The best pillows for side and back sleepers

Probably, even if you think of yourself as a side sleeper. When 664 Danish workers wore motion sensors for up to six days, they spent 54.1% of their time in bed on their side, 37.5% on their back and 7.3% on their front, and changed position about 1.6 times an hour^[1]. Yet in a phone survey of 812 Australian adults, only about 11% said they mostly sleep on their back^[4]. The studies used different people and methods, but the gap suggests back time is easy to underestimate. Even sleep-lab patients are unreliable judges: about 30% of 300 got their own position wrong at lights-out, while still awake^[2]. To learn your real mix, film one night on your phone or ask a bed partner.

How your mix changes with age

Most people drift toward their side and move less as they age. In the sensor study, back time fell from 41.2% of time in bed at ages 20 to 34 to 32.8% at 55 to 65, and heavier people also spent more time on their side^[1]. A filmed lab study (10 people per age group) found position shifts fell from 4.4 an hour in young children to 2.1 in adults aged 65 to 80^[5]. The height that suits you at 30 may need nudging toward your side-sleeping height by 60, one more argument for a pillow you can adjust.

On your back, a pillow should support the natural curve of your neck. On your side, it has to fill the gap your shoulder creates. Researchers who measured 40 adults drew the same distinction, and concluded that a pillow of uniform height suits neither position well^[6].

Back sleeping: medium height, chin level

Sleep Foundation says back sleepers tend to prefer a medium loft of 3 to 5 inches, and warns that a pillow that's too thick props the head too far forward^[7]. The lab evidence is thin but points the same way. In 16 young adults X-rayed lying on their backs, the authors judged a 10 cm (about 4 in) pillow the best fit for a normal neck curve, compared with no pillow or a 20 cm one^[8]. In another small study, summarized in a 2021 review, 19 women in their fifties found a 7 cm (about 2.75 in) pillow most comfortable on their backs^[9].

Side sleeping: fill the shoulder gap

On your side, the pillow makes up the distance from your ear to the mattress: usually at least 4 inches, and more with broad shoulders^[10]. Our guide to choosing a pillow shows how to measure yours.

That review concluded there is still no firm answer on the best height for either position. It also summarized a design study that found typical pillows too high for back sleeping and too low for side sleeping^[9]. The good news is that the ranges overlap, so for many people the fix is about an inch of adjustment, not two pillows.

Four designs make one pillow work at two heights: adjustable fill, two fixed heights, a low center with higher sides, and fill that moves with you. None has been tested head to head in combination sleepers, so treat what follows as practical guidance, not proven rankings.

1. Adjustable fill

Coop and Helix let you add or remove fill (Helix also has zippers), and the Saatva Latex has a plush outer layer you can remove to lower it. Set the height near the overlap, around 4–4.5 in compressed. Shredded fill also shifts as you turn, which makes this the most forgiving option and is why the Coop Original is our top pick. Alignment in side lying may depend more on pillow height and shape than on fill^[11], so being able to set the height matters more than the material.

2. Two fixed heights

The Osteo Cervical flips between 4.1 and 5.2 inches, and TEMPUR-Neck comes in three sizes from 3.5 to 4.75 inches. You get one height, so choose it for the position you spend most time in. Don't expect the contour shape itself to do much: in a trial of 106 side sleepers, foam contour pillows did no better for waking symptoms than regular-shaped ones^[12].

3. Low center, higher sides

Butterfly and U-shaped pillows dip in the middle for your back and rise at the ends for your side, like the Osteo's hollow center. Designers have proposed the shape for exactly this problem, but frequent position changes may not leave your head in the matching zone^[9]. If you turn onto your side toward the middle, you land on the low part.

4. Fill that moves with you

Water and springy latex respond as you shift. The Mediflow sets its height with water. In a 1997 crossover trial, 41 people with neck pain used their usual pillow, a roll pillow and a water-based pillow in turn, and the water-based pillow was associated with less morning pain and better sleep quality^[13]. The trial was small and unblinded, and scored 3 out of 10 on a standard quality scale^[14]. Purple Harmony's latex is responsive too, but its fixed heights start at 5.5 inches, so choose Low unless you have broad shoulders.

Medium to medium-firm (about 5–6/10) suits most combination sleepers. It's firm enough to hold side-sleeping height, and soft enough that your head can sink into the center on your back. Sleep Foundation says most back sleepers prefer medium-firm, and that a pillow that's too thick or firm can create pressure points in the neck^[7]. Very firm cervical foam can feel like a ledge under your neck on your back. If broad shoulders mean you need a firmer pillow anyway, see our firm pillow guide.

Set the pillow for your side first, then lower it until your back feels right. Side sleeping needs more height, so it's the harder target.

1. 1

   Start with your side

   Lie on your side. Add or remove fill until your nose lines up with the middle of your chest, without tilting up or down.

2. 2

   Check it on your back

   Roll over. If your chin tips toward your chest, take out one small handful at a time until your forehead and chin are level.

3. 3

   Shape a low center

   Push some shredded fill out toward the two ends. You get a dip for your back and fuller ends for your side.

4. 4

   Keep the spare fill

   Bag what you remove. You may want it back after a new mattress, or as you spend more time on your side.

A one-week test

1. Nights 1–2: sleep on your starting setting. Before you get up, note the position you woke in and any neck, shoulder or upper-back stiffness.
2. Nights 3–4: if you woke stiff on your side, add a handful. If you woke stiff on your back, or felt your chin pushed forward, remove one.
3. Nights 5–7: leave it alone and see whether mornings are consistently better. If no single setting works for both positions, set it for the one you spend most of the night in.

A week is a sensible minimum. The 106-person trial above gave each pillow a week^[12], and only 70.8% of necks had settled after 15 minutes of side lying^[15], so a few minutes in a store tells you little. The effort can pay off: in 84 people with neck pain, adjusting pillow height to the individual brought a meaningful drop in pain for half of them, though the study had no comparison group^[16].

For close calls, Sleep Foundation's testers offer a clue. On a latex pillow sold in 4- and 5-inch lofts, most back sleepers preferred the 4-inch, while combination sleepers were more comfortable on the 5-inch^[7]. If you're torn, try the higher setting first, as long as your chin stays level on your back. Redo the test after a mattress change, because side-lying spinal alignment differs significantly between soft and firm mattresses^[17].

Not for your neck, for most people. Side sleeping has a slight edge in the evidence, and a clear one for snoring. In the 812-adult survey, people who mostly slept on their side were less likely to wake with neck pain (odds ratio 0.6) or pain between the shoulder blades or in the arm (0.7). Back sleeping showed no significant link either way, even though it's often recommended for neck symptoms. People whose position varied reported more shoulder-blade or arm pain (odds ratio 1.9)^[4]. A scoping review judged the wider evidence too thin for firm conclusions^[18].

How you lie matters as much as which way. A study that filmed 53 adults at home classed back lying, and side lying with the legs stacked, as supportive. Side lying with the top thigh pulled forward, which twists the spine, and lying face-down counted as provocative. People who woke with neck symptoms changed posture more often (an average of 23.6 vs 18.3 times a night) and spent more time in provocative postures (a median of 185 vs 84 minutes)^[19]. The study was small and can't show cause and effect, but it suggests your roll onto your side should end with your knees together or a pillow between them. See our knee pillow guide.

Your back is the better choice with a sore shoulder. Pressure on the rotator cuff was significantly lower on the back than on the side or front^[20], so it makes a natural relief position. See pillows for shoulder pain.

If you snore, your back is usually the worst position for it. The NHS lists back sleeping as a snoring risk and advises sleeping on your side^[21]. In a sleep-lab study of 72 habitual snorers, those without sleep apnea snored for less time, and less loudly, on their side. In those with apnea, turning had a less predictable effect^[22].

Sleep apnea is often position-dependent too. In 574 sleep-clinic patients, 55.9% had at least twice as many breathing interruptions an hour on their back as on their side^[3]. The head matters, not just the body. Among 199 patients with sensors on the chest and forehead, turning the head sideways while lying on the back cut more than 5 events an hour in 46.2% of those whose apnea was worse on their back^[23]. That's a reason to pick a pillow you can turn your head on comfortably, but a pillow is not an apnea treatment.

Keeping off your back, called positional therapy, does help some people. A Cochrane review of eight short trials found it lowered the apnea-hypopnea index by about 7 events an hour compared with an inactive control, while CPAP lowered it by about 6 events an hour more than positional therapy^[24]. Treatment decisions belong with a sleep clinician. Our CPAP pillow guide covers sleeping comfortably with a mask.

You can shift the balance, but few people stick with hard-line methods, so plan on keeping some back time. The classic trick is a tennis ball sewn into the back of a sleep shirt. An Australian sleep clinic surveyed patients prescribed it for positional apnea. Of the 67 who replied, an average of 2.5 years later, only 6.0% still used it. Another 13.4% said they had learned to avoid their back, 80.6% had done neither, and most who quit found it too uncomfortable^[25]. Gentler setups are easier to live with:

• A pillow behind your back. A body pillow along your back makes rolling over harder, and the NHS suggests a special pillow or wedge to keep you on your side^[21]. See our body pillow guide.
• A side setup that doesn't hurt. If side sleeping makes your shoulder or neck ache, you'll keep rolling back for relief. Get the height right, and rest your top arm on a pillow so it stays in a neutral position^[26].
• Fall asleep on your side. You can't control where you end up, but you can choose where you start.

When favoring your side is worth the effort

• Night-time reflux: in 57 patients monitored overnight, median acid exposure was 0.0% of the time on the left side, against 0.6% on the back and 1.2% on the right^[27]. If you prop yourself up on your back instead, the method studied raises the head of the bed about 8 in (20 cm) with blocks under the legs or a wedge, and even that evidence is rated weak^[28]. A taller head pillow isn't the same thing: it tilts your head, not your chest.
• Pregnancy: the NHS advises going to sleep on your side, because after 28 weeks falling asleep on your back can double the risk of stillbirth. If you wake on your back, just turn onto your side again^[29]. A pooled analysis found 2.63 times the odds of late stillbirth for going to sleep on the back from 28 weeks, compared with the left side^[30]. See our pregnancy and body pillow guide.