Do you like to sleep on a pillow stack or do you have one, flat-as-a-pancake, pillow that you’ve had forever? No matter how you like to sleep, the important thing is that your neck and body are aligned at night. Here’s all you need to know to choose a pillow that will help keep your spine in alignment and your body healthy.

Understanding Neck Alignment

When you are asleep, your postural goal should be to keep your spine in neutral alignment. This means that nothing is twisted or torqued sideways or up-and-down. It means that your spine is allowed to lay as it naturally wants to, without being pushed or pulled in any particular direction.

While your nighttime posture depends on quite a few things, like your mattress, your sleep position, and more, your neck alignment is primarily influenced by your pillow. A pillow that is good for you helps maintain that neutral position, while one that isn’t good for you will keep you out of alignment. Note that a pillow that works for you may not work for your partner or someone else.

Here’s how to tell if your pillow is doing its job.

For Side Sleepers

If you are a side sleeper, test your pillow by lying on it as if you were trying to fall asleep. First, make sure the pillow’s position is correct. The bulk of it should be in the small of your neck, with complete contact throughout the length of your neck. You should not have pillows under your shoulders or touching your back.

Next, have someone take a photo of you from the back and the front and compare it to the chart below:



You should be able to draw a straight line from your sternum, up your neck, and through the middle of your face. The line shouldn’t have bends or twists. These indicate a postural problem and that you likely need a new pillow.

For Back Sleepers

Again, lie down as if you were about to fall asleep. The basics are the same. The pillow should like mostly in the small of your neck and should make contact with your entire neck. However, you shouldn’t have pillows under your back or your shoulders. In addition, make sure that the back of your head is lying on the pillow and you don’t have it scrunched up and pressing against the top of your head.

Take a photo and compare it to the chart below:



The line you draw this time will curve, because your neck naturally curves. However, you don’t want the curve to be exaggerated or too shallow. If you’re not sure, take a photo of yourself with good posture while standing and compare it to the one you took while lying down. Your neck posture should look the same, or you may need a new pillow.

For Stomach Sleepers

Maintaining healthy neck position is very difficult if you sleep on your stomach because you usually have to twist your head sideways to breathe. Consider sleeping without a pillow or changing your sleep position to one that is healthier for your body.

How to Choose the Right Pillow

You’ll want to choose the pillow that keeps your spine in alignment. Needless to say, this may take some trial and error. Many pillow manufacturers understand this and will give you a trial period when you buy your pillow. Be sure to keep track of this, in case you need to return your pillow later.

If at all possible, take a potential new pillow home and sleep on it for several days before you make your decision. Most people know pretty quickly if a pillow is right for them. In addition to performing the tests above, many people notice neck and back pain within a night or two if a pillow won’t work for them.

Not sure where to start? Many back sleepers like memory foam, because of the way it cradles the neck and head. You could also try an adjustable pillow, where you can add or remove different kinds of filling until you find the combination that keeps your spine in alignment all night.

Do I Need More Than One Pillow?



Most people should be able to find one pillow that keeps their neck in alignment and is comfortable to sleep on. In fact, layering pillows can cause more harm than good. Sure, you may be able to layer several pillows to get the height of one good one, but these can slide or shift overnight. This can cause spinal damage and neck pain.

While it’s best to sleep with only one pillow under your head, many sleepers benefit from the use of other pillows elsewhere on the body.

  • Back sleepers often sleep better with a pillow under their knees. Ideally, this wouldn’t be necessary, but when we hunch over computers all day we often end up with excessive arching in the lower back. Raising the knees with a pillow helps reduce that arch and brings the spine back into alignment.
  • Side sleepers often like to sleep with a pillow between their knees. This helps keep the pelvis straight so that the top side isn’t torqued forward all night. Some side sleepers achieve this with a body pillow that they can also wrap their arms around, which can help with shoulder alignment, too.
  • Pregnant women can benefit from a body pillow or several different pillows to arrange as they will. This can help them deal with the various aches and pains that can pop up as the human body grows another human. As pregnancy progresses, many women find that a pillow under the belly offers needed support for the lower back.

You may have to experiment to find the pillow arrangement that works best for you and keeps your neck aligned. Take your time, and you should be able to find a pillow or pillows that will help you sleep well for a long time.

If you are in the market for a pillow, take a look at our in-depth pillow buying guides and reviews.

by: Sarah Winfrey