Is Sleeping Without a Pillow Good or Bad for You?

Reviewed by Dr Seeta Shah, Medical Doctor & Nutritional Therapist, The Green Doctor

For some, they cannot go anywhere without it; others can have up to three, and then there are a few who can forgo it completely. We’re talking about pillows, of course. But what is the best option for your well-being? To pillow or not to pillow? That is the question.

Pillows prop you up; in essence, they function to support your head and neck to provide neutral spinal alignment. It’s an important function as it’s estimated that 40% to 70% of people will have at least one significant episode of neck pain at some point in their lives. Whether you plump for a pillow is dependent on a few factors. You need to consider the following: 

• Your sleeping position
  
• Body shape
  
• Any symptoms you experience when you're asleep, such as snoring or neck pain
  

It’s not necessarily important to have a pillow, but when lying in bed, your head should be level with your torso to benefit your spine and posture. For those of you who suffer from neck aches, a pillow will help alleviate the pain: the NHS advises a low, firm pillow. 

Our sleep panel expert, Dr Seeta, believes that your sleeping position is an important factor in considering the need for a pillow in bed:

“This all depends on the positioning of your neck when you sleep. For people who sleep on their stomachs, not using a pillow may help keep the spine in a more natural alignment. However, for back or side sleepers, going without a pillow can strain the neck and shoulders, leading to discomfort over time. As with anything, my advice would be to listen to your body and see what works best for you.”

Is sleeping without a pillow good for stomach sleepers?

Front or stomach sleepers don’t need height when sleeping, so they should aim to sleep without a pillow – or opt for a super thin, ultra-low pillow. To make this position more comfortable, it’s advisable to place a pillow under the pelvis or lower belly to flatten the lower back curve and ease strain on the lumbar region. In the long term, it’s best for stomach sleepers to try to transition away from this position due to the strain it can place on the back. 

What happens to your neck without a pillow as a side sleeper?

This is the go-to sleeping position for most of us, and side sleepers do need a pillow. Apart from comfort, its main purpose is to bridge the gap between the ear and the mattress when lying on your side. Finding out your loft height (ear to shoulder tip distance) is a reliable measurement of the pillow you need: 

• Those with broad shoulders should look for a firm pillow with a higher loft (about 10-13cm / 4-5in)
  
• A smaller frame should look for a medium loft (about 7-10cm / 3-4in)
  

Another way to find out the size of the gap is to take a selfie of your body in the sleeping position to determine your loft height. The general mattress rule is that if you have a soft mattress, you’ll need a low pillow, and a firm mattress needs a high pillow. If you don’t have a pillow and you prefer to sleep on your side, you could be heading for trouble, as this causes your neck to bend and shoulder loading. The consequences are neck pain and back aches.

What happens to your neck without a pillow as a back sleeper?

Back sleepers should not rely solely on their mattress for support; instead of no pillow at all, a thinner one is recommended. Even though it’s thin, the sleep solution should not be an entirely flat pillow because your head is likely to tip backwards. Memory foam options can contour to your sleeping position to provide optimal support. Look for low and medium-profile pillows to avoid neck overextension.

Below is an overview of why each sleeping position needs support for their head and neck:

• back sleeper (head drops back, cervical curve unsupported)
• side sleeper (head drops toward shoulder, neck bend)
• stomach sleeper (slightly better than with a thick pillow)

Signs your pillow is causing your neck pain 

If your pillow isn’t supportive enough for your sleeping position, you will experience discomfort or even pain. Below are the seven most common signs you’re not getting the support you need:

• If you wake up with stiffness in your neck, which then eases throughout the morning. This indicates that your muscles have been strained during the night
• Experiencing headaches which start at the base of the skull shows there’s neck strain from poor overnight support
• A shoulder ache on your sleeping side reveals that your pillow is likely to be too low, with pressure on your shoulder
• If you fold your pillow in half, it shows that you need more support, and it's likely your pillow has lost structure
• Visible flat spots, lumps, or yellowing are all signs that the pillow needs replacing
• Your pillow is over two years old, and after this time, even quality fill can lose support
• You find you sleep better on hotel pillows or when you’re not at home
  

How to choose the right pillow height to prevent neck pain

Our table below shows the neck pain if your pillow is either too high or too low:

Is it actually better for your neck to sleep without a pillow?

For most people, the answer is no. The only exception is for stomach sleepers, for whom any pillow height increases the risk of neck rotation damage. Sleeping on your side requires a pillow tall and firm enough to fill the ear-to-shoulder gap created in this position. The morning after sleeping with a pillow can provide an indication of its effectiveness. 

Dr Seeta agrees, advising that for some, going without a pillow can provide relief:

“It can help in some cases, particularly if you sleep on your stomach, as a pillow can cause your neck to bend unnaturally. Without a pillow, your head stays closer to the mattress, which may reduce strain and ease any tension. However, if you sleep on your back or side, not using a pillow might worsen neck pain due to a lack of support for your head and neck.“ 

The desire to sleep without a pillow usually means the current pillow is wrong, not that pillows themselves are the problem. The solution is a better pillow, not no pillow.

Does a no-pillow bedtime help with snoring or breathing? 

If you snore, have sleep apnea, or have acid reflux, the zero-pillow approach is not a good idea. If you suffer from these conditions, you need elevation during the night, and therefore you shouldn’t go without a pillow. Dr Seeta suggests that a pillow sometimes helps prevent snoring:

“For some people, sleeping without a pillow may improve breathing slightly by keeping the airways more open. However, most people benefit from a pillow that supports the head and keeps the neck aligned, which can also reduce snoring.”

When you’re on your back, lying flat means the tongue and soft palate fall backwards, narrowing the airway. A thin pillow or slight elevation keeps the airway more open. However, on your side, you generally need a pillow to keep your neck neutral; without one, your head droops, which can also narrow the airway. 

There is a group who are an exception to the pillow rule. Stomach sleepers who snore can go without a pillow or use an ultra-thin one.  

Who should never use a pillow?

Babies up to 12 months don’t need a pillow, and for safety reasons, they shouldn’t have one. At this age, they’re more likely to be at risk of suffocation at night. As mentioned, those who sleep on their front will benefit from going without a pillow. Dr Seeta explains that having no pillow is best for these groups:

“Those who consistently sleep on their stomachs might be better off without a pillow, as it prevents excessive neck twisting. People with neck, shoulder, or back problems should not give up their pillow without consulting a doctor or physiotherapist first. Infants should also never use pillows due to the risk of suffocation.”

If you’re suffering a neck injury, acid reflux or you’re pregnant, you should consult a clinician on your best bed set-up – but a pillow is highly recommended. We’ve provided advice on how to get the most out of a cushioned companion.

Acute neck injury: If you’re a back sleeper, opt for a thin pillow. Side sleepers should have a medium to firm pillow that exactly matches their shoulder width.

Reflux: a pillow plus a wedge so the torso is elevated on the left side if possible.

Pregnancy (trimester 2–3): a side-sleeper should have a head pillow and a body/knee/bump wedge; add a torso wedge if you’re suffering from reflux.

How to test “no pillow” safely 

If you’re unsure of the pillow you need, or you think you can go without, conduct a three-night experiment. This uses materials which mimic a pillow and assess how you feel the next morning. Below is how to conduct the test depending on your position:

• Back sleepers – place a rolled towel in the pillow case under the neck, and adjust its thickness until your neck feels better the next day.
• Side sleepers – trial a rolled-up T-shirt and compare it with 1-2cm of foam, then see which improves symptoms of neck pain as an indication of pillow support.
  
• Front sleepers - try a body pillow at mid-section to reduce twist, as this helps to train you into a side sleeping position.
  

Keep a journal beside your bed so you can track your symptoms; if your neck or shoulder pain gets worse with this method, you should not continue.

How to choose the right pillow (if “no pillow” isn’t for you) 

Let’s face it, with all the options on the market, poor pillows shouldn’t come between you and a good night’s sleep. If you’re used to having a pillow to rest your head on and you don’t like to go without, you need to consider which one is most aligned with your comfort and needs. When you’re asleep, the aim is to have your head level with your spine. If you’re on your side, this pillow should have an adjustable or higher loft to fill the gap between your shoulder and the mattress. If you like to sleep on your back, choose a low, contoured pillow to avoid extension. Stomach sleepers should try to find a pillow setup that transitions from lying on their front to a side sleeping position.

Designed to take the weight off your shoulders, our Memory Foam Bamboo Pillow features orthopaedically approved memory foam which contours to your sleeping position. Keeping your head and neck in perfect alignment, it’s wrapped up in a super soft breathable bamboo cover. 

If you’re suffering from neck or shoulder pain, our Hybrid Bamboo Pillow features our innovation, CharcoCell Foam™ – a unique bamboo charcoal infusion with pressure-sensitive, 3rd-generation memory foam that provides personalised, targeted support and alleviates aches.

Conclusion

Pillows can be an effective sleep aid for achieving a better night’s sleep, but only if they provide neutral alignment. To recap, side and back sleepers need a highly supportive and contouring pillow to fill in gaps and prevent hyperextension. Stomach sleepers are best suited to having a slim pillow or even none at all. If you sleep on your front, a pillow should be placed under the torso to reduce the curve in the back; the aim is to transition from the front to a side sleeping position.  

If you’re experiencing tension or strain in your neck or shoulders, conduct a trial period of three to five nights with a slim pillow to see if symptoms improve. If you’re considering a pillow for your baby, they must be at least 12 months old before they sleep with one. If you have an injury or are pregnant, consult a clinician for the best advice on using a pillow and its benefits. A memory foam bamboo pillow is a highly adaptable option, suiting all sleeping positions and providing spinal alignment. Highly breathable, a bamboo pillow is also thermoregulating, hypoallergenic and moisture-wicking, so be prepared to reach new heights of restorative sleep with one of our pillows. 

FAQ

1. Why do some people prefer sleeping without a pillow?

Some find pillows uncomfortable or blame them for neck pain. Others like the natural flat alignment or a simpler bedding setup.

2. How can I sleep comfortably without a pillow?

Start gradually with a thinner pillow or rolled towel. Ensure your mattress is supportive and try back-sleeping first to avoid strain.

3. Will I sleep better without a pillow?

It depends. Stomach sleepers may rest better without one, but side and back sleepers usually need support. Comfort and alignment are key.

4. Can sleeping without a pillow help with snoring?

For some, lying flat can reduce snoring. But for back sleepers, it may worsen it, as the tongue can block the airway. Position matters most.

5. Can going pillow-free help with allergies?

Possibly. Pillows trap dust and mites, so skipping one may reduce allergens. But clean bedding and mattress hygiene matter more.

6. How many pillows should I use?

One supportive pillow is usually best. Too many can misalign the spine. Use extra pillows only for comfort under the knees or between the legs.

7. Should babies or young children sleep without pillows?

Yes. Babies under 12 months should never use a pillow for safety. Toddlers can go pillow-free until they need a small, firm kids’ pillow.