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Woman rubbing neck pain area

What’s the Best Pillow for my Sleep Position?

by Matt McGowan D.C.

November 2019


I get asked often about the best type of pillow to use at night.  The answer can be complicated because it ultimately depends on how you spend the majority of your night’s sleep.  This can be a difficult thing for a patient to pinpoint as we often flip and flop around throughout the night. For a truly restless sleeper who moves a lot, sometimes the best answer is to have a combination of pillows that fit your various needs.  My advice to patients is to determine what position you wake up in since this is often the position of choice that you spend the majority of your night in.

Here are a few notes on pillow choice based on position:

Back Sleeper:  When lying on our backs we should be able to draw a straight line from out ear through our shoulder, through our hip joint, and through the malleolus (bone that sticks out on the side of your ankle).  Often times back sleepers use too high or thick of a pillow flexing their neck too far forward causing a misalignment in their body. There is certainly a benefit to filling the space in the curve of your neck, but the thickness of the pillow should not displace your head forward of that imaginary straight line.

Side Sleeper:  With side sleeping it is a different imaginary line we are concerned with.  This line starts at your nose and should continue straight and uninterrupted through your sternum (chest plate), belly button, and eventually pubic bone.  In order for this to occur, the thickness of the pillow must offset the distance measured between your ear and the tip of your shoulder. Often times side sleepers go wrong with having too thin a pillow that does not fill the necessary space from ear to shoulder.  In this case, the body often tries to compensate by placing their hand or wrist under the pillow or chin. Conversely you can have too thick a pillow which forces your head to be laterally flexed all night.

Stomach Sleeper:  My first recommendation is always to avoid this position if at all possible.  This position forces you to spend a portion of the night with your head turned all the way in one direction, placing a lot of strain on the muscles of the neck as well as a lot of lateral pressure on the jaw.  Furthermore, it is a bad position for your lower back as gravity will press your lower back further into extension causing a lot of lower back tightness in the morning. If you cannot give up this position, the next best scenario is to have a very thin pillow if one at all, and you can also place a pillow under your hip bones and pelvic area to keep your lower back from hyperextending.

If you find yourself waking up in the morning with more neck tightness or discomfort than you had when you went to bed, it is worth investigating if a more suitable pillow can be part of your solution.  The best way to go about it is to have a spouse or partner look at your sleeping position and check for the lines we discussed. If you fall into a complicated case due to multiple sleeping positions, there are some specialty pillows out there that offer a combination of options.  If you have any difficulty determining if this is an issue for you, any of the chiropractors here at Core Therapies would be happy to help you out.

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