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Do you really need to sleep with a pillow?

We have the facts about how pillows help you sleep.

Black man sleeping peacefully with pillow Credit: Getty Images / Fizkes

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It’s hard to imagine a bed without pillows. Be it at a hotel or in a movie or ad, a standard bed nearly always has two pillows propped against the headboard. Some are even covered in dozens of decorative cushions. This might raise the question, is sleeping without a pillow a problem?

For most people, the answer is “yes,” according to sleep experts, for the simple reason that an unsupported head can cause neck and back pain, or worse. Here’s why you probably need a pillow—and how you might go about finding one that works for you.

Pillows can keep your spine aligned

a woman sleeps happily in blue pajamas on white sheets
Credit: Getty Images / FreshSplash

A good pillow might help reduce back or neck aches.

The sleep experts we spoke with agreed that pillows aren’t purely decorative. “Pillows are an integral part of sound sleep and healthy sleep,” says Dr. Paul Schalch Lepe, a head-and-neck surgeon and sleep specialist at UC San Diego Health. He adds that pillows are often neglected as part of improving sleep quality and treating sleep disorders.

By keeping your neck and spine in a more neutral alignment, pillows can help alleviate and prevent musculoskeletal discomfort, according to Catherine Siengsukon, a physical therapist and director of the Sleep, Health & Wellness Lab at the University of Kansas Medical Center. “We've all had the experience where we do sleep in an uncomfortable position and then wake up with neck pain,” she says.

Pillows aren’t just for heads and necks either. Some side sleepers benefit from placing a pillow between their knees to keep their lumbar spines in a more neutral position, Siengsukon says. People who sleep on their backs might feel more comfortable with a pillow under their knees.

You can test these out yourself, or consult with a physical therapist to help you figure out which pillow positioning will work best for you.

Not every sleeper needs the same type of pillow

someone sleeps on their side in bed
Credit: Getty Images / Svitlana Hulko

Side sleepers might prefer a different pillow than back or stomach sleepers.

Pillows under the head might be particularly beneficial to side sleepers, Siengsukon says. If you lie on your side without a pillow, your shoulders and torso will keep your spine higher than your head. This means your head will likely tilt down toward the mattress and your neck won’t be in alignment with the rest of your spine. This sort of position could cause discomfort or soreness.

As for back sleepers, a too thick pillow can tilt a person’s head forward and narrow their airway, Siengsukon says. This can be a problem for people with certain sleep conditions such as sleep apnea.

She says stomach sleepers can probably get away with not having a pillow or opting for a thinner pillow. But she cautions that this position sometimes leads to increased head rotation as a stomach sleeper tries to avoid getting their face squished into a pillow or mattress. As a stomach sleeper, Siengsukon uses a thinner pillow and sleeps with her face on the side of the pillow.

But the relationship between pillows and sleeping positions can be complicated when people move around in the middle of the night. “A great pillow for [side sleeping] might be too thick if you roll over onto your stomach,” Siengsukon says.

Schalch Lepe has seen stomach and back sleepers struggle with sleep apnea and other sleep issues. He generally recommends sleeping on your side, adding that pillows can be used in sleep therapy to encourage patients to move away from their natural positions.

Get advice on your ideal pillow

a man sleeps on the coop home goods pillow
Credit: Reviewed / Betsey Goldwasser

The Coop Home Goods pillows are comfortable and supportive. We don't think you can go wrong with either model.

Having a good pillow may be important for comfortable sleeping free of aches and pains. Research suggests that using less comfortable pillows might be tied to poorer quality sleep. Some evidence indicates that certain pillow characteristics, such as those made of latex, might be more beneficial to sleepers. (Siengsukon says this could be because latex pillows are firmer and provide more support.)

For anyone hoping to improve their night’s rest through the benefits of sleeping with a pillow, try getting advice from the brand you’re shopping with. “More and more sleep stores are developing ways of having a pillow specialist to try to find the right pillow,” Schalch Lepe says.

“[The] wrong pillow could potentially cause, over the long run, neck pain, shoulder pain, [and] discomfort, but in the short term it could disrupt sleep,” he says. “If someone is tossing and turning and waking more frequently due to issues with body and neck position... then it is really having a direct impact on the quality of sleep.”

If you don’t have any sleep- or back-related health conditions, you can do some good ol’ trial and error to find the most comfortable pillow for you. In Reviewed’s tests to find the best bed pillows, we landed on the Coop Home Goods pillows as the best overall pick. In addition to a complimentary “pillow concierge,” the brand offers a 100-day return window. Gently used pillows are donated to charities, and customers are granted a full return.

Beyond the generous policies, we’re big fans because you can add or remove the pillow’s stuffing to get a personalized level of support. Even still, the company makes two versions—the Original for side sleepers and the Eden for stomach or back sleepers—because even an adjustable pillow may not not be one-size-fits-all. And while we haven’t tested them, Coop also offers accessory pillows for knees and backs.

But the perfect pillow may not be a silver bullet solution for better sleep. Siengsukon says she worries that insomnia patients are sometimes told they need a specific product like a pillow or medication to sleep well. “I try to stay away from saying you need this one product to help you sleep,” she says. “It’s never that simple or easy.”

She adds that whether you use a pillow will ultimately boil down to your own preference, spine anatomy, and history of discomfort and pain.

If you struggle with insomnia, neck discomfort, or sleep apnea, you should consult a doctor or physical therapist about what steps you might take to improve the situation, and whether or not that includes getting a new pillow.

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