We all want a good night’s sleep, but do we really need a pillow to get it? To answer this question, we have to consider a lot of different factors, but we have to give special attention to whether you have a firm or a soft mattress, and if you like to sleep on your stomach, your back, or your side. With those things in mind, we’ll consider some of the best and worst reasons for sleeping without a pillow.
The first and most basic issues are determining your sleep position and the firmness of your mattress. These issues are critical to the quality of your sleep because the biggest effect that a pillow has on your sleep is how it changes the position of your head and spine (https://www.ncbi.nlm.nih.gov/pubmed/26512267). In cases where a pillow helps to put your spine in a more natural position, it will usually improve the quality of your sleep, but in when the pillow puts your head either too high or too low, it’s probably making your sleep worse (https://www.health.harvard.edu/pain/say-good-night-to-neck-pain).
Stomach Sleepers
At the end of a hard day, laying down on a cozy bed has to be one of life’s greatest comforts, but if you’re sleeping on your stomach, comfort isn’t the only thing you need to think about. If you sleep on your stomach you need to think about how your neck is positioned on top of your spine while you’re sleeping.
If you sleep on your stomach and you have a particularly soft mattress, one that doesn’t support your spine in a neutral position and lets your hips sink into the mattress, then it is probably a good idea to ditch the pillow. With a soft mattress, a pillow, and in particular those pillows that are very thick, raise your head up and pushes it back while you’re sleeping. Add that to having to turn your head to its side to lay down and you have a recipe for neck pain in the morning and torsion on your spine. If, however, you have a very firm mattress, then stomach sleepers might be able to use a thinner pillow, although getting rid of the pillow is still the preferred option.
Back Sleepers
Sleeping on your back is the most comfortable position for many people, and whether or not you need a pillow in this position depends on a variety of factors. Just like with stomach sleepers, people who sleep on their back have to consider the position of their spine when deciding whether or not they need a pillow, and again, the answer to this question has a lot to do with how firm your mattress is.
If your mattress is firm enough to keep your hips from dipping into the mattress too far, then it is perfectly okay to skip the pillow because your spine will already be in a neutral position, but if you have a very soft mattress that allows your hips to dip into the mattress, then it’s a different story. In this case, you will probably need to have pillow thick enough to pull your head into its naturally curved position.
People with heartburn or other esophageal issues should also use a pillow as this raises the throat into a position higher than their stomach, which can limit problems in some people who are sensitive to stomach problems (https://www.drweil.com/health-wellness/body-mind-spirit/gastrointestinal/gerd-gastroesophageal-reflux-disease/).
Side Sleepers
Side sleepers have a more definitive answer than stomach or back sleepers, and that answer is pretty consistent across people and mattress types. Because we don’t want the spine to dip to either side, especially at the neck, side sleepers need a rather thick, firm pillow to keep their spine straight.
The real issue with side sleeping is that whether you have a firm or soft mattress it’s hard to sleep comfortably without a pillow because all your weight is going to pressing right onto the one shoulder that’s in contact with the mattress. Some side sleepers who want to get rid of their pillow try to sleep on their arm, which is uncomfortable for most people, but also puts excessive pressure on the veins and arteries of the arm. There is also research that indicates that letting your head fall below the position of the rest of your body might increase pressure in your eyes and cause issues with people susceptible to glaucoma (https://www.ncbi.nlm.nih.gov/pubmed/24248001). The best option for a side sleeper is to get a pillow that’s thick enough to keep their head in alignment with their back while sleeping.
Pregnancy and The Fetal Position
While almost everyone will have to consider the same basic issues when figuring out whether they should or should not sleep with a pillow, pregnancy is a special case. It’s clear to most people why a woman might not want to sleep on her stomach during pregnancy, but as the baby gets heavier and it starts to put more pressure on the back, some women also find sleeping on their back uncomfortable. In most cases, pregnant women may want to try sleeping on their sides with their knees slightly tucked in. In this position, pregnant women want to follow the same basic guidelines as everyone else and make sure that they have a pillow that can keep their spine straight while they sleep.
The Bottom Line
The bottom line when deciding whether to sleep with a pillow is figuring out what sleeping position is most comfortable for you and how firm of a mattress you have. The easiest rule of thumb to remember is that you should always try to keep your spine in whichever position feels the most natural, making sure your head is in natural alignment with the rest of your back. So, if you enjoy sleeping on your stomach or on your side, the first thing you should consider is how a pillow might affect your body in that position. If a pillow would put your head in line with your back, then use one, if it would put it out of line with your back, then you’re probably okay to skip it.