How to Position Your Head on the Pillow: Proper Sleep Posture for Maximum Comfort

If you’re experiencing back pain when you wake up in the morning, you might think it’s time to buy a new mattress. While a quality mattress plays a key role in your comfort, both while you sleep and when you’re awake, your sleep quality and comfort don’t depend on your mattress alone.

Your pillow can also impact your sleep quality and your overall comfort. Choosing a quality pillow is an important first step, but it’s equally as important to understand how to position your head on a pillow.

I’ve experienced this issue firsthand. I live with a chronic condition that causes lower back pain, so when I upgraded my mattress, I noticed a significant improvement in my back pain. However, if I’m not careful about how I position my head on my pillow, I can experience neck stiffness and pain, and even an increase in lower back pain.

To get to the bottom of how to position your head on a pillow and why this position matters so much, I talked with several experts. Read on to learn the essential details of sleep ergonomics, how to position your head on a pillow, and how to choose the pillow that’s right for you.

Understanding sleep ergonomics

Payal Sahni, PT, DPT, MPT, and lead Physical Therapy Supervisor of Outpatient Services at Helen Hayes Hospital explains that sleep ergonomics can impact you in many ways. “Sleep ergonomics is the science of creating optimal body alignment by modifying the immediate external environment,” Dr. Sahni says. Creating that optimal alignment can help to prevent pain, enhancing the quality of your sleep. “Often described as ‘re-charging’ and ‘healing’ of one’s mind and body, the quality of sleep has a major impact on an individual’s physical and psychological state,” she explains.

When sleep ergonomics don’t allow you to get quality sleep, you could experience many issues.

Increased cortisol

Jenny Fritts, DPT, is a physical therapist at Mercy Medical Center. “When sleep quality reduces, this affects a number of things, but I explain to my patients the most impactful thing it can do is cause your cortisol levels to remain high if you do not get good quality sleep,” says Dr. Fritts. That higher cortisol level increases inflammation in your body, and that can increase swelling and puffiness throughout your face and body. It can also exacerbate pain. “It also affects your mood, and keeps your body in a constant on-edge state,” says Dr. Fritts.

Pain and stiffness

Sean Ormond, MD, dual board-certified in anesthesiology and interventional pain management, is a Medical Doctor and Pain Specialist at Atlas Pain Specialists. He explains that sleep ergonomics are crucial in maintaining spinal alignment, reducing pressure points, and alleviating discomfort. This is particularly important for people with chronic pain conditions.

“By addressing factors such as pillow selection and sleeping position, individuals can mitigate pain, stiffness, and other sleep-related issues,” Dr. Ormond says. However, poor sleep ergonomics can make pain and stiffness worse.

Mood and cognitive changes

Anita L. Davis, PT, DPT, FNCP, is a physical therapist at Brooks Rehabilitation. She explains that since sleep deprivation can lead to hormonal changes, it can also affect your mood. “It doesn’t take long for the best of us to simply get ‘cranky’ with one or two nights of poor sleep,” she says.

Additionally, poor quality sleep can impact your cognitive skills. “Our decision making and thought processing is slowed and maybe less accurate when it comes to ‘executive skills’ critical discernment,” says Dr. Davis.

Additional potential health issues

Dr. Sahni notes that sleep can impact individuals differently depending on their age. “Poor sleep quality can cause behavioral problems, anxiety, and attention deficits in children, affecting learning,” she says. In contrast, adolescents experiencing lack of quality sleep can result in inattention, chronic fatigue, memory deficits, and depression. Older adults with poor quality sleep may see increased risks of falls or stroke, balance deficits, and social withdrawal.

The role of pillows

Support

Dr. Ormond explains that pillows are essential in supporting the head, neck, and shoulders while you sleep, and that helps to create spinal alignment.

Comfort

“The right pillow can alleviate pressure points, reduce strain on neck muscles, and enhance overall comfort,” he says. “Conversely, using the wrong pillow or improper positioning can lead to neck stiffness, headaches, and discomfort.”

Choosing the right pillow

Since pillows are so important to quality sleep and your health, it’s important to choose a pillow that’s right for you. Dr. Sahni notes that the best pillow for your needs will largely depend on your sleeping position. “Whether you are a side sleeper or you prefer sleeping on your back or stomach, the goal must always be to maintain correct head and neck alignment that will promote muscle relaxation, and hence improve sleep quality,” she explains.

As you shop for a pillow, consider the amount of height you need. For example, if you sleep on your stomach, you will need a very thin pillow to keep your neck and spine aligned. But if you sleep on your side, you’ll need a thicker pillow to support your head so that your neck doesn’t curve down toward the bed.

I’ve highlighted some of the common pillow types that are best for different types of sleepers, as identified by experts.

Pillows for side sleepers

Dr. Sahni notes that a firm, contoured pillow may be a better choice for side sleepers. The pillow is raised on one side to conform to the neck, and it holds the head and neck parallel to the bed.

Fritts notes that these curved or indented pillows that are contoured for a person’s head and are often made of memory foam. Some also have a cutout for your shoulder, and these are popular pillows for neck pain. “The contoured ones are really good for those that need optimal support,” she says, including people with a history of head, neck, or shoulder injuries. Older individuals with arthritis and overall increased fragility may also find contoured pillows ideal.

Pillows for back sleepers

If you sleep on your back, a medium-firm pillow may be the right choice and provide the support that you need. “This type of pillow produces slight extension of your neck and cervical spine, reducing neck muscle activity and [resulting] in improved sleep quality,” Dr. Sahni explains.

Pillows for stomach sleepers

If you sleep on your stomach, a soft or feathered pillow may help to prevent excessive neck tension and resulting muscle tightness, according to Dr. Sahni. These softer types of pillows compress more than firmer pillows like those made of memory foam, and if you sleep on your stomach, this compression can help to keep your spine aligned.

Pillows for those with allergies

Ormond highlights the fact that it’s also important to consider whether you have allergies, which may make some pillow types, like down pillows, impractical. “[Latex pillows] offer a responsive and supportive surface, suitable for those with allergies or sensitivity to synthetic materials.”

How to start your search for a pillow

The above advice may help you to narrow down your options to the right type of pillow for your sleep position, but it’s still important to choose the right thickness to support your head and neck. Dr. Davis explains that a pillow should help to fill the gap between your shoulder and head.

Dr. Davis recommends that you place a towel roll in the bottom of your current pillow, inside the pillowcase. The towel helps to create the support between your head and neck, replicating how your new pillow should feel. “It may take a couple of nights to find the right size of towel roll that feels most comfortable,” says Dr. Davis. However, taking the time to find the right height that you need can help you to identify the height and contour that you need in a new pillow.

Dr. Davis notes that you should pay attention to whether you’re tempted to pile on extra pillows, which can prop up your head but add extra strain and neck pain. “Sometimes the attempts to add more pillows are unknowingly done to support the neck,” she says. If you’ve used multiple pillows for years, you may need to gradually start using thinner pillows and slowly remove that extra pillow before you can adjust to a different sleep position.

How to position your head on a pillow

Just as you need to select a pillow based on your sleeping position, how you position your head on a pillow also differs depending on how you sleep.

Back sleepers

Fritts recommends that back sleepers make sure their cervical spine and neck are as neutral as possible. “You don’t want your pillow pushing your chin towards your chest too much, but you need to have enough support that your head is not falling back too much,” she explains. The best pillow for back sleepers should support the gap between your head and shoulders, and the bottom of the pillow should start just above your shoulders.

She notes that you may want to put a pillow under your knees, too, which can help to keep your entire spine aligned.

Side sleepers

If you sleep on your side, it’s also important to establish a neutral spine and neck alignment. “You don’t want your head pushed too much to the left or right,” she says. “It should be as flat and neutral as possible.” The pillow needs to support the gap between your head and shoulders, and it should start just above your shoulders.

You may also want to place a pillow in between your knees, which helps to keep your spine in alignment.

Stomach sleepers

“This is overall a tough position and not ideal for any segment of your spine,” says Dr. Fritts. If you need to sleep on your stomach, Fritts recommends slightly turning to one side or the other to avoid putting too much strain on your neck. “Place a pillow under your hips as well, if you can,” Dr. Fritts recommends. “Your neck will not be in neutral alignment unless you have a pillow with a face cutout and can sleep face down, however, rarely do people find this comfortable for sleeping.”

Like the other positions, your pillow should not start any lower than your shoulders.

Common mistakes to avoid

As you shop for a pillow and focus on how to position your head, be sure to avoid these common mistakes.

Not supporting the entire neck

Dr. Sahni notes that it’s common for people to not support the entire length of their neck on the pillow. “This happens when the head is positioned too far down the pillow,” she says. Sleeping without your neck supported can interfere with your head and neck alignment and result in excessive neck muscle activity.

Placing the shoulders on the pillow

Dr. Sahni explains that many sleepers place their shoulders on the pillow. Doing so can raise the torso and impact the head and neck alignment. Your pillow should start just above your shoulders.

Choosing a pillow that’s too fluffy

Dr. Fritts explains that a pillow can be too fluffy. “Some people believe that the fluffier the pillow, the better,” she says, but a pillow that’s too fluffy can create extra stress on your neck. “It’s about finding the perfect balance between fluffy and neutral,” Dr. Fritts says.

Using a pillow that’s too old

Dr. Davis notes that pillows wear out and our bodies change over time. “The pillow from a few years ago may not ‘fit’ now like it used to,” she says. Dr. Davis explains that it’s reasonable to replace pillows every four to five years if your comfort and sleep issues have changed.

Transitioning to the correct position

Supportive pillow

Old habits are hard to break. If you’ve been sleeping with a pillow in an incorrect position for years, you’ll need to slowly transition into the correct position. Dr. Fritts recommends starting with a supportive pillow that’s right for your sleep position. Then, start each night off with the pillow in a correct or more optimal position.

Creating a new habit

“If you turn in the middle of the night, give yourself some grace,” she says, since it will take your body time to develop the habit of sleeping in that new position. If you find that you’ve moved in the middle of the night, Dr. Fritts recommends trying to change back to the correct position. “It may take a month or so for it to become more of a habit for the body in that position,” she says.

What about a supportive mattress?

In addition to finding the right pillow for your sleep style and positioning your head on the pillow correctly, a supportive mattress promotes correct spinal alignment and can help to relax the muscles along your spine. “A mattress that helps to maintain normal curvatures of thoracic and lumbar spinal regions and conforms to the body may improve sleep duration and quality,” says Dr. Sahni.

Dr. Fritts recommends that you test mattresses in a store to determine which ones you really like and which is the best mattress for you. “Sometimes mattresses that are too firm hurt your shoulders and hips, as they do not contour around the joints as well as a softer alternative,” she explains. But at the same time, a mattress that’s too soft can lack support, so finding a good mattress is a matter of finding a good balance.

She notes that you can adjust your pillow choice based on the mattress to improve your sleeping posture. “A firmer mattress may need a fuller or fluffier pillow, whereas a softer mattress may be matched with a flatter or thinner pillow for good posture,” Dr. Fritts says.

Frequently asked questions (FAQs)

Where should your neck be on a pillow?

According to Dr. Sahni, it’s important to use your pillow to support the entire length of your neck. Dr. Fritts recommends adjusting your pillow so that the bottom of the pillow comes to the top of your shoulders, which provides the best neck support.

How far up should your head be on a pillow?

Your head’s position will depend on your neck support and the size of your pillow. Position your head so that your entire neck is supported by the pillow, recommends Dr. Sahni.

Should my shoulders be on my pillow?

According to Dr. Davis, unless you have a medical condition like reflux, your pillow should start at the top of your shoulders. This position allows it to support your head and neck without elevating your whole torso.

What is the healthiest sleeping position?

Dr. Sahni explains that the healthiest sleeping position is one that encourages good quality sleep, and that position can be different for every individual. “However, some sleeping positions are more beneficial than others and may be recommended by your health care providers based on your specific medical needs,” she explains.

Dr. Sahni notes that pregnant women are often advised to sleep on their left side after the second trimester, which promotes optimal blood circulation. Those with breathing problems are often advised to avoid sleeping on their stomach or back in order to promote optimal oxygen levels. “It is best to get in touch with your health care provider to discuss the best sleeping position for you,” she recommends.