The right pillow height depends on how you sleep — and experts say many people get it wrong

After nearly a decade of trial and error, I finally found a mattress I loved. Every night, I looked forward to crawling into a bed that eased, rather than exacerbated, my chronic lower back pain. In my excitement, I decided to give my bedroom the ultimate makeover and buy new pillows. I did my research and settled on highly reviewed shredded memory foam, but it took exactly one night to realize I hated them.

The loft was entirely too high, and the dense foam didn’t offer enough “sink” for a combination sleeper who cycles through stomach, side and back positions all in the same night. The lower back pain I had finally managed was instantly replaced by a stiff, aching neck. I promptly went back to my old pillows.

“One of the biggest mistakes people make is choosing a pillow based solely on material or softness rather than considering how well it supports their head and neck in their usual sleep position,” says Dr. Danielle Wall, a board-certified internist, hospitalist at the University of Vermont Medical Center, and sleep adviser at Sit ‘n Sleep. “Loft and support matter because a pillow that is too high or too low can change the position of the neck while you sleep.”

Before you plunk down your hard-earned cash on a pillow that could hurt rather than help, here’s what sleep and physical therapy experts say about finding the ideal height.

Consider pillow height, not just fill or price

When shopping for bedding, it’s easy to get distracted by marketing buzzwords like “luxury down” or “advanced cooling gel.” However, structural alignment should always come first. “Choose function over comfort,” says Ashley Katzenback, a physical therapist. “The pillow’s job is to keep the head, neck and spine in neutral alignment.”

A 2021 meta-analysis published in Clinical Biomechanics suggested that neck alignment during side sleeping may not differ between rubber and feather pillows, but may be affected by the pillow’s shape and height.

Finding that perfect height requires looking at your sleep setup as a whole ecosystem. “Your sleep position, body size, shoulder width, mattress firmness and personal comfort can all affect what feels supportive,” says Wall.

In other words, you can’t evaluate a pillow without considering what it’s resting on. “It’s important to consider the mattress because the amount a person’s shoulder or body sinks into the bed can change the amount of space the pillow needs to fill,” Wall says.

And a bit of good news: A luxury price tag is no guarantee of a pain-free morning. “Price shouldn’t be the primary indicator of whether a pillow is right for you,” says Wall. “A more expensive pillow isn’t automatically going to provide better support. Instead, I’d consider adjustability, durability, how well the pillow maintains its shape and whether the loft works with your sleep position.”

Reassess your pillow preferences as you age

If you’ve been sleeping on the exact same style of pillow for decades (or worse … the exact same pillow), your body may start letting you know it’s time for an upgrade. Your anatomy changes over time, so your bedding should too.

“As we get older, we lose water content in our spinal discs and they flatten out a little bit,” says Katzenback. “The natural lordosis — the inward curve — in our neck may flatten out a bit as we age, and we will not be able to mold into just any pillow. The pillow needs to conform to our neck instead.”

Let your sleep position be your guide

While individual needs vary, expert guidelines provide a helpful starting baseline.

“In the most general terms, side sleepers generally need a firmer pillow that is 5-plus inches thick; back sleepers need a 3-to-5-inch thickness; and stomach sleepers need almost no pillow at all,” says Katzenback.

A 2021 review published in Healthcare noted that while there are no definitive universal conclusions on a single “optimal” pillow height, individual laboratory studies have favored heights of 7 or 10 cm (about 2.75 or 4 inches) for back sleeping and around 10 cm (4 inches) for side sleeping comfort. Keep in mind that because foam compresses under the weight of your head, the active height you get while sleeping is often lower than the loft printed on the label.

The best pillows for back sleepers

Go low to medium loft: “Back sleepers generally want enough support to keep the head from being pushed too far forward, but not so little support that the neck feels unsupported,” says Wall. “A moderate or lower loft may work well.”

Test it on your own bed: “A common mistake is choosing a pillow that is simply too tall or firm because it feels supportive in the store,” Wall warns. “What matters is how your head and neck are positioned when you’re actually lying on your specific mattress.”

The best pillows for side sleepers

Fill the gap: “Side sleepers generally need more loft than back sleepers because the pillow needs to fill the space between the head and the mattress created by the shoulder,” says Wall. “The goal is to keep the head from tilting downward toward the mattress or upward away from it.”

Prioritize shape retention: “A pillow that compresses substantially may provide very different support after several hours than it did when the sleeper first went to bed,” explains Wall. Choose fills that hold their structural integrity until morning.

Align your lower spine: To achieve total-body alignment, look below the neck. “Opt for one firm or high-loft pillow under your head, and a second between the knees to align the hips,” recommends Dr. Hana Patel, a general practitioner specializing in mental health and sleep who works in the NHS and private practice.

The best pillows for stomach sleepers

Go ultra-thin (or skip it entirely): “Stomach sleepers generally benefit from a thinner pillow because a high pillow can push the head and neck awkwardly upward while the person is already sleeping with their head turned to one side,” says Wall.

Support your pelvis: “I’d recommend using one thin, soft pillow under your head, as well as one under your pelvis,” says Patel, which helps take the pressure off your lower back.

Address the root cause: If you are consistently waking up stiff, a new product might not be the answer. “It may be worth experimenting with a different sleep position rather than simply buying a different pillow,” suggests Wall.

The best pillows for combination sleepers

Prioritize adjustable fills: “Combination sleepers have a more difficult balancing act because the pillow that feels ideal on your side may feel too high when you roll onto your back,” says Wall. “In that case, an adjustable-fill pillow can be useful because the sleeper can change the loft rather than being locked into one fixed height.”

Meet our experts

• Danielle Wall, MD, board-certified internist and hospitalist at the University of Vermont Medical Center and sleep adviser at Sit ‘n Sleep

• Ashley Katzenback, PT, DPT, owner of Cape Concierge Physical Therapy in Massachusetts

• Hana Patel, MBBS, NHS and private GP specialist in mental health and sleep and resident sleep expert at Time4Sleep

Our health content is for informational purposes only and is not intended as professional medical advice. Consult a medical professional on questions about your health.