How to Sleep With Neck Pain: Positions and Pillow Height

If your neck hurts, sleep on your back or your side, and use a pillow that keeps your head level with the rest of your spine. Avoid sleeping on your stomach, because it holds the neck rotated for hours. No position or pillow is a cure, and pain that does not settle should be assessed by a provider.

Key takeaways

• Back and side sleeping make it easiest to keep the neck in a neutral line. Stomach sleeping forces the head to turn to one side for hours.
• The right pillow height depends on your position. A back sleeper needs less height than a side sleeper, and a side sleeper's height depends largely on shoulder width.
• Numbness, weakness, pain after an injury or pain that keeps getting worse needs a provider, not a new pillow.

Which sleeping position is best for neck pain?

The goal is the same in every position: keep the head in line with the spine so the neck muscles are not holding a tilt or a twist all night. Back and side sleeping both allow that. Stomach sleeping does not.

• Back: the head rests on the pillow, and the pillow also fills the small gap under the neck. Too high a pillow pushes the chin toward the chest. Too low lets the head tip back. Our guide to the best pillow for back sleepers goes into this position in more detail.
• Side: the shoulder is now the widest point between your head and the mattress, and the pillow has to fill that gap. If it is too low, the head drops toward the mattress. If it is too high, the head tips up and away. See the best pillow for side sleepers for more.
• Stomach: to breathe, you turn your head to one side and keep it there. The neck stays rotated, often with the chin lifted. That is the position we would try to move you out of.

How high should my pillow be in each position?

There is no single correct height. The table shows what the pillow has to do in each position.

Your mattress matters too. On a soft mattress, such as memory foam, your shoulder and hips sink deeper, so you may need a lower pillow than you would on a firm one. Weight changes the picture for the same reason.

For side sleeping there is some research. In a pilot EMG study of 15 adults, a pillow height matched to shoulder width produced the lowest neck and shoulder muscle activity and the highest comfort rating (Jiao et al., 2025). We cover that study in side sleeping, shoulder width and pillow height. For a broader look at the evidence, see adjusting pillow height for neck pain: clinical studies.

What can I change tonight?

1. Pick your position. If you wake up on your stomach, start the night on your back or side. Turning over in your sleep is normal, so aim for the position you fall asleep in.
2. Check the line. Have someone look at you from the side, or take a photo. In bed on your side, the nose should point roughly in line with the middle of your chest. On your back, the chin should not tuck down or tip up.
3. Adjust the height. If your pillow is too thick or too thin, add a folded towel under it or take one out. These are temporary fixes while you work out what you need.
4. Support the rest of the body. Side sleepers can place a pillow between the knees. Back sleepers can place one under the knees. This keeps the trunk from twisting and pulling on the neck.
5. Give it time. A new setup can feel odd at first. Change one thing at a time so you know what made the difference.

Not sure whether your current pillow is the problem? Read how to tell if your pillow is the wrong height. For a longer look at matching a pillow to position and mattress, see how to choose the right pillow based on your sleep position and mattress.

Is it the pillow, or something else?

A pillow that does not fit can add to neck strain overnight. It is rarely the only factor. Daytime posture, stress, activity and poor sleep all play a part, and pain can in turn disturb sleep. We look at that loop in does poor sleep make neck and back pain worse?

When should I see a provider about neck pain?

See your own provider, such as a physician, chiropractor or physical therapist, if you have any of the following:

• Numbness, tingling or weakness in an arm or hand
• Neck pain after a fall, a car accident or another injury
• Severe headache, fever or a stiff neck together with feeling unwell
• Pain that keeps getting worse, wakes you every night or does not settle

In these cases a different pillow will not solve the problem. Get the cause assessed first. Seek urgent care if symptoms come on suddenly or feel severe.

Scope: what we know and what we do not

Research on sleeping position and pillow height is limited. Studies often include only small groups of mostly healthy adults, and the Jiao et al. (2025) study was a pilot of 15 adults. Much of the work measures muscle activity or comfort over short periods. It does not show that a pillow treats a neck condition. We position a fitted pillow as an adjunct to care, not a treatment, and we make no promise of pain relief.

How does Pillowise approach pillow height?

A pillow should fit the body, like a shoe size. One stock height cannot suit every shoulder width, neck and sleeping position. Pillowise uses three measurements: shoulder width, neck circumference and neck height. It adds your sleeping position, meaning the position in which you fall asleep, and your mattress firmness. The Pillowise algorithm then picks one of 7 sizes. If you do not know your mattress firmness, we use medium. If you are unsure of your position, we use side.

The core is Dutch memory foam, and the standard pillow measures 22 x 14 in. The cover is removable and machine washable at 104°F. A fit can still need adjusting, for example in pregnancy, which is why a provider checks how you lie on the pillow. After you bring it home, give it 7 to 10 days to adjust. The 30-day comfort guarantee lets you exchange it for another size or return it for a refund within 30 days of purchase. Return shipping is paid by the customer.

Find a provider near you

Pillowise is sold only through licensed chiropractors, physical therapists and massage therapists, not in stores or online. The provider takes your measurements, and the measurement is free at every reseller. If you want to know what happens at the appointment, read what happens in a pillow fitting. You can also try the manual measurement on our sizing page. If you pay with an FSA or HSA, ask your plan administrator what is covered.

Find a Pillowise provider near you for a free measurement

Are you a chiropractor, PT or LMT? Learn how to offer fitted pillows in your practice.

Thijs van der Hilst, physiotherapist
Co-founder of Pillowise