For most adults, sleeping without a pillow is not better. Back and side sleepers usually need a pillow to keep the head, neck and spine in a neutral position. Stomach sleepers may feel more comfortable without a pillow or with a very thin one because a thick pillow can push the neck upward while the head is turned to one side.
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Four details usually determine whether sleeping without a pillow works for you: your sleeping position, mattress, pillow height and how your neck feels when you wake up.
Sleeping Without a Pillow: At a Glance
| Sleep position | Usually better choice | Why |
|---|---|---|
| Side sleeping | Use a supportive, relatively thick pillow | Fills the gap between the shoulder and head |
| Back sleeping | Use a low or medium-height pillow | Supports the natural curve of the neck |
| Stomach sleeping | Use no pillow or a very thin pillow | Reduces how far the neck bends upward |
| Infant sleep | No pillow | Pillows and soft bedding increase suffocation risk |
Is Sleeping Without a Pillow Good for Side Sleepers?
Usually not. Side sleeping creates a large gap between the mattress and the side of the head. Without a pillow, the neck can bend toward the mattress, making it harder to keep the head, neck and spine aligned.
A side sleeper generally needs a pillow thick and firm enough to fill the space between the shoulder and neck without pushing the head upward. A pillow between the knees can also help keep the hips and spine aligned.
Your pillow may be too low or too soft if you regularly wake with:
- Neck stiffness
- Shoulder pain
- A head that tilts toward the mattress
- Tingling or discomfort in an arm
- A need to reposition frequently during the night
Is Sleeping Without a Pillow Good for Back Sleepers?
Most back sleepers are better off using a pillow. A pillow supports the small natural curve of the neck and helps prevent the head from tilting backward or downward.
The best pillow is not necessarily the tallest one. Your chin should not be pushed toward your chest, and your jaw should not point sharply toward the ceiling. The pillow should keep your neck in line with your chest and back.
A pillow under the knees may also reduce lower-back strain by helping you maintain a more comfortable spinal position.
Is Sleeping Without a Pillow Good for Stomach Sleepers?
It can be better for some stomach sleepers, but stomach sleeping can still strain the neck and lower back.
Stomach sleepers usually turn their head to one side to breathe. A thick pillow raises the head and increases the bend through the neck. Removing the pillow or using a very thin one may reduce that extra bend.
The neck can still remain rotated for hours, though. Cleveland Clinic lists stomach sleeping as a common contributor to sleep-related neck and back pain. If you can change positions, moving toward side sleeping may be a better long-term option than simply removing the pillow.
If you cannot change position, you might try:
- No pillow or a very thin pillow under the head
- A thin pillow under the hips or lower abdomen
- A mattress that does not let the midsection sink too far
Can Sleeping Without a Pillow Relieve Neck Pain?
Sometimes, but removing a pillow is not a reliable treatment for neck pain.
If your pillow is too high, too firm or poorly suited to your sleeping position, switching to a thinner pillow may reduce morning stiffness. Some stomach sleepers also feel better without a pillow because their neck is not pushed upward.
Back and side sleepers may develop more neck pain without enough support. A pillow that is too low lets the head drop, while no pillow can make that position worse. Research directly comparing pillowless sleep with different pillow designs remains limited, so neutral alignment and morning comfort are better guides than advice telling everyone to stop using pillows.
How to Tell Whether You Need a Pillow
Your pillow is probably helping if:
- Your head stays level with your spine
- Your neck feels relaxed rather than stretched
- You do not wake with new neck or shoulder pain
- You can breathe comfortably
- You sleep through the night without repeatedly adjusting your head
Try changing the pillow before removing it completely. A thinner pillow, an adjustable-fill pillow or a folded towel can help you test a lower height.
When you lie on your side, ask someone to check whether your nose stays roughly in line with the centre of your chest. When you lie on your back, your chin should stay neutral rather than pointing sharply upward or toward your chest.
Who Should Avoid Sleeping Without a Pillow?
Sleeping without a pillow may be a poor choice if you:
- Sleep mainly on your side
- Have recurring neck, shoulder or upper-back pain
- Wake with headaches or arm tingling
- Sleep on a mattress that lets your shoulders or hips sink unevenly
- Have acid reflux or heartburn at night
- Snore heavily or have symptoms of obstructive sleep apnea
Changing your pillow does not treat sleep apnea. Loud snoring, pauses in breathing witnessed by someone else, gasping during sleep and excessive daytime sleepiness should be assessed by a healthcare professional. Sleeping position can affect breathing, and side sleeping is often recommended for people who snore or have sleep apnea symptoms.
What About Babies?
Babies should sleep without a pillow. The Centers for Disease Control and Prevention and the National Institutes of Health recommend placing infants on their backs on a firm, flat sleep surface with only a fitted sheet. Pillows, loose blankets and other soft objects should stay out of the sleep area because they can increase the risk of suffocation and other sleep-related deaths.
This guidance applies to infant sleep. It is different from the guidance for most adults.
The Bottom Line
Sleeping without a pillow usually does not suit back or side sleepers because it can disrupt neck and spinal alignment. It may work for some stomach sleepers, especially when a standard pillow causes neck strain.
Choose the setup that keeps your head and neck neutral and lets you wake without pain. If removing your pillow causes stiffness, headaches, shoulder pain or numbness, stop and try a pillow with a better height and level of support.