Back to School: Teen Sleep, Start Times, and Neck Pain

Last updated: October 2026

Back-to-school season brings earlier alarms, and most teens were already short on sleep. In 2015 surveillance data, 72.7% of US high school students reported sleeping less than 8 hours on school nights (Wheaton et al., 2018). In a review of 6 studies, delaying school start times by 25 to 60 minutes added 25 to 77 minutes of sleep per weeknight (Minges & Redeker, 2016). Below is what the research shows about teen sleep, how it connects to neck pain, and where pillow height comes in.

Key takeaways

In 2015, 72.7% of US high school students and 57.8% of middle school students in 9 states reported short sleep on school nights (Wheaton et al., 2018).
In a longitudinal study of 1,773 adolescents, insufficient sleep at age 16 predicted neck pain at age 18 (Auvinen et al., 2010).
A Pillowise fitting takes three measurements (shoulder width, neck circumference and neck length) and adds sleeping position and bed type to choose from seven sizes.

How much sleep are teens getting?

The CDC analyzed the 2015 Youth Risk Behavior Surveys, with a national high school sample of 14,471 students (Wheaton et al., 2018). Short sleep was defined as under 8 hours on school nights for ages 13 to 18, and under 9 hours for ages 6 to 12.

Nationally, 72.7% of high school students reported short sleep, with states ranging from 61.8% to 82.5%. Among middle school students in 9 states, 57.8% reported short sleep.

Sleep was self-reported, and the middle school figure is not nationally representative.

Do later school start times help?

A systematic review found 6 experimental studies of delayed school start times (Minges & Redeker, 2016).

Start times were delayed by 25 to 60 minutes, and total sleep time rose by 25 to 77 minutes per weeknight. The authors also reported some daytime and health benefits.

Half the studies had no control group, and the authors call for more rigorous trials with objective sleep measures.

Is neck pain common in young people?

A Global Burden of Disease analysis estimated that neck pain cases in children and adolescents worldwide rose from about 8.49 million in 1990 to 10.32 million in 2021, while age-standardized rates stayed roughly stable (Sun et al., 2025). Prevalence peaked at ages 15 to 19.

Is teen sleep linked to neck pain?

In a longitudinal study of 1,773 adolescents in the Northern Finland Birth Cohort 1986, insufficient sleep quantity or quality at age 16 predicted neck pain at age 18 (Auvinen et al., 2010).

The study measured sleep, not pillows. It shows sleep is worth asking about in young patients with neck pain.

What does pillow height change overnight?

In a radiographic study of 16 adults, raising the pillow from 0 to 10 to 20 cm increased T1 slope and C2-7 Cobb angle while neck tilt decreased (Kim et al., 2015). A crossover study of 10 healthy participants paired with finite element modeling measured how heights from 110 to 170 mm shift pressure across the head and neck (Ren et al., 2016).

In a pilot EMG study of 15 adults lying on their side, the height matched to shoulder width produced the lowest neck and shoulder muscle activity (Jiao et al., 2025).

Why do generic pillows miss?

A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009). No single optimal pillow height can be specified, because it depends on four variables that differ from person to person: cervical alignment, body dimension, contact pressure, and muscle activity (Lei et al., 2021).

What we measure

Pillowise is a fitted cervical pillow that licensed healthcare providers measure and dispense, made in seven sizes.

Our sleep specialists take three measurements: shoulder width, neck circumference, and neck length. Combined with sleeping position and bed type, an algorithm identifies the best-fitting pillow from seven sizes.

Shoulder width is the measurement the EMG study found mattered most. A height matched to it produced the lowest neck and shoulder muscle activity during side sleeping (Jiao et al., 2025), and body dimension is what drives the individual optimum (Tian et al., 2025).

A systematic review of 11 studies covering 309 participants identified a 7 to 11 cm unloaded central height among the parameters supporting spinal alignment and sleep comfort (Radwan et al., 2021). The size is chosen from those three measurements plus sleeping position and bed type, rather than from a single stock height.

For younger patients, Pillowise Junior comes in three sizes, fitted by a provider.

Pillowise pillows are made from premium Dutch memory foam and certified to OEKO-TEX Standard 100, meaning every component has been tested against the standard's limits for harmful substances.

Scope

The research on pillow height and cervical alignment was conducted in adults. No study has tested a fitted pillow in children or teens, and Pillowise does not claim one has. The most recent systematic review found no clear advantage for any pillow type in chronic neck pain (Ghosh et al., 2025).

For providers

Back-to-school visits are a good time to ask teens and parents how many hours of sleep the teen gets on school nights.

For young patients with neck pain, asking about sleep quantity and quality, sleeping position, and what they sleep on gives useful context.

A fitted pillow extends the work of the visit into the hours between visits, alongside the exercise, manual therapy, and other care the provider is already delivering.

Common questions

How much sleep do teens need?

The CDC analysis used under 8 hours on school nights as short sleep for ages 13 to 18, and 72.7% of US high school students fell below it in 2015 (Wheaton et al., 2018).

Do later school start times help teens sleep more?

In a review of 6 studies, delays of 25 to 60 minutes added 25 to 77 minutes of sleep per weeknight (Minges & Redeker, 2016). Half the studies had no control group.

Can a pillow help with teen neck pain?

No study has tested a fitted pillow in children or teens, and we make no such claim. Sleep itself has been linked to later neck pain in adolescents (Auvinen et al., 2010), which makes sleep worth discussing with a provider.

Is a contoured pillow from a store enough?

Not reliably. A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009), and no single optimal height can be specified because it depends on four variables that differ from person to person (Lei et al., 2021). A contour helps only if its height matches the person using it. That is what the fitting settles, in a provider's office.

Find a Pillowise provider or become one

Pillowise pillows are clinically measured and dispensed exclusively through licensed healthcare providers as part of broader sleep, posture, and recovery education.

To locate a Pillowise provider near you, visit: Find a Reseller

Licensed healthcare providers interested in offering Pillowise may register here: Become a Reseller

References

Auvinen, J. P., Tammelin, T. H., Taimela, S. P., Zitting, P. J., Järvelin, M.-R., Taanila, A. M., & Karppinen, J. I. (2010). Is insufficient quantity and quality of sleep a risk factor for neck, shoulder and low back pain? A longitudinal study among adolescents. European Spine Journal, 19(4), 641-649. https://doi.org/10.1007/s00586-009-1215-2

Ghosh, S. K., Goyal, M., & Goyal, K. S. (2025). Effect of pillow on pain, disability and sleep quality in patients with chronic neck pain: A systematic review. Rehabilitación, 59(3), 100922. https://doi.org/10.1016/j.rh.2025.100922

Gordon, S. J., Grimmer-Somers, K., & Trott, P. (2009). Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy, 14(6), 671-678. https://doi.org/10.1016/j.math.2009.02.006

Jiao, R., Xiao, W., Wang, M., Yu, S., & Li, H. (2025). The impact of pillow height on neck muscle activity: A pilot study. Sleep and Breathing, 29(1), 40. https://doi.org/10.1007/s11325-024-03219-6

Kim, H. C., Jun, H. S., Kim, J. H., Ahn, J. H., Chang, I. B., Song, J. H., & Oh, J. K. (2015). The effect of different pillow heights on the parameters of cervicothoracic spine segments. Korean Journal of Spine, 12(3), 135-138. https://doi.org/10.14245/kjs.2015.12.3.135

Lei, J.-X., Yang, P.-F., Yang, A.-L., Gong, Y.-F., Shang, P., & Yuan, X.-C. (2021). Ergonomic consideration in pillow height determinants and evaluation. Healthcare, 9(10), 1333. https://doi.org/10.3390/healthcare9101333

Minges, K. E., & Redeker, N. S. (2016). Delayed school start times and adolescent sleep: A systematic review of the experimental evidence. Sleep Medicine Reviews, 28, 86-95. https://doi.org/10.1016/j.smrv.2015.06.002

Radwan, A., Ashton, N., Gates, T., Kilmer, A., & VanFleet, M. (2021). Effect of different pillow designs on promoting sleep comfort, quality, & spinal alignment: A systematic review. European Journal of Integrative Medicine, 42, 101269. https://doi.org/10.1016/j.eujim.2020.101269

Ren, S., Wong, D. W.-C., Yang, H., Zhou, Y., Lin, J., & Zhang, M. (2016). Effect of pillow height on the biomechanics of the head-neck complex: Investigation of the cranio-cervical pressure and cervical spine alignment. PeerJ, 4, e2397. https://doi.org/10.7717/peerj.2397

Sun, C., Lin, H., Zhang, Z., Yang, X., Zhou, J., Wang, R., & Xue, Y. (2025). Global, regional and national burden of neck pain in children and adolescents: GBD 2021 systematic analysis. Frontiers in Neurology, 16, 1625954. https://doi.org/10.3389/fneur.2025.1625954

Tian, S., Yao, C., Wang, Y., Cao, X., Sun, Y., Wang, L., & Fan, Y. (2025). The individualized optimal pillow height and neck support design for side sleepers. Medical and Biological Engineering and Computing, 63(2), 535-544. https://doi.org/10.1007/s11517-024-03204-x

Wheaton, A. G., Jones, S. E., Cooper, A. C., & Croft, J. B. (2018). Short sleep duration among middle school and high school students, United States, 2015. MMWR. Morbidity and Mortality Weekly Report, 67(3), 85-90. https://doi.org/10.15585/mmwr.mm6703a1