The right pillow is essential in keeping the neck in a supported position with neutral alignment during sleep. Without the right pillow support, the intricate structures in the neck will be stressed, which will worsen any existing neck condition and lead to daytime neck pain or stiffness.

See How to Treat a Stiff Neck After Sleeping

The key is to find a pillow that is the right height and firmness for the person's size, sleeping position, and personal preferences.

Best Pillows for Sleeping Positions

Sleeping positions are a major factor in determining the best kind of pillow. Sleeping on the back or side, if possible, is advised for those with neck pain.

When sleeping on the back

A fairly low pillow is better in this position. Extra support can be provided by adding a small rolled towel or small roll-shaped pillow positioned under the neck. The rolled towel or pillow can be put in the pillowcase. Some pillows combine both these elements by including a roll-shaped area for the neck and a deeper, lower area for the head.

Some people find it beneficial to try and change the position of the pillow to be more comfortable.  For example, many people find that sleeping with the pillow tucked under the shoulders a bit can be more comfortable.  Tucking the pillow under the shoulders will position the head further up on the pillow, so the neck is not flexed (bent forward).  This position may feel as though the head is more extended slightly, and may be more comfortable for those with muscle pain in the neck.

When sleeping on the back, it is best to place a pillow under the knees to minimize strain on the lower back as well.


When sleeping on the side

A higher pillow is advised in this case, so the neck and head are aligned straight over the shoulders as they would be when standing with good posture. A rolled towel or roll-shaped pillow should be put under the neck and supplemented with a pillow for the head.

See Ten Tips for Improving Posture and Ergonomics

Resting one arm on a pillow and adding a pillow between the knees offers additional support for the spine. Some body pillows may provide support similar to this mix of pillows.

When sleeping on the stomach

This position is not recommended because it tends to make the back arch and the head turn, stressing the neck. Changing sleep patterns can be a challenge, but trying to fall asleep in another position is suggested. If that is not possible, a flat pillow should be used for the head, or no pillow at all. Another option is to try positioning the pillow under the forehead so the nose is lifted off the mattress and the head and neck can remain in a more neutral position

In addition, the hips and abdomen should be supported with a pillow to maintain the natural inward curve in the lower spine.

When sitting up

Horseshoe-shaped body pillows can be helpful in avoiding neck strain for sleeping in a sitting position, such as sitting on a plane or in a car, or while sitting in a recliner. These small pillows support the neck so the head doesn’t fall too far to one side. The pillow should be small enough that the head is aligned squarely over the shoulders and not pushed forward.

For anyone who is more comfortable sleeping at an incline in an adjustable bed or propped up on pillows, it is worth considering this type of pillow to support the head and neck.


Many people change positions as they sleep. Pillows designed for both side sleeping and back sleeping feature a lower center area for sleeping on the back, with fuller areas on each end for side sleeping.

Ron Miller is a licensed physical therapist with more than 20 years of experience specializing in spine care. He helped develop the physical therapy department at the NeuroSpine Center of Wisconsin, where he focuses on manual therapy, spinal stabilization, and therapeutic exercises.