What Is the Best Pillow and Sleeping Position? A Chiropractor’s Guide to Sleep and Spine Alignment

The Importance Of Healthy Sleep Posture

As chiropractors, two of the most common questions we hear are: What is the best pillow? and What is the best sleeping position? The reason these questions come up so often is that many people wake up with pain that wasn’t there the night before. While there are certainly good and bad sleeping positions, as well as good and bad pillows, the answer to these questions is more complicated than it may seem. Multiple factors influence the best choice for each person, including body type, posture, past injuries, mattress type, and personal preference.

The Importance of Sleep and Spinal Alignment

Before discussing pillows and sleeping positions, it’s essential to understand the importance of sleep and spinal alignment. Quality sleep allows the body to recover and heal, and maintaining good spinal alignment throughout the night reduces the risk of waking up with stiffness or pain. Poor alignment during sleep can place stress on the muscles, joints, and nerves, leading to discomfort that persists throughout the day.

How to Choose the Right Pillow

The ideal pillow supports the natural curvature of the neck and keeps the spine in neutral alignment. However, the best pillow for one person may not be the best for another. Here are a few key considerations:

• Body Type and Shoulder Width: Individuals with broad shoulders who sleep on their side need a thicker pillow to keep their neck aligned. A pillow that is too thin will cause the head to tilt downward, straining the neck.

• Sleeping Position:

  • Side Sleepers should choose a pillow that fills the gap between the head and shoulder to keep the spine straight. A pillow between the knees can also help keep the hips and lower back aligned.

  • Back Sleepers generally need a thinner pillow to prevent their head from being pushed too far forward. However, those with an exaggerated upper back curvature (hyperkyphosis) may require a slightly thicker pillow to support their posture.

  • Stomach Sleeping is generally not recommended, as it forces the neck into excessive rotation, leading to strain over time.

• Neck and Upper Back Posture: Individuals with hyperkyphosis but narrow shoulders may need a thicker pillow for back sleeping and a narrower pillow for side sleeping to maintain proper alignment.

Sleeping Position and Lower Back Support

Neck support isn’t the only factor—hip and lower back alignment are just as important.

• Side Sleepers: Most side sleepers benefit from using a pillow between the knees. Those with wider hips may need a firmer and thicker pillow for better support, while those with narrower hips may be comfortable with a softer or thinner pillow.

• Back Sleepers: Individuals with an exaggerated lumbar curve (hyperlordosis) often feel more comfortable sleeping with a pillow under their knees. This slight elevation helps reduce excessive arching of the lower back and minimizes strain.

Finding What Works for You

Since every person’s body and sleep habits are unique, the “best” pillow and sleeping position vary from person to person. The key is to maintain proper spinal alignment and ensure comfort throughout the night. If you frequently wake up with pain, consider adjusting your pillow, sleeping position, or mattress to better support your body’s needs.

If you need personalized recommendations, we’re happy to help! At Evergreen Spine & Sports Medicine, we assess posture, sleep habits, and musculoskeletal health to guide you toward better, pain-free sleep.

Personal Note From Dr. Gonzales

What do I use?  I am a very average size woman with no major preexisting conditions of the spine or abnormal spinal curvature.  I use a firm memory foam mattress, a small memory foam cervical side sleeper pillow, and a king size body pillow between my knees and to hug.