Is It Better to Skip the Pillow? Here’s How to Know if You Should Be Sleeping With a Pillow

Getting a good night’s sleep is important. Sleep affects your mood, immune function, and overall health. Laying your head down on a soft, cozy pillow can seem like a great way to fall asleep. But is it better to sleep without a pillow? That depends on your preferred sleeping position and if you have other medical conditions. 

Let’s look at the benefits of sleeping without a pillow, and when using a pillow is beneficial. 

What are the benefits of sleeping with a pillow?

There can be benefits to sleeping with pillows. When used properly, a pillow helps support your spine and improves breathing and circulation while you sleep. How well a pillow does these things depends on things like: 

• Pillow height or “loft”

• Pillow firmness, often determined by the type of material inside a pillow

• Pillow shape

Here are some possible benefits to sleeping with a pillow.

Less neck pain

Pillows can be used to support good head and neck alignment. When the spine is aligned, muscles in the neck and shoulders can relax. This can lead to a better night’s rest and less neck pain and stiffness in the morning. 

If you’re a side sleeper, using a pillow can help maintain your neck alignment. Side sleepers may find that using a thick, firm pillow reduces neck pain by keeping the head supported and in-line with the rest of the body.

Improved breathing 

Pillows can also be positioned to keep your throat open and improve breathing overnight. One study found that using pillows can reduce snoring and help people with obstructive sleep apnea (OSA). 

In OSA, the throat becomes blocked off during sleep. This can cause people to stop breathing for brief periods of time and lead to interruptions in sleep. There’s evidence that some pillows can help reduce the frequency of these episodes.

Less heartburn

Another common condition that can interrupt sleep is heartburn from gastroesophageal reflux disease (GERD). People with GERD experience pain and heartburn when acid in the stomach moves backward (refluxes) into the throat. 

GERD symptoms can get worse when you’re trying to sleep. That’s because lying flat makes it easier for food to reflux. If you’re struggling with GERD, experts recommend elevating the head of your bed or using a wedge pillow to raise your head and chest. These position changes can reduce heartburn. 

What are the benefits of sleeping with no pillow?

Most people like the comfort of a pillow when going to sleep. But there are situations in which using a pillow can interfere with sleep or make other health conditions worse. Let’s look at some of the benefits of sleeping without a pillow.

Improve allergies

The last thing you want to deal with when you lie down to sleep are itchy, watery eyes, sneezing, and a runny nose from allergies. Unfortunately, pillows can collect dust and other allergens. And some pillows are made from materials like feathers or down that can trigger allergies. While allergies to feathers are rare, people can have allergic reactions to the dust mites or bacteria that may contaminate the feathers. Sleeping without a pillow can eliminate those exposures and ease allergy symptoms.

Better skin

Pillows may also carry bacteria, dead skin cells, or residual hair care products. These things might make it more likely for you to develop pimples and blackheads — especially if you have acne-prone skin. Plus, some research shows that wrinkles can develop due to skin compression while sleeping. But it’s not clear yet how much pillow use affects this. 

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Effects on posture 

For some people, sleeping with no pillow can help with sleep posture. This is particularly true for people who sleep on their stomachs. 

For stomach sleepers, pillows can cause the head and neck to overextend (bend too far back). So, sleeping with no pillow can improve neck and spinal alignment for stomach sleepers.

How to use a pillow if you’re a side sleeper

Most people sleep while lying on their side. And this position is recommended for people who are in the second or third trimester of pregnancy. Side sleeping can also help reduce snoring. 

Side sleepers need to keep the neck's natural curve in line with their spine and hips. Finding the right pillow can accomplish that. 

Side sleepers should look for firm pillows that are high enough to keep the head in line with the neck and spine. Side sleepers usually like medium to high loft pillows, which are about 4 to 6 inches in height. A firm material like latex or memory foam often provides the proper support for the head and neck.

How to use a pillow if you’re a stomach sleeper

Stomach sleepers often turn their head to the side during sleep to breathe. This can cause the neck and spine to twist. Adding a pillow under your head in this position can cause your neck to overextend (bend too far back), which can lead to neck pain.

For this reason, many stomach sleepers choose not to use a pillow. If you do use a pillow as a stomach sleeper, pick a thin pillow with a soft, compressible material. Latex or down pillows work fine if you don’t have any allergies.

How to use a pillow if you’re a back sleeper

Pillows for back sleepers should align the neck with the spine so the head doesn’t push too far forward or fall too far back. 

Back sleepers should look for a medium loft pillow. This is a pillow that’s about 3 to 5 inches high. Many back sleepers prefer a pillow that has medium firmness. The best material will depend on how dense a pillow is packed, and a personal preference for how the pillow feels.

Should you use a specialized pillow?

Specialized pillows have a shape that helps maintain a particular sleep position. People with certain health conditions may benefit from using a specialized pillow.

Knee pillow

Knee pillows are specialized pillows kept between the knees while you sleep. They have hollowed-out sides of various sizes so your legs can rest comfortably within the pillow.

Knee pillows have certain advantages:

• They keep pressure off your knees.

• They help maintain alignment of the spine and hips.

• They’re less likely to shift while sleeping as opposed to using a regular pillow.

People who might benefit most from a knee pillow include:

• Side sleepers

• Pregnant people

• People with lower back pain or sciatica

Neck/cervical pillow

Cervical pillows are designed to support the neck and keep it in a neutral position. Cervical pillows are often made of memory foam and shaped to follow the natural curve of your neck. People use cervical pillows to prevent or treat neck pain.

There’s mixed evidence about how effective cervical pillows are. Individual studies looking at the effects of cervical pillows in people with neck problems found cervical pillows to be helpful. But a review of multiple studies didn’t find enough evidence to conclude that cervical pillows helped with neck pain.  

Wedge pillow

Wedge pillows are a triangle-shaped pillow that can be adjusted to elevate your upper or lower body at various angles. Sleeping with a wedge pillow can help people with respiratory, stomach, or musculoskeletal issues. Both back and side sleepers can use wedge pillows.

You may want to try using a wedge pillow if:

• You have heartburn. Wedge pillows can help prevent stomach acid from coming up the esophagus during sleep. 

• You have sleep apnea. Studies show that sleeping with the head of the bed elevated improves symptoms of sleep apnea. You can achieve the same effect in a regular bed using a wedge pillow. 

• You have sinus issues. Whether it’s a cold or a chronic problem with nasal congestion, sleeping with your head and chest elevated on a wedge pillow can help relieve sinus pressure. 

• You have back pain. Wedge pillows can be placed both behind the back and under the knees. This placement helps take the strain off the lower back and can improve back pain. 

• You have lower leg swelling. If you have problems with edema (swelling) in the legs, your healthcare professional may recommend elevating your feet when lying down. A wedge pillow can be a comfortable way to prop up your legs. 

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Written by:

Brian Clista, MD

Dr. Clista is a board-certified pediatrician who works in private practice in Pittsburgh, Pennsylvania. He previously served as a National Health Service Corporation Scholar in the inner city of Pittsburgh for 11 years.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

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