Is Your Pillow Giving You Neck Problems?

Photographed by Michael Beckert.
I have a hefty pile of pillows on my bed: a body pillow, throw pillows, feather pillows, and a pillow from Etsy that I had custom-made to look like my dog. But I really only sleep on one, which is a ratty cotton pillow that's flat but perfect for belly sleepers like me. Even though I sleep like a rock most nights, sometimes I'll wake up with a horribly achy neck.
Can sleeping on the wrong type of pillow cause neck pain? Actually yes: Your pillow matters quite a bit, says Raj Dasgupta, MD, FAASM, assistant professor of clinical medicine at Keck School of Medicine at the University of Southern California. Sleep is like a puzzle, with "different pieces that can help individuals obtain that great sleep," Dr. Dasgupta says. One piece of the puzzle might be the lighting and temperature of your bedroom. Your sleep position is another, and you should choose your pillow based on it.
There are three main sleeping positions: back, side, and stomach. Typically, sleeping on your back or side is best for preventing neck pain. "The one position that we don't encourage you sleeping on is on your stomach, even though people do it," Dr. Dasgupta says. When you're sleeping on your stomach you're forced to turn your neck to the side, because you can't sleep buried in your pillow, he says. "And that's where we get a lot of neck pain from." Plus, when you're on your stomach your back also has to be arched slightly, which can result in back pain. Guilty as charged.
Ideally, you should be sleeping on your back with a pillow behind your head, Dr. Dasgupta says. That pillow should allow your neck to be positioned so that you're looking straight at the ceiling. "If the pillow is too fluffy or too big, then you're going to flex your head forward, and it's going to cause some issues," he says. Aim to get a rounded pillow or try a flat pillow with a small neck roll around where your neck would be. When you're choosing a pillow at the store, Dr. Dasgupta recommends leaning on a pillow against a wall and making sure your eyes still face straight forward.
If you're a side sleeper: "There's going to be a gap between your head and the mattress," he says. "So your pillow should serve as a filler to make sure your neck doesn't extend." Some experts say that if you sleep on your side, you should use a pillow that's higher under their neck than it is your head. And Dr. Dasgupta adds that side sleepers should use a firm pillow that can stabilize the neck while you sleep.
As for stomach sleepers, well, we're all screwed — sort of. Dr. Dasgupta says that it is possible to train yourself to sleep in a different position, but most people tend to rotate naturally throughout the night. But it's worth trying to fall asleep on your back or side, to see if that helps quell your neck pain.
There's not one perfect pillow for every type of sleeper, because all bodies are different. Some people might find that firm pillows work best, and others might prefer soft. "Firm and soft are relative terms," and a lot of pillow manufacturers neglect to mention that, Dr. Dasgupta says. In general, it's best to avoid extremes — keep your inner Goldilocks in mind when shopping. "You don't want it too fluffy, or too thin, or too soft, or too firm."
If you are waking up with neck pain, or are unable to sleep through the night on your pillow, then it might be worthwhile to take a look at your sleep environment as a whole and see what needs to be changed. For many people, it might be a sign that you need a different pillow. Even if you are satisfied with a subpar pillow, like I am, it might not be the healthiest option for your neck. Pillows are important to getting a good night's sleep and ensuring that your spine and neck are healthy. Try stretching regularly or seeing a doctor if your pain in the neck persists.

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