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Is it better to sleep with or without a pillow?

By Amelia Willson | 4 Minute Read

If you’ve been waking up with neck pain, you may be wondering if you should try sleeping without a pillow. There are plenty of articles online that tout the benefits of sleeping without a pillow. Should you believe the hype?

While we put a lot of effort into researching and finding the best mattress for our sleep needs, and diligently replace them every 7 years or so, we tend to forget about the impact pillows have on our sleep. As a result, we can end up with the wrong pillows for our sleeping position, or too-old pillows that are no longer supportive. If you’ve got a great mattress but still have trouble sleeping, it’s no wonder you start to blame your pillow.

Pillows themselves are not inherently evil. Along with your mattress, they actually play an important role in supporting healthy spinal alignment while you sleep.

The question is not whether or not you should sleep without a pillow. Rather, the question is whether or not you should sleep without a pillow, based on your sleeping position.

In large part, your sleep position dictates what kind of pillow you should use, and whether sleeping without a pillow will help or hurt you.

Side sleepers: should you sleep without a pillow?

side sleeping spinal alignmentThis is the clearest case of all: absolutely not. Although side sleeping is generally considered the healthiest sleeping position, that all goes out the window if you sleep without proper pillow support. Side sleepers need a pillow to work in conjunction with their mattress to keep their spine straight while they sleep, from their hips all the way to their head.  

A contouring mattress allows a side sleeper’s pressure points to sink into the mattress, but without a pillow, the weight of their head will wrench their neck downwards and out of alignment with the rest of their spine. Choosing to sleep on your shoulder is not an adequate alternative, as this causes undue pressure and numbing sensations on your arm and shoulder muscles. Plus, it does so unevenly, as only one side is affected.

Side sleepers need a thick, supportive pillow that is as thick as the distance between their neck and their shoulder. Cervical pillows help support a side sleeper’s neck, as do contour memory foam pillows that have a higher loft beneath the neck and a lower one beneath the head.

A proper pillow keeps the side sleeper’s head and neck straight and aligned with the spine. A pillow that is too thick will tilt the neck and head up and out of alignment, while a pillow that is too-soft or too-thin will tilt it down.

Beyond the head pillow, side sleepers may benefit from a thin pillow between the knees that relieves strain and keep the spine straight all the way down to your hips.

The bottom line: Side sleepers should NOT sleep without a pillow.

Back sleepers: should you sleep without a pillow?

back sleeping spine alignmentWhen a back sleeper lies down on an innerspring or firm mattress, small gaps naturally develop between the lower back and the mattress, as well as the between the neck and the mattress. Memory foam and contouring mattresses address the space between the lower spine, letting the hips sink deeper down into the mattress as the memory foam hugs the lower back.

But there’s still a space between the neck and the mattress surface. Sleeping without a pillow leaves an uncomfortable space as the back sleeper’s head sinks down into the mattress. A too-thick pillow creates the opposite effect, uncomfortably tilting the head forward and the chin into the chest.

For back sleepers to keep the neck level with rest of their spine, a thin, contouring pillow rises to the occasion, filling the space as needed.  Cervical pillows, rounded pillows that support the neck, or pillows with built-in neck support and divots for the head are all good options. Additionally, a small pillow beneath the knees or a thin pillow beneath the lumbar spine can both relieve strain on the lower back.

The bottom line: Back sleepers should NOT sleep without a pillow, unless they have lower back pain and use a firm mattress with very little contour (although they may be better served by a better-contouring mattress and a thin pillow).  

Stomach sleepers: should you sleep without a pillow?

stomach sleeping spinal alignmentFinally, we’ve reached the one sleeping position that can truly benefit from sleeping without a pillow: stomach sleeping. Although it prevents snoring and sleep apnea, stomach sleeping is universally regarded as the most unhealthy sleep position, since it necessarily forces one to twist their neck and head out of alignment with their spine.

Sleep experts recommend stomach sleepers sleep with a very thin pillow, or no pillow at all. Some people simply feel uncomfortable sleeping without a pillow, in which case they should use a very thin pillow. But if you can sleep without one, do – it keeps your head level with the mattress surface and the rest of your spine.

With or without a head pillow, stomach sleepers can also benefit from a thin pillow placed beneath the hips to help even out the spine.

The bottom line: Stomach sleepers can benefit from sleeping without a pillow.

What’s the bottom line?

Ultimately, whether or not you choose to sleep without a pillow comes down to your personal preferences and sleep needs. The most important thing is that you find your particular pillow/mattress combination comfortable to sleep on night after night.

However, here are the general guidelines when it comes to sleeping without a pillow:

  • Side sleepers should always use a pillow, and a thick one at that.
  • Back sleepers should sleep with a thinner pillow, although if they are sleeping on a very firm mattress they may find no pillow at all to be more comfortable.
  • As long as they find it comfortable, stomach sleepers should sleep with no pillow at all.

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