Is It Better To Sleep With or Without a Pillow?

Instead of asking yourself do you need a pillow for sleep, you should be asking is does your sleeping position require a pillow for support? The answer depends on whether you are a side, back or stomach sleeper, as each of these positions aligns the body differently and needs a different type of support.

There are a few things that you need to think over and address to ensure a proper base when it comes to sleep. You have undoubtedly heard on countless occasions what a difference a new mattress makes, how quickly it needs replacing, how a special type of pillow cured somebody’s neck pain, etc. If you are moving, have persistent issues or are simply curious about this, you may have found yourself overwhelmed by the sudden surge of information and products you didn’t even know existed. From generic models of bed frames and memory foam mattresses to a million and one other specialty items, there’s a lot to choose from, and the process can seem a bit intimidating at first. After all, everybody seems to own these things, and it’s natural to assume you also need them.

People are not wrong to recommend a lot of these items; a comfortable, sensibly designed and uncluttered environment is essential for establishing and maintaining healthy sleep. But the question might have already crossed your mind – what do you need out of all these things to achieve that goal? Do you even need a pillow?

The question you should be asking instead is, does your sleeping position require a pillow for support? Because the answer mainly depends on whether you are a side, back or stomach sleeper, as each of these positions aligns the body differently and needs a different type of support, or rather, support in a different area. A pillow is sometimes necessary, but sometimes does more damage than good.

We will cover sleeping positions one by one in a second to explain what we mean and offer a couple of possible answers.

Side Sleeping

The universally favorite position occurs in three common forms:

  • Fetal position, curled-up position, with arms in front or under the pillow, and legs bent in the knees. This position is twice as prevalent in women than men and is reported in 41% of people.
  • Log position, featuring straight, stretched out legs and arms naturally falling as if the person was standing up. 15% of people sleep in this position.
  • Yearner position, similar to the log, except here the arms are reaching forward. 13% of people reported sleeping like this.

Sleeping on your side is beneficial for a number of reasons: it prevents sleep apnea, snoring, and acid reflux while keeping the spine aligned with ease. This position is therefore optimal for people with gastrointestinal issues or chronic back pain, as well as pregnant women.

However, the downsides include potential face wrinkling and shallow breathing, although the latter applies only to people who sleep in the fetal position. By pulling the knees too high up, or tilting the head downwards, you are restricting your diaphragm which makes it harder to take deep breaths. Other than this, people who have arthritis also tend to have more issues the tighter they are curled up. Luckily, both of these matters can easily be solved if one only remembers to stretch out a bit more than usual.

Do Side Sleepers Need a Pillow?

The answer, in this case, is: absolutely yes, side sleepers without a dilemma need a good pillow. While sleeping on your side (especially left side) is considered the healthiest way to position yourself, without a combination of proper mattress and pillow support, that claim is out of the window. Without a pillow, your head will pull your neck downwards and out of alignment from the rest of your body, and sleeping on your shoulder is another bad idea – you’re likely to wake up with a numb arm, which is even worse because only one side will be affected.

What side sleepers need is a good contouring mattress that allows the pressure points of your body to sink in, and a thick pillow to lift your head to match the rest of your body. Consider either a cervical pillow or a memory foam pillow, which will have a higher loft right below your neck, and lower under your head.

Beware of pillows that are too thick though, as they will tilt your head upwards and cause issues with your back and neck. A pillow too soft will have the same effect as no pillow at all, so choose wisely and try out different kinds to gain some perspective. The good way to start would be to simply measure the distance from your head to your shoulders, then work your way from there.

Besides the pillow for your head, you might benefit from keeping a thin pillow between your knees to relieve some of the pressure from your hips and keep the spine straight.

What to consider when choosing a pillow as a side sleeper:

  • Material. The variety is more abundant than one might initially think. Down pillows (filled with geese feathers) are durable, adjustable and lightweight, but not very allergy-friendly, affordable, and often aren’t supportive enough for side sleepers. Down alternatives have a shorter lifespan but are less allergenic. Latex pillows provide good support and keep cool during sleep, but the thickness isn’t adjustable. The list goes on and on; you will have some homework to do before you even get to shopping.
  • Thickness. Side sleepers prefer the thickest pillows of the bunch, but that doesn’t mean the super-thick pillow will fit you in particular. Remember that your head shouldn’t be angled in any direction.
  • Price. Depending on the characteristics mentioned above, pillow prices can be very expensive or really cheap. But as you just saw, the most expensive ones (usually down pillows) don’t automatically tick all the boxes when it comes to your specific needs. Good quality pillows can be found in all categories, and it all comes down to finding an option that works for you – that might as well be a cheap polyester pillow, as long as you aren’t compromising something important to fit into the budget.
  • Firmness. Firm pillows are appropriate for side sleepers. They provide the necessary support and don’t flatten out as soon as softer pillows. It is especially remarkable if you are overweight, as your head would otherwise easily sink into the pillow and the whole point of having one would be lost.

Back Sleeping

About 8% of people sleep in savasana or soldier position (arms are down, legs either both straight or one bent), while only around 5% sleep in the so-called “starfish” position, with their arms above the head. Back sleeping is good for preventing neck pain along with the wrinkling that comes from side sleeping (as it keeps the face open). It also prevents acid reflux. It is not difficult to keep the body in a straight line in this position either. However, back sleeping is known to worsen sleep apnea and snoring (which can directly decrease the quality and duration of one’s sleep), as well as cause lower back pain, if not done correctly. We are just about to address that, too.

Do Back Sleepers Need a Pillow?

Once again, yes. Not as firm a yes as in the case of side sleepers, because there are some pillow-free scenarios that could potentially work for back sleepers. Don’t insist on it though, because the number one option definitely includes a pillow, and here’s why:

Back sleepers naturally have gaps between their neck and the mattress and under the lower part of their spine when laying on a firm or innerspring mattress. The lower back gap can be addressed with the help of contouring or memory foam mattresses, as these allow one’s hips to dig a little deeper and straighten the spine. However, the issue with the neck remains, and this is where the pillow comes into play. If you were to sleep without one, your head would dig into the mattress and leave the uncomfortable room, whereas a big, thick pillow would be the opposite extreme as your head would be forced forward and into your chest. Both scenarios could result in next-day pain or stiffness which could easily be avoided by finding the comfortable middle ground.

A thinner, contouring pillow might be the answer here. It will fill the space as needed, but won’t awkwardly angle your head, ensuring good posture and sound sleep. There are plenty of such options to check out between cervical pillows, pillows with built-in neck support, or rounded pillows similar to those one might bring along to a flight or train ride.

Aside from that, a second, small pillow could be positioned under the knees, much like what side sleepers might use as well, to help lessen the pressure from the lower back. Additionally, another good option for back sleepers would be to place the pillow under the lumbar spine to minimize the back strain.

Things to consider when choosing a pillow as a back sleeper:

  • Shape The most common type of pillows has a full or flat surface and a neutral effect on your body, whereas a contoured pillow might be more suitable for people with back or neck pain as they are elevated right below the neck.
  • Price The range of different models’ prices is wide enough to suit everybody’s needs, just be sure to research them beforehand and not settle for low quality because of the low price. In the end, that money will be wasted, and you will have to find another pillow as your problems won’t be solved. Investing a bit in the start will pay off more in the longer run.
  • Thickness Back sleepers tend to go for pillows around 3 inches thick on average. Do feel free to suit yourself though, as other factors like shoulder width, head size, and weight are also important to consider. Having a pillow that’s a bit thinner or thicker might feel more comfortable, and that is not a bad thing. Don’t follow the general rule blindly – it is just the average, after all.

Stomach Sleeping

With the single benefit of preventing sleep apnea and snoring, sleeping on your stomach compromises just about everything else. The cons include face wrinkling, breast sag, neck and back pain, pressure on joints and muscles, as well as the misalignment of one’s spine. As the center of your weight is located in your core, when you sleep on your stomach, it sinks into the bed and creates pressure on the rest of your body. This discomfort causes stomach sleepers to change positions more often during sleep, resulting in a reduced overall quality of sleep for over 7% of people who sleep in this way.

Do Stomach Sleepers Need a Pillow?

We have finally reached the one case in which an individual might actually benefit from not using a pillow. Sleeping on your stomach is generally viewed as the worst sleeping position for your health. This is largely because of the inevitable curving of your neck which steps out of alignment with the rest of your body. Along with the neck and head problems, additional issues can arise if a stomach sleeper uses a mattress that is too soft or too firm – either the pressure points of their body will sink even lower, or their back and shoulders will be pushed too far out and distort the straight line.

Experts often recommend you sleep without a pillow in this case. For some people, though, sleeping without a pillow can seem strange, as we’ve become so accustomed to having at least one, if not more of them on our beds. If you feel this way, simply buying the thinnest pillow you can find isn’t guaranteed to provide optimal results.

If you do opt for purchasing one, we’ve listed some features to look for below. Additionally, whether you end up sleeping with or without a pillow, putting a second, thin pillow below your hips can also prove beneficial when sleeping on your stomach.

Things to consider when choosing a pillow as a stomach sleeper:

  • Thickness – Between 2-5 inches is the preferred pillow thickness of most stomach sleepers. This, of course, also depends on an individual’s weight, shoulder width and so forth, but a pillow thicker than five inches is considered unsuitable here.
  • Price – If you are on a budget, it’s useful information to keep in mind here as well that real down models are typically the most expensive types, while polyester pillows are the cheapest. Before you go shopping, figure out a maximum you are okay with spending and do some research on types of pillows to know what you want.
  • Moldability Because of the frequent position switching and the general discomfort of sleeping on your stomach, this is a key characteristic to consider. If a pillow can’t re-shape efficiently to attend to your needs, it’s a clear sign to avoid it and keep searching. Your head should be in a neutral position, facing forward or downwards, like it would be were you standing up. The curved shape of the pillow, similar to the kind you would lie on while being massaged, might prove useful as it will leave some space between your face and the bed, making breathing easier.


In conclusion, there’s a reason that pillows are so wide-spread, as sleeping without one is a bad idea most of the time. Establishing a proper support for your body during sleep might not seem like such an important thing until chronic back pain or a stiff neck changes your mind, but let’s not wait for that to happen – the urgency of the necessary switch in mattresses or pillows will only rush you and potentially make you settle for less.

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