.
You can check most of this at home with a tape measure and someone to look at you lying down, before you buy anything.
Key takeaways
- Height first: the pillow’s height when your head is on it matters more than its material or shape.
- Side sleepers: need the most height, set by shoulder width; often about 4 to 6 inches (10 to 15 cm) compressed.
- Back sleepers: need less height, often about 2 to 4 inches (5 to 10 cm) compressed, with support under the neck.
- Stomach sleepers: need a very thin pillow, or none.
- Firmness: firm enough that the head does not sink to the mattress overnight, soft enough to be comfortable on the ear and jaw.
- Trial: give a new setup 1 to 2 weeks before judging it.
How to measure your pillow height
If you sleep on your side
- Stand tall: stand with your back against a wall, shoulders relaxed.
- Measure: from the side of your neck, just below the ear, straight out to the outer edge of your shoulder. This is the gap the pillow needs to fill.
- Check the line: lie on your side on your current pillow and ask someone to look at you from the front. Your nose, chin and breastbone should form a straight line, parallel to the mattress. If your head tilts down toward the mattress, the pillow is too low. If it tilts up toward the ceiling, it is too high.
People with broad shoulders often need 5 to 6 inches (13 to 15 cm). People with narrow shoulders may need 3 to 4 inches (8 to 10 cm). A softer mattress lets the shoulder sink further, so you may need less pillow height on a soft bed than on a firm one.
If you sleep on your back
- Lie down: lie on your back on the pillow.
- Check the angle: your face should point straight up at the ceiling, with the chin neither pressed toward your chest nor tipped back.
- Check the gap: slide a hand behind your neck. If there is a large gap, a small towel roll, about the thickness of your wrist, along the bottom of the pillowcase can fill it.
Most back sleepers find a compressed height of about 2 to 4 inches (5 to 10 cm) comfortable. If your forehead sits higher than your chin, the pillow is too high.
If you sleep in more than one position
Many people change position through the night. A pillow that is slightly lower in the middle and higher at the edges, or a pillow folded at one end, lets you roll from back to side and find the right height each way. Two thin pillows instead of one thick one also let you add or remove height.
Firmness and filling
- Firmness: press the pillow with your hand. If it flattens to less than half its height, it may not hold your head up through the night when you are on your side.
- Fillings that shift: loose fillings can be moved to change height, but they also move away from the neck overnight. Shake them back before sleep.
- Fillings that hold shape: solid foam keeps its height but cannot be adjusted. Check the height before you commit.
- Age: a pillow that no longer springs back after you fold it in half has usually lost its support.
Measure your shoulder, check your head is level, and change one thing at a time.
Common mistakes
- Buying for the label: a pillow sold for neck pain is not automatically the right height for your shoulder width or sleeping position.
- Stacking pillows: two full pillows on your back push the chin toward the chest.
- Shoulder on the pillow: when side lying, keep the shoulder below the pillow so it supports the neck, not the shoulder.
- Judging after one night: almost any new pillow feels odd at first.
- Changing the pillow and the mattress together: you cannot tell which change helped.
How long changes take to help
A new pillow height often feels unfamiliar for several nights. Most people can tell within 1 to 2 weeks whether it helps. If you wake with less stiffness, or the stiffness clears faster in the morning, the height is probably close. If you are still waking with neck pain every day after 3 to 4 weeks of a well-measured pillow, the pillow is unlikely to be the main cause.
Where else this could be coming from
- Neck arthritis (cervical spondylosis): morning stiffness that eases within about 30 to 60 minutes of moving, whatever the pillow.
- A pinched nerve in the neck: pain or tingling down one arm that may be eased by resting the hand on top of the head.
- Shoulder problems: pain lying on one side that sits at the outer upper arm, not the neck, often from the rotator cuff or bursa.
- Upper back stiffness: a stiff, rounded upper back can push the head forward when lying on your back, so a flat pillow feels like it tips the head back.
- Daytime posture: if pain builds across the day at a desk or phone, the night may simply be where you notice it.
Get it checked if
- Emergency: call your local emergency number if neck pain comes with a sudden severe headache, fever with a stiff neck, or chest pain and breathlessness.
- Today: see a doctor today if you notice worsening arm weakness, loss of hand coordination, unsteady walking, or loss of bladder or bowel control.
- Soon: get it checked if pain wakes you most nights in any position, 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.
Fit the pillow to your shoulder width and the way you sleep.
Written by Louise Yow, Neck & Shoulder Physio.