Poor Sleep and Later Chronic Pain: What Long-Term Studies Show

Last updated: October 2026

Long-running population studies in Norway have followed thousands of adults who started out free of chronic pain. In 13,429 adults followed for 11 years, insomnia at the start was linked to a higher risk of later chronic musculoskeletal complaints, including neck complaints (Uhlig et al., 2018). In 6,033 adults, long-term poor sleep quality was linked to a higher risk of chronic pain than consistently good sleep (Skarpsno et al., 2021). Below is what these studies show, how large the effects are, and where pillow height comes in.

Key takeaways

In 13,429 Norwegian adults, insomnia was linked to a 16% higher risk of any chronic musculoskeletal complaint and a 34% higher risk of neck complaints 11 years later (Uhlig et al., 2018).
Long-term poor sleep was linked to roughly double the risk of chronic widespread pain compared with consistently good sleep (Skarpsno et al., 2021).
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.

Does insomnia predict chronic pain later?

The HUNT study followed 13,429 Norwegian adults aged 20 to 70 with no chronic musculoskeletal complaints at the start, for 11 years (Uhlig et al., 2018).

Insomnia at the start was linked to a higher risk of any chronic musculoskeletal complaint (RR 1.16), neck complaints (RR 1.34), knee complaints (RR 1.34), and chronic widespread complaints (RR 1.58). It was not linked to complaints in only one or two body regions.

Does long-term poor sleep matter more?

A second HUNT analysis tracked sleep quality across three surveys from 1995 to 2019 in 6,033 adults free of chronic pain (Skarpsno et al., 2021).

Compared with people who slept well at both earlier surveys, those with long-term poor sleep had a higher risk of any chronic musculoskeletal pain (RR 1.41) and of chronic widespread pain (RR 2.09). People whose sleep went from good to poor also had a higher risk of chronic pain (RR 1.25).

How large are these effects?

Most of the effects are modest. About a third of the people who slept well still developed chronic pain over the study period, so these are increases on an already common outcome (Skarpsno et al., 2021). The clearest result was for chronic widespread pain in people with long-term poor sleep.

What do these studies not show?

Both studies are observational, with self-reported sleep, in Norwegian adults. They show that poor sleep is linked to later chronic pain, not that improving sleep prevents it (Uhlig et al., 2018; Skarpsno et al., 2021).

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.

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 HUNT studies measured sleep and later pain, not pillows. No study has tested whether a fitted pillow changes the risk of developing chronic pain, and we make no such claim. The most recent systematic review found no clear advantage for any pillow type in chronic neck pain (Ghosh et al., 2025).

For providers

Poor sleep in a patient without chronic pain is worth noting, since long-term studies link it to later musculoskeletal complaints.

Asking how long sleep problems have lasted, which position the patient sleeps in, 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

Can poor sleep lead to chronic pain?

Long-term studies link it. Insomnia was associated with a 16% higher risk of any chronic musculoskeletal complaint over 11 years (Uhlig et al., 2018). The studies are observational, so they do not prove cause.

Is insomnia linked to neck pain?

In the HUNT study, insomnia was linked to a 34% higher risk of chronic neck complaints 11 years later (Uhlig et al., 2018).

Can a pillow lower the risk of chronic pain?

No study has tested that, and we make no such claim. A pillow fitting addresses head and neck height during sleep.

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

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

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

Skarpsno, E. S., Nilsen, T. I. L., Hagen, K., & Mork, P. J. (2021). Long-term changes in self-reported sleep quality and risk of chronic musculoskeletal pain: The HUNT Study. Journal of Sleep Research, 30(6), e13354. https://doi.org/10.1111/jsr.13354

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

Uhlig, B. L., Sand, T., Nilsen, T. I., Mork, P. J., & Hagen, K. (2018). Insomnia and risk of chronic musculoskeletal complaints: Longitudinal data from the HUNT study, Norway. BMC Musculoskeletal Disorders, 19(1), 128. https://doi.org/10.1186/s12891-018-2035-5