A growing body of research has made it clear just how important good sleep is to your health and well-being. In fact, your dreams may signal something about your health. While finding the best bedding is key, not everyone has the same sleep style. And there’s been debate over whether it’s better to sleep with or without a pillow for quite some time. Some argue that sleeping without a pillow is better for your back, while others swear a pillow is the way to go.
It’s important to get this out of the way upfront: There hasn’t been a scientific head-to-head comparison of people who sleep with pillows and those who sleep without them to see which one is better. But doctors who treat people with back and neck issues say there is some common logic to keep in mind when it comes to this debate.
Meet the experts: Ari R. Berg, M.D., spine surgeon at Hackensack University Medical Center and assistant professor of Orthopedic Surgery at the Hackensack Meridian School of Medicine; Jason A. Smith, M.D., associate medical director and chair of Physical Medicine and Rehabilitation at Atlantic Health; Mara Vucich, D.O., a spine specialist at the Maryland Spine Center at Mercy
So, is it better to sleep with or without a pillow? Here’s what doctors want you to know.
Is it better to sleep with or without a pillow?
Again, there is no absolute science to rely on with this question. “Medically, we don’t really know the answer to that question,” says Mara Vucich, D.O., a spine specialist at the Maryland Spine Center at Mercy. But doctors seem to agree that keeping your spine in a “neutral” position is the best way to lower the risk of back and neck pain.
In case you’re not familiar, a neutral spine position is when your head, neck, and back are in alignment, while allowing for the natural curves in each.
“For the vast majority of people, it is significantly better to sleep with a pillow,” says Ari R. Berg, M.D., spine surgeon at Hackensack University Medical Center and assistant Professor of Orthopedic Surgery at the Hackensack Meridian School of Medicine. “Regardless of what position you sleep in, a pillow should support your head and neck in a way that maintains your body’s neutral spinal alignment.” That means the pillow will help to keep the natural curve of your neck aligned with the rest of your spine, just as if you were standing with good posture.
But pillows aren’t magic, and the wrong pillow may throw your alignment out of whack, Dr. Vucich says. Still, it’s usually more challenging to maintain a neutral spine without a pillow, according to Dr. Berg. “Without a pillow, most sleeping positions will force your neck into a strained, unnatural angle for hours on end, leading to muscle pain, stiffness, and even nerve irritation,” he says. (There is a potential exception for stomach sleepers, though.)
What are the benefits of sleeping with a pillow?
Again, it’s important to sleep with the right pillow. “Sleeping with a pillow allows for maintained alignment of the cervical spine,” says Jason A. Smith, M.D., associate medical director and chair of Physical Medicine and Rehabilitation at Atlantic Health. Keeping your neck as close to level as possible can help to keep your joints from getting aggravated, he says.
“If they are annoyed, these joints can cause muscle spasms and even headaches,” Dr. Smith says. Sleeping with a pillow may feel more comfortable than sleeping without one, Vucich says.
But there are specific elements to keep in mind when it comes to choosing the right pillow, and a lot comes down to your sleeping position, according to Dr. Berg. “For side sleepers, a good pillow will fill the gap between the ear and the outside of the shoulder, preventing the head from collapsing downward,” he says. “For back sleepers, a pillow will support the natural curve of the neck, preventing the head from tilting too far back.”
This usually means that side sleepers have a loftier pillow, while back sleepers should have a medium-loft pillow, Dr. Vucich says. People who sleep on their stomachs will need the lowest loft, she adds.
“By keeping your neck in a neutral position, the best pillow for you will allow the muscles in your neck and shoulders to fully relax, so you can get into a comfortable position without the need to toss and turn a lot, and fall into a deep, restorative sleep, so you can recover during the night,” Dr. Berg says.
What are the benefits of sleeping without a pillow?
There really aren’t a lot—unless you’re a stomach sleeper. “When you lie on your stomach, you are forced to turn your head to one side for hours, which already puts your neck in a twisted and compromised position,” Dr. Berg explains. “If you add a pillow, you force your head to be angled upwards and twisted.”
Removing the pillow allows your head and neck to be in a more level, slightly less strained position relative to your spine, he says. “For this reason, if you are a stomach sleeper and cannot change your position, sleeping without a pillow or with a very thin, flat one is the best option for you,” Dr. Berg adds.
But Dr. Smith still suggests using a flat pillow over doing without. “If the pillow you are sleeping with currently bothers your neck, my advice would be to change the pillow—not necessary; go without one,” Dr. Smith says.
What downsides can come from sleeping with a pillow?
There aren’t downsides from sleeping with a pillow as a whole, Dr. Smith says. It’s more that you can struggle if you’re sleeping with the wrong pillow. “If a pillow is too high or too soft, it can cause significant alterations in your neck alignment, causing pain down the road,” he says.
But there are also particular concerns depending on your sleep position. “For a back sleeper, a pillow that’s too high will push your chin towards your chest, flexing your neck forward and straining the muscles in the back of your neck and upper back,” Dr. Berg says. “For a side sleeper, it will bend your neck upwards, straining the opposite side. This is a very common cause of waking up with what people call a crick in your neck.”
If you’re a side sleeper and your pillow is too thin, your head will drop toward the mattress, straining your muscles and ligaments on the upper side of your neck and shoulder, Dr. Berg points out.
There are also firmness levels to consider. “A pillow that is too soft may collapse during the night, failing to provide consistent support,” Dr. Berg says. “A pillow that is too firm may create pressure points.”
What are the downsides of sleeping without a pillow?
Sleeping without a pillow leaves you without neck support while you snooze, Dr. Smith points out. Not only that, it can be uncomfortable. “While this can also throw off your neck alignment, more importantly for most people sleeping without some form of neck support affects their comfort—therefore affecting the ability to get a good night’s sleep,” Dr. Smith says. “This can lead to problems on its own.”
Even if you’re able to get your spine into alignment when you fall into sleep without a pillow, it’s likely that you’ll move during the night and throw that off, Dr. Berg says. “If you are a side sleeper, your head may fall dramatically below your shoulder, causing severe lateral strain on your neck,” he says. “This can lead to significant pain, stiffness, and, over time, potential muscle and ligament injury.”
For back sleepers, lack of support causes the head to tilt backward and hyperextend, Dr. Berg says. “This compresses the small joints in the back of your neck and strains the muscles and ligaments in the front,” he adds.
The bottom line
It’s a good idea to sleep with a pillow. However, the right one for you will vary based on your body composition and sleeping position. “You want to, and you need to, maintain a neutral spine,” Dr. Berg says. “The pillow is simply the tool you use to achieve that.”
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