The Hidden Link Between Pillow Height and Neck Pain — And How to Get It Right

Waking up with a stiff neck or sore shoulders? Your pillow could be the sneaky culprit—and not just because it’s too soft or too firm. More likely, it’s the wrong height. Yep, the height of your pillow can seriously mess with your spine while you sleep. According to recent studies, getting this one detail right can ease neck pain and even improve your overall sleep quality. Let’s break down why that is—and how you can find the perfect pillow height for you.

Why Pillow Height Actually Matters

Your neck isn’t just hanging out while you sleep—it’s part of your cervical spine, which needs proper support for all 6–8 hours of rest. When your pillow’s too tall, it pushes your head forward or sideways in a way that strains your neck. Too low, and your head sinks down, flattening that natural curve your spine needs. Either way, you’re looking at tight muscles, sore joints, and not-so-great sleep.

And here's the kicker: there's no universal “perfect pillow height.” What works for someone else might not work for you. Your sleep position, body size, and even how firm your mattress is can all change what kind of support your neck needs.

Finding Your Perfect Pillow Height: Enter the “Set-up for Spinal Sleep” Method

Rather than guessing or buying a bunch of pillows you’ll end up returning, try a more scientific approach: the “Set-up for Spinal Sleep” method. It’s a personalized system that uses your body and sleep habits to guide you to the right pillow height.

Here’s how it works:

• First, figure out how you sleep—on your side, back, or stomach.
• Then, measure the space between your head/neck and the mattress.
• Use pillow inserts or layers to tweak the height until your spine feels supported and natural.
• Test it out. Make small adjustments over time until it feels just right.

The goal? A pillow that hugs your neck’s natural curve without pushing your head up or letting it fall. You should feel relaxed—no pressure in your neck or shoulders.

What the Research Says: Pillow Height = Pain Relief

In 2023, a study published in the Journal of Physical Therapy Science looked at how adjusting pillow height affected neck pain. Researchers tracked 84 people dealing with chronic neck discomfort. Each one had their pillow tailored using the “Set-up for Spinal Sleep” method.

What they found was pretty impressive:

• Half of the participants reported a major drop in neck pain within just 3 months.
• Those who started with the worst symptoms got the biggest benefits.
• Many also felt fewer physical issues linked to stress and poor sleep.
• And people who liked their new pillow height the most? They were also the ones who felt the best overall.

So yes, adjusting your pillow height isn’t just about comfort—it’s about real relief.

The Bottom Line: Don't Sleep on This Fix

If you’ve been dealing with nagging neck pain or restless nights, don’t overlook your pillow. A quick height adjustment could make a huge difference. Skip the one-size-fits-all options and go for a pillow that lets you customize. Whether that means removable layers, inserts, or a professional fit, the goal is the same: alignment that supports your neck, not strains it.

May Good Sleep Be With You.

Reference: Yamada S, Hoshi T, Toda M, Tsuge T, Matsudaira K, Oka H. Changes in neck pain and somatic symptoms before and after the adjustment of the pillow height. J Phys Ther Sci. 2023 Feb;35(2):106-113. doi: 10.1589/jpts.35.106. Epub 2023 Feb 1. PMID: 36744195; PMCID: PMC9889209.