A physiotherapist’s guide to choosing (and adjusting) the right pillow
Quick answer: There’s no single “best” pillow height or shape, it depends on your sleeping position, body size and mattress. Combination sleepers (who move between back and side) generally need a pillow that can adjust between positions, rather than one fixed height. Look for adjustability, natural neck alignment, and the ability to change the pillow yourself if it isn’t right.
If you regularly wake with a sore or stiff neck, your pillow is worth looking at.
As a physiotherapist who has treated people with headaches and neck pain for many years, I have lost count of the number of patients who have told me they have spent hundreds of dollars trying to find the “right” pillow.
Memory foam. Latex. Contoured. High profile. Low profile. Expensive ergonomic pillows.
And yet they were still waking with neck pain or headaches.
That was one of the main reasons I created the NAP Pillow.
I didn’t set out simply to create another comfortable pillow. I wanted to address one of the problems I kept seeing clinically: most pillows aren’t adjustable enough to accommodate the way people actually sleep.
There isn’t one perfect pillow height or shape that will suit everyone.
Your body size, shoulder width, mattress and sleeping position all influence how much support you need. Someone sleeping on their side generally needs more pillow height than they do when lying on their back.
This is where things become difficult for people who move during their sleep.
You may need a relatively supportive pillow when you are on your side, but if you roll onto your back, that same height can push your head forwards.
The goal should be relatively simple: your pillow should help support your head and neck in a comfortable, neutral position.
Clinical guidance similarly recommends choosing a pillow height that helps maintain alignment rather than allowing the head to be pushed too far forwards, backwards or sideways.
We often think about posture as something that matters while sitting at a desk or looking at our phone.
But you may spend seven or eight hours a night in bed.
If your pillow pushes your head forwards while you are lying on your back, I think of it as being like slouching while lying down.
Instead of the head resting naturally over the neck, it is held in a flexed position for hours.
This is one of the most common problems I see with pillows.
A pillow can feel incredibly soft and comfortable when you first lie on it, but comfort doesn’t necessarily tell you whether the height is right for your neck.
This is particularly important if you are a combination sleeper, someone who moves between their side and back during the night.
When you lie on your side, there is a space between your head and the mattress created partly by the width of your shoulder. Your pillow needs enough height to fill that space so your head isn’t dropping towards the mattress.
When you roll onto your back, you don’t need that same height.
A pillow that works beautifully on your side may therefore be too high on your back.
And a pillow that feels perfect on your back may be too low when you move onto your side.
This was the problem I wanted to solve.
For years I recommended different pillows to patients.
But I kept seeing the same problem.
People would buy an expensive pillow, use it for a few nights, decide it wasn’t right and then buy another one.
Often there wasn’t anything inherently wrong with the pillow. It simply wasn’t the right height or shape for that person, or it worked in one sleeping position but not another.
I wanted a pillow that could accommodate movement.
That led to the design of the NAP Pillow.
The centre of the pillow has a lower nest designed to allow your head to sit in a more neutral position while lying on your back.
The sides provide the additional height needed when you roll onto your side.
The idea is that instead of needing to find one compromise height that is supposed to work in every position, different areas of the pillow can support you differently depending on how you are sleeping.
Pulling together the criteria that actually matter, rather than brand or price first:
No two people have exactly the same body shape.
Your shoulder width alone can make a significant difference to the amount of pillow support you need when lying on your side. Your mattress also matters. If you sink further into a soft mattress, for example, you may need less pillow height than you would on a firmer mattress.
That is why I didn’t want the NAP Pillow to have one fixed height.
There is a zip along the long side of the pillow which gives you access to the filling. You can:
Each pillow also comes with an additional bag of wool fill, so you have room to experiment with the height rather than being stuck with the way the pillow arrives.
For me, this is one of the most important features when choosing a pillow for neck pain.
The pillow should adjust to you, rather than expecting you to adjust to the pillow.
This is another area I pay attention to clinically.
Your jaw does not operate completely independently of your head and neck. Changes in head position can alter the position of the jaw and the activity of some of the muscles involved in chewing and clenching.
A study examining jaw muscle (masseter and temporalis) activity in relation to head posture found measurable differences in muscle activity during chewing (Gadotti et al., 2005, Journal of Oral Rehabilitation). A related pilot study looked specifically at chewing and head posture using surface EMG (PubMed ID 32071851).
However, bruxism is complex and can have several contributing factors, pillow height alone won’t resolve jaw clenching for everyone.
Head and neck position influences the jaw, and this gives us another reason to avoid sleeping for hours with the head pushed significantly forwards.
If you clench your jaw at night, getting your head and neck into a comfortable, neutral position is one piece of the overall picture.
Once I knew the shape and adjustability I wanted, I also wanted to use natural materials wherever practical.
The NAP Pillow is filled entirely with wool knops and has a cotton outer.
Wool is breathable, naturally temperature regulating and resilient, which makes it particularly well suited to a pillow that needs to be reshaped and adjusted.
It is also practical.
The pillow itself is washable. You simply remove the wool filling, place the outer pillow in the washing machine on a wool wash, allow it to dry and then refill it.
Sometimes changing a pillow makes a significant difference.
But a pillow isn’t a treatment for every cause of neck pain.
Neck pain can come from the joints, muscles and other structures of the cervical spine, and headaches can have many different causes.
If you are regularly waking with neck pain or headaches, or your symptoms are persistent or worsening, it is worth having the cause properly assessed rather than assuming your pillow is responsible.
At The Headache Clinic, we assess the upper cervical spine in people experiencing headache, migraine and neck pain to determine whether dysfunction in the neck may be contributing to their symptoms.
Your pillow is one part of the picture.
But given how many hours you spend sleeping, it is an important part to get right.
How do I know if my pillow is causing my neck pain?
If you wake with neck stiffness that eases within an hour of getting up, your pillow is a reasonable first thing to check. Pain that persists through the day, or that’s worsening over time, is worth having assessed by a health professional rather than assumed to be pillow-related.
What pillow height is best for side sleepers?
Side sleepers generally need more height than back sleepers, enough to fill the gap created by the width of the shoulder so the head doesn’t tilt down toward the mattress. The exact amount varies by body size and mattress firmness, which is why a fixed-height pillow often doesn’t suit everyone.
Can a pillow alone fix chronic neck pain?
Not on its own. A pillow can support better alignment while you sleep, but neck pain can come from the joints, muscles and other structures of the cervical spine. Persistent or worsening symptoms are worth having properly assessed.
Ultimately, the NAP Pillow came from years of seeing people with neck pain and headaches buying pillow after pillow without solving the problem.
I wanted something that could accommodate the way people actually sleep. Something that provided a lower position when lying on your back. More support when you rolled onto your side. And, importantly, something you could adjust yourself rather than being told that one predetermined pillow height should somehow suit everyone.
That’s what led to the NAP Pillow.
Because the best pillow for neck pain isn’t necessarily the softest, firmest or most expensive pillow.
It is the one that helps keep your head and neck well supported in the positions you actually sleep in.
1. Gadotti IC, Berzin F, Biasotto-Gonzalez D. (2005). Preliminary rapport on head posture and muscle activity in subjects with class I and II. Journal of Oral Rehabilitation, 32(11), 794–799. https://pubmed.ncbi.nlm.nih.gov/16202042/
2. Electromyography of the masticatory muscles during chewing in different head and neck postures — a pilot study. https://pubmed.ncbi.nlm.nih.gov/32071851/
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